Common use of Telephone Number   Telephone Number Clause in Contracts

Telephone Number   Telephone Number. Fax Number (if available) Fax Number (if available) E-Mail (if available) E-Mail (if available) (Signature) (Signature of Additional Subscriber) EXECUTION BY SUBSCRIBER WHICH IS AN ENTITY (Corporation, Partnership, Trust, Etc.) ____________________________________________________________________________ Name of Entity (Please Print) Date of Incorporation or Organization: _________________________________________ State of Principal Office: ____________________________________________________ Federal Taxpayer Identification Number: ________________________________________ ____________________________________________ Office Address ____________________________________________ City, State and Zip Code ____________________________________________ Telephone Number ____________________________________________ Fax Number (if available) ____________________________________________ E-Mail (if available) [seal] By: _____________________________ Name: Title: Attest: ____________________________ (If Entity is a Corporation) *If Subscriber is a Registered Representative with a FINRA member firm, have the following acknowledgement signed by the appropriate party: The undersigned FINRA member firm acknowledges receipt of the notice required by Rule 3050 of the FINRA Conduct Rules ____________________________ Name of FINRA Firm By: ________________________ Name: Title: COMPANY: DEERFIELD RESOURCES, LTD. By: _______________________________ Name: Xxxxxxxx Xxx Title: Chief Executive Officer

Appears in 2 contracts

Samples: Form of Subscription Agreement (China TMK Battery Systems Inc.), Subscription Agreement (Deerfield Resources, Ltd.)

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Telephone Number   Telephone Number. Fax Number (if available) Fax Number (if available) E-Mail (if available) E-Mail (if available) (Signature) (Signature of Additional SubscriberPurchaser) ACCEPTED this ______ day of _______________ 2017, on behalf of the Company. By: Chief Executive Officer EXECUTION BY SUBSCRIBER WHICH IS AN ENTITY (Corporatione.g., Partnershipcorporation, Trustpartnership, EtcLLC, trust, etc.) _____________________________________________________________________________ Name of Entity (Please Print) Date of Incorporation or Organization: _____________________________________________________ State of Principal Office: ________________________________________________________________ Federal Taxpayer Identification Number: ____________________________________________________ ____________________________________________ Office Address ____________________________________________ City, State and Zip Code ____________________________________________ Telephone Number ____________________________________________ Fax Number (if available) ____________________________________________ E-Mail (if available) [seal] By: Name: Title: Address ACCEPTED this _______________ day of _______________ Name: Title: Attest: ____________________________ (If Entity is a Corporation) *If Subscriber is a Registered Representative with a FINRA member firm2017, have the following acknowledgement signed by the appropriate party: The undersigned FINRA member firm acknowledges receipt on behalf of the notice required by Rule 3050 of the FINRA Conduct Rules ____________________________ Name of FINRA Firm By: ________________________ Name: Title: COMPANY: DEERFIELD RESOURCES, LTDCompany. By: _______________________________ Name: Xxxxxxxx Xxx Title: Chief Executive OfficerOfficer Appendix A INVESTOR QUESTIONNAIRE Instructions: Check all boxes below which correctly describe you.

Appears in 2 contracts

Samples: Form of Subscription Agreement, Form of Subscription Agreement (Minn Shares Inc)

Telephone Number   Telephone Number. Fax Number (if available) Fax Number (if available) --------------------------------- ----------------------------------- E-Mail (if available) E-Mail (if available) --------------------------------- ----------------------------------- (Signature) (Signature of Additional SubscriberPurchaser) ACCEPTED this __ day of _________ 2007, on behalf of Pubco. By: -------------------------------- Name: Title: EXECUTION BY SUBSCRIBER WHICH IS AN ENTITY (Corporation, Partnership, LLC, Trust, Etc.) ____________________________________________________________________________ -------------------------------------------------------------------------------- Name of Entity (Please Print) Date of Incorporation or Organization: _________________________________________ State of Principal Office: _____________________________________________________ Federal Taxpayer Identification Number: _______________________________________ -------------------------------------------- Office Address -------------------------------------------- City, State and Zip Code -------------------------------------------- Telephone Number -------------------------------------------- Fax Number (if available) -------------------------------------------- E-Mail (if available) By: ------------------------------- Name: Title: ACCEPTED this ___ ___________________________________day of _________ Office Address ____________________________________________ City2007, State and Zip Code ____________________________________________ Telephone Number ____________________________________________ Fax Number (if available) ____________________________________________ E-Mail (if available) [seal] on behalf of Pubco. By: _____________________________ ------------------------------- Name: Title: Attest: ____________________________ (If Entity is a Corporation) *If Subscriber is a Registered Representative with a FINRA member firm, have the following acknowledgement signed by the appropriate party: The undersigned FINRA member firm acknowledges receipt of the notice required by Rule 3050 of the FINRA Conduct Rules ____________________________ Name of FINRA Firm By: ________________________ Name: Title: COMPANY: DEERFIELD RESOURCES, LTD. By: _______________________________ Name: Xxxxxxxx Xxx Title: Chief Executive Officer:

Appears in 1 contract

Samples: Subscription Agreement (RedRoller Holdings, Inc.)

Telephone Number   Telephone Number. Fax Number (if available) Fax Number (if available) E-Mail (if available) E-Mail (if available) (Signature) (Signature of Additional SubscriberPurchaser) EXECUTION BY SUBSCRIBER WHICH IS AN ENTITY (Corporation, Partnership, LLC, Trust, Etc.) _____________________________Name of Entity (Please Print) Date of Incorporation or Organization: Federal Taxpayer Identification Number: _______________________________________________ Name of Entity (Please Print) Date of Incorporation or Organization: Office Address _________________________________________ State of Principal Office: ____________________________________________________ Federal Taxpayer Identification Number: ________________________________________ ____________________________________________ Office Address ____________________________________________ City, State and Zip Code _______________________________________________ Telephone Number _______________________________________________ Fax Number (if available) _______________________________________________ E-Mail (if available) [seal] By: Type of entity (e.g., corporation, trust, limited partnership, general partnership IXX Trust, Pension or Profit Sharing Plan or Trust):_____________________________ Name: Title: Attest: ____________________________ (If Entity is a Corporation) *If Subscriber is a Registered Representative with a FINRA member firm, have the following acknowledgement signed by the appropriate party: The undersigned FINRA member firm acknowledges receipt of the notice required by Rule 3050 of the FINRA Conduct Rules ____________________________ Name of FINRA Firm By: ________________________ Name: Title: COMPANY: DEERFIELD RESOURCES, LTD. By: _______________________________ Date of formation or incorporation: Whether the Subscriber was organized for the specific purpose of acquiring securities of New Generation Biofuels Holdings, Inc.: Yes ______ No______ Each individual authorized to execute documents on behalf of the Subscriber in connection with this investment: Name: Xxxxxxxx Xxx ____________________________ Name: ____________________________ Title: Chief Executive Officer____________________________ Title: ____________________________ The Subscribers state of formation or incorporation: _______ The business of the entity: Certain Subscribers must provide the following information:

Appears in 1 contract

Samples: Subscription Agreement (New Generation Biofuels Holdings, Inc)

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Telephone Number   Telephone Number. Fax Number (if available) Fax Number (if available) E-Mail (if available) E-Mail (if available) (Signature) (Signature of Additional Subscriber) ACCEPTED this ___ day of _________ 2008, on behalf of Transdel Pharmaceuticals, Inc. By:_______________________ Name: Xxxxxx Xxxxx, Ph.D. Title: Chief Executive Officer EXECUTION BY SUBSCRIBER WHICH IS AN ENTITY (Corporation, Partnership, Trust, Etc.) ____________________________________________________________________________ Name of Entity (Please Print) Date of Incorporation or Organization: _________________________________________ State of Principal Office: ____________________________________________________ Federal Taxpayer Identification Number: ________________________________________ ____________________________________________ Office Address ____________________________________________ City, State and Zip Code ____________________________________________ Telephone Number ____________________________________________ Fax Number (if available) ____________________________________________ E-Mail (if available) [seal] Attest: (If Entity is a Corporation) By: _____________________________ Name: Title: Attest: ____________________________ (If Entity is a Corporation) *If Subscriber is a Registered Representative with a FINRA an NASD member firm, have the following acknowledgement signed by the appropriate party: The undersigned FINRA NASD member firm acknowledges receipt of the notice required by Rule 3050 of the FINRA NASD Conduct Rules Name of NASD Firm ACCEPTED this ___________________ day of __________ Name 2008, on behalf of FINRA Firm Transdel Pharmaceuticals, Inc. By: ________________________ Name: Title: COMPANY: DEERFIELD RESOURCES, LTD. By: _______________________________ Name: Xxxxxxxx Xxx Xxxxxx Xxxxx, Ph.D. Title: Chief Executive Officer

Appears in 1 contract

Samples: Subscription Agreement (Transdel Pharmaceuticals Inc)

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