PROTOTYPE DEMONSTRATION REQUEST FORM

CIEC: 04/12
Name of Company or Individual:

Contact Address:

City/State/Zip:

Phone Number:

Fax Number:

Email:

Contract Terms: Only serious and financially capable prospective business partners, investors and customers will be invited to the Hydro-Electric Reactor prototype demonstrations. A refundable deposit of $100,000.00 (One Hundred Thousand U.S. Dollars) is required for the demonstration. This amount will be regarded as an advanced payment which will be applied to your purchase price for any product, rights or investments. You will receive an invitation to participate in the prototype demonstration within 2 weeks from the receipt of your formal request and deposit.

Note: If the Hydro-Electric Reactor does not perform as claimed, the prospective business partner will be entitled to a refund of $100,000.00 (One Hundred Thousand U.S. Dollars) less 5% for administrative and engineering costs.

If, however, you cannot afford to pay the $100,000.00 Deposit, you can pay a non-refundable amount of $5,000.00 (Five Thousand U.S. Dollars) to cover the cost of your demonstration request.

Alternatively, prospective business partners can bring their own electrical engineers and testing equipment to conduct their own tests, free of charge, before negotiations.

Make your check payable to:
Cogar International Energy Corporation

Send your completed Prototype Demonstration Request Form and Check to:
Attention: Marketing Department
Cogar International Energy Corporation
15171 Pipeline Lane
Huntington Beach, CA 92649