EFTA02444174.pdf

"Steven A. Victor, M.D. Chairman and Chief Executive Officer"

"LaserSculpt, 30 East 76th Street, 6th Floor New York, New York 10021"

"In order to determine whether the undersigned may purchase any Units or Constituent Securities, please answer the following"

"Confidential Investor Questionnaire Page II of II ... EFTA_R1_01520539 ... EFTA02444184"

"The undersigned considers himself/herself/itself to be an experienced, sophisticated investor."

"together with the amount of any shares of the Common Stock and/or other securities issued by the Company already owned by the Entity"

"The undersigned is capable of evaluating the risks and merits of an investment in Units and Constituent Securities"

"ascertain whether a prospective investor would be deemed an accredited investor as defined in Rule 501 of Regulation D"

"LaserSculpt, Inc. (the Company), a Delaware corporation"

"determine whether offers and sales by LaserSculpt, Inc. (the Company)... may be made to the undersigned pursuant to (i) Regulation D of the Securities"

"Is the undersigned a person affiliated with a member of the National Association of Securities Dealers, Inc. (the NASD) or any other securities broker"

"Is the undersigned a senior officer of a bank... investment company (whether or not registered as such with the U.S. Securities and Exchange Commissio"

"Any director or executive officer of the Company"