APPENDIX I

                              KVH INDUSTRIES, INC.

                         STOCK CERTIFICATE QUESTIONNAIRE



         Pursuant to  Sections 3 of the  Agreement,  please  provide us with the
following information:

     1. The exact  name that your  Shares are to be  registered  in (this is the
name that will appear on your stock certificate(s)).  You may use a nominee name
if appropriate:



     2. The relationship  between the Purchaser of the Shares and the Registered
Holder listed in response to item 1 above:


     3. The mailing address of the Registered  Holder listed in response to item
1 above:


     4.  The  Social  Security  Number  or  Tax  Identification  Number  of  the
Registered Holder listed in response to item 1 above: