Good Vibrations Shoes Inc (GVSI)

[surfkast]

OTCIQ® Basic Order Form


Company Name:
U.S. Trading Symbol:
Address:
City, State, Zip:
Main Telephone:
Company Website:

Select Service

OTCIQ Basic $3,000 Annual Fee
OTCIQ is an information portal for CEOs, CFOs and IROs that provides real-time market data, secure company information management, a weekly OTC Market Report that gives you a comprehensive summary of your company’s OTC market performance and access to a suite of optional Premium Issuer Services. The OTCIQ Basic Service is ideal for companies that make their primary company disclosure through the SEC or other securities regulator.

0 Real-time Level 2 Quote Display Service (Optional) $3,000 Annual Fee
Sponsor Level 2 Quotes for your stock so investors can have free access to the same market data professional traders have. Broker-Dealer identifiers, bid and ask prices, and time & sales data delivered to investors on Error! Hyperlink reference not valid.www.otcmarkets.com and on your corporate IR site – all in real-time.

0 Blue Sky Monitoring Service (Optional) $3,000 Annual Fee
A customized daily audit of your Blue Sky compliance status in each U.S. state or territory including a daily view of information that is distributed to broker-dealers and guidance on ways to maximize compliance through available exemptions.


Authorize User(s):

Designate persons below (each an “Authorized User”) to receive Company Credentials to access OTCIQ.


Authorized User 1:
Name:
Title/Affiliation:
Email:
Business Phone:
Authorized User 2: (Optional)







PLEASE NOTE: Company Credentials may not be used by any person other than the Authorized User. In the event an Authorized User leaves the Company or otherwise is no longer an Authorized User, the Company must notify OTC Markets Group immediately to terminate access or assign a new Authorized User. Changes to Authorized Users should be made using the OTCIQ User Change Request Form via DocuSign.









Transfer Agent Authorization

0 I have authorized the below named Transfer Agent to provide information related to the Company’s securities, including shares authorized, shares issued and outstanding, directly to OTC Markets Group via the Transfer Agent Verified Shares Program. Authorization is required to process this Order Form.

Transfer Agent Name:
Contact Name:
Email:
Phone Number:

Confirm Review of Stock Promotion Policy and Best Practices
0 An officer of the Company has reviewed OTC Markets Group Policy on Stock Promotion and the Best Practices for Issuers.


Payment Information

All Fees are non-refundable and must be paid upon submission of this Order Form.

• ACH/Wire Payment Instructions:

JP Morgan Chase Money Transfer & Wire Department
4 New York Plaza New York, NY 10004
ABA Routing Number: 021000021
Credit the Account of: OTC Markets Group Inc.
Account #: 764232302

SWIFT Code: CHASUS33

To avoid delay in processing your ACH/Wire payment:
- On the Memo Line/Special Instruction/Pay Detail - Include 1) Company Name, 2) “OTCIQ” and 3) Invoice number (if available).
- Send an email to [e-mail] confirming your payment details (company name or account number, invoice(s) paid, as applicable)

• Credit Card Payment Instructions:

Email [e-mail] to request a payment link. Please include your Company Name and “OTCIQ Basic” in your email request.


Billing Contacts

All invoices and billing notices will be sent by email to the contact(s) listed below.

Primary Billing Contact Alternate Billing Contact
Name


Company Affiliation or Title


Address


City, State, Zip:


Email


Telephone




Background Check Authorization

As a matter of practice, OTC Markets Group collects personal information from individuals associated with companies in our markets in order to conduct comprehensive background checks for the purpose of maintaining the integrity of our markets. We collect this information in connection with applications to various services that OTC Markets Group provides. We also use personal information collected in this form for the purpose of conducting ongoing compliance or surveillance reviews of companies on our markets and the individuals associated with such companies. OTC Markets Group takes the security of your information very seriously. Please read the Privacy Policy Statement.

Enter the name and requested information of each Authorized User and the company officer signing this OTCIQ Basic Order Form:

Position/Title Full
Legal Name Other Names Date of
Birth (MM/DD/YYYY) Home Address
(City, State & Country)



















Please indicate whether any of the persons listed above have, in the last five years, been the subject of:
YES
NO
A. A conviction in a criminal proceeding or named as a defendant in a pending criminal proceeding (excluding traffic violations and other minor offenses).
Names of Individuals:
0
0

B. The entry of an order, judgment, or decree, not subsequently reversed, suspended or vacated, by a court of competent jurisdiction that permanently or temporarily enjoined, barred, suspended or otherwise limited such person’s involvement in any type of business, securities, commodities, or banking activities.
Names of Individuals:
0
0

Please indicate whether any of the persons listed under Sections 2 and 3 above have ever been the subject of:
YES
NO
C. A finding or judgment by a court of competent jurisdiction (in a civil action), the Securities and Exchange Commission, the Commodity Futures Trading Commission, or a state securities regulator of a violation of federal or state securities or commodities law, which finding or judgment has not been reversed, suspended, or vacated.
Names of Individuals:
0
0

D. The entry of an order by a self-regulatory organization that permanently or temporarily barred, suspended or otherwise limited such person’s involvement in any type of business or securities activities.
Names of Individuals:
0
0








Company Signature

I represent that the information provided herein is current, true and complete. I acknowledge that I have read and understand the Privacy Policy Statement and consent to the collection, use and disclosure of the information in this Form for the purpose of conducting a background check, and any further use as set out in the Privacy Policy. I further represent that any personal data provided herein has been collected, and is being shared with OTC Markets Group, in accordance with all applicable privacy laws (e.g. the required consent has been obtained from third parties).



Signature of Company Officer: ¬¬¬¬¬¬¬¬¬¬¬¬¬¬



Date:

Print Officer Name:

Company Name:






Next Steps

1) Submit this completed OTCIQ Basic Order Form at [e-mail];
2) Submit Payment (see page 2 for instructions)
3) After we verify your information and confirm payment, we will provide Company Credentials (user ID and passwords)
to the Authorized Users to access OTCIQ.com.

https://www.otcmarkets.com/corporate-services/products/otciq
It is understood that all posts on the site are to be considered opinions. They do not need to indicate this in their posts.

Readers determine the veracity of the posts they read and the credibility of other Users