Common use of FORM OF SUBSCRIPTION Clause in Contracts

FORM OF SUBSCRIPTION. TO: Intelimax Media Inc. 2320 - 000 Xxxx Xxxxxxxx, Xxxxxxxxx, Xxxxxxx Xxxxxxxx, X0X 0X0 The undersigned Holder of the within Warrants hereby subscribes for ____________ common shares (the “Shares”) of Intelimax Media Inc. (the “Company) pursuant to the within Warrants at US$____ per Share on the terms specified in the said Warrants. This subscription is accompanied by a certified cheque or bank draft payable to or to the order of the Company for the whole amount of the purchase price of the Shares. The undersigned hereby directs that the Shares be registered as follows: NAME(S) IN FULL ADDRESS(ES) NUMBER OF SHARES ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ TOTAL: ___________________________ (Please print full name in which share certificates are to be issued, stating whether Mr., Mrs. or Miss is applicable). DATED this ________ day of __________________ , ______. In the presence of: ___________________________ ___________________________ Signature of Witness Signature of Warrant Holder Please print below your name and address in full. Name (Mr./Mrs./Miss) ___________________________ Address ___________________________ ___________________________

Appears in 1 contract

Samples: Settlement and Subscription Agreement (Intelimax Media Inc.)

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FORM OF SUBSCRIPTION. TO: Intelimax Media Inc. 2320 - Urex Energy Corp. 00000 X. XxXxxxxx Xxxx. Xxxxxxxx 000-000 Xxxx XxxxxxxxXxxx, Xxxxxxxxx, Xxxxxxx Xxxxxxxx, X0X 0X0 Xxxxxx 00000 XXX The undersigned Holder of the within Warrants hereby subscribes for ____________ common shares (the "Shares") of Intelimax Media Inc. Urex Energy Corp. (the "Company") pursuant to the within Warrants at US$____ 1.00 per Share on the terms specified in the said Warrants. This subscription is accompanied by a certified cheque or bank draft payable to or to the order of the Company for the whole amount of the purchase price of the Shares. The undersigned represents that, at the time of the exercise of these Warrants, all of the representations and warranties contained in Section 6 of the Subscription Agreement between the Company and the undersigned pursuant to which these Warrants were issued are true and accurate. The undersigned hereby directs that the Shares be registered as follows: NAME(S) IN FULL ADDRESS(ES) NUMBER OF SHARES ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ TOTAL: ___________________________ (Please print full name in which share certificates are to be issued, stating whether Mr., Mrs. or Miss is applicable). DATED this ________ day of __________________ , ______. In the presence of: __________________________________________ ________________________________________ Signature of Witness Signature of Warrant Holder Please print below your name and address in full. Name (Mr./Mrs./Miss) __________________________________________________________ Address __________________________________________________________ __________________________________________________________

Appears in 1 contract

Samples: Private Placement Subscription Agreement (Urex Energy Corp.)

FORM OF SUBSCRIPTION. TO: Intelimax Media Inc. 2320 - 000 Xxxx X. Xxxxxxxx, XxxxxxxxxSuite 2320,Vancouver, Xxxxxxx XxxxxxxxBritish Columbia, X0X 0X0 V6B 4N4 The undersigned Holder of the within Warrants hereby subscribes for ____________ common shares (the “Shares”) of Intelimax Media Inc. (the “Company) pursuant to the within Warrants at US$____ 0.30 per Share on the terms specified in the said Warrants. This subscription is accompanied by a certified cheque or bank draft payable to or to the order of the Company for the whole amount of the purchase price of the Shares. The undersigned hereby directs that the Shares be registered as follows: NAME(S) IN FULL ADDRESS(ES) NUMBER OF SHARES ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ TOTAL: ___________________________ (Please print full name in which share certificates are to be issued, stating whether Mr., Mrs. or Miss is applicable). DATED this ________ day of __________________ , ______. In the presence of: ________________________________________ Signature of Witness ____________________________________________ Signature of Witness Signature of Warrant Holder Please print below your name and address in full. Name (Mr./Mrs./Miss) _______________________________________ Address ___________________________ ___________________________

Appears in 1 contract

Samples: Private Placement Subscription Agreement (Intelimax Media Inc.)

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FORM OF SUBSCRIPTION. TO: Intelimax Media Inc. 2320 - Urex Energy Corp. 00000 X. XxXxxxxx Xxxx. Xxxxxxxx 000-000 Xxxx XxxxxxxxXxxx, Xxxxxxxxx, Xxxxxxx Xxxxxxxx, X0X 0X0 Xxxxxx 00000 XXX The undersigned Holder of the within Warrants hereby subscribes for ____________ common shares (the "Shares") of Intelimax Media Inc. Urex Energy Corp. (the "Company") pursuant to the within Warrants at US$____ 0.50 per Share on the terms specified in the said Warrants. This subscription is accompanied by a certified cheque or bank draft payable to or to the order of the Company for the whole amount of the purchase price of the Shares. The undersigned represents that, at the time of the exercise of these Warrants, all of the representations and warranties contained in Section 6 of the Subscription Agreement between the Company and the undersigned pursuant to which these Warrants were issued are true and accurate. The undersigned hereby directs that the Shares be registered as follows: NAME(S) IN FULL ADDRESS(ES) NUMBER OF SHARES ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ TOTAL: ___________________________ (Please print full name in which share certificates are to be issued, stating whether Mr., Mrs. or Miss is applicable). DATED this ________ day of __________________ , ______. In the presence of: ___________________________________________ __________________________________ Signature of Witness Signature of Warrant Holder Please print below your name and address in full. Name (Mr./Mrs./Miss) _________________________________________________________ Address _________________________________________________________ _________________________________________________________

Appears in 1 contract

Samples: Private Placement Subscription Agreement (Urex Energy Corp.)

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