“I understand that Time Certificates are not offered and cannot be sold to any person who is not a resident of the State of Minnesota. I hereby certify that I am a bona fide resident of the State of Minnesota and am providing information that is for my primary residence address.

I understand that the offering of Time Certificates is not registered under the Securities Act of 1933, but is rather being conducted based on an exemption from registration which requires that the offering be made solely to and securities sold solely to Minnesota residents.

Therefore, I understand that Capitol Acceptance Corporation's reliance on such an exemption is predicated on my representations to Capitol Acceptance Corporation as to my state of residency. I further understand that if my representations of residency are false, I agree to indemnify and hold Capitol Acceptance Corporation harmless against any and all loss, damage or liability due to my false representations as to my state of residency.”