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EXHIBIT 99(g)
GENERAL SUBSCRIPTION APPLICATION AND AGREEMENT
FIRST COMMERCIAL BANCORP, INC.
000 XXXX XXXXXX, XXXXX 000
XXXXXXXXXX, XXXXXXXXXX 00000
(000) 000-0000
SIR/MADAM:
The undersigned, having read the Prospectus dated _______________, 1996
of First Commercial Bancorp, Inc. (the "Company"), hereby subscribe(s) for the
number of shares (the "Shares") of Common Stock of the Company, par value $0.01
per share (the "Common Stock") set forth opposite their respective names at
$0.10 per Share. This Subscription Agreement constitutes an offer by the
subscriber(s) to purchase the number of Shares specified below which cannot be
revoked prior to acceptance or rejection thereof by the Company.
APPLICATIONS FOR SUBSCRIPTIONS OR A NOTICE OF GUARANTEED DELIVERY MUST
BE RECEIVED BY THE FIRST NATIONAL BANK OF BOSTON (THE "SUBSCRIPTION AGENT") WITH
PAYMENT IN FULL BY 5:00 P.M., CALIFORNIA TIME ON _______________, 1996, UNLESS
EXTENDED BY THE COMPANY TO A TIME NOT LATER THAN 5:00 P.M., CALIFORNIA TIME ON
_______________, 1996 (IN EITHER CASE, THE "OFFERING EXPIRATION DATE"). THE
COMPANY MAY TERMINATE THE OFFERING AT ANY TIME, AND ACCEPTED SUBSCRIPTIONS ARE
SUBJECT TO CANCELLATION IN THE EVENT THAT THE COMPANY SHOULD ELECT TO CANCEL THE
OFFERING IN ITS ENTIRETY.
Enclosed with this Subscription Agreement is a check payable to "The
First National Bank of Boston," as Subscription Agent, for the amount of this
subscription for ______________ Shares at $0.10 per Share, in the total sum of
$__________________, which amount when received may be held in an account which
is not insured by the FDIC.
HOW SHARES ARE TO BE REGISTERED:
Name and Address (Please Print)
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
(Circle One)
Individual Individual Retirement Account
Custodian Trustee
Tenants in Common Joint Tenants
Xxxxx Plan Other _________
Subscription should be mailed or delivered to:
By Mail: The First National Bank of Boston
Shareholder Services Division
X.X. Xxx 0000
Xxxx Xxxx 00-00-00
Xxxxxx, Xxxxxxxxxxxxx 00000
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By Facsimile Transmission: (000) 000-0000
(000) 000-0000
(for Eligible Institutions Only)
Confirm by Telephone
(000) 000-0000
By Hand: BancBoston Trust Company of New York
00 Xxxxxxxx, Xxxxx Xxxxx
Xxx Xxxx, Xxx Xxxx
By Wire Transfer: The First National Bank of Boston
000 Xxxxxxx Xxxxxx
Xxxxxx, Xxxxxxxxxxxxx 00000
Attn: Xxxx Xxxx
ABA# 000000000
By Overnight Courier: The First National Bank of Boston
Shareholder Services Division
Mail Stop 45-01-19
000 Xxxxxx Xxxxxx
Xxxxxx, Xxxxxxxxxxxxx 00000
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IN WITNESS WHEREOF, I (we) have executed this Subscription Agreement,
in triplicate, and return two (2) copies, along with the full subscription price
for all of the Shares to be purchased. I (We) understand that all information
submitted on this Subscription Agreement will be treated confidentially by the
Company.
Date: _______________________, 1996 Date: _______________________, 1996
____________________________________ ____________________________________
Signature Signature
____________________________________ ____________________________________
Name (Please print or type) Name (Please print or type)
Business Address: Business Address:
____________________________________ ____________________________________
Street Street
____________________________________ ____________________________________
City, State, and Zip City, State, and Zip
____________________________________ ____________________________________
Telephone Telephone
Residence Address: Residence Address:
____________________________________ ____________________________________
Street Street
____________________________________ ____________________________________
City, State, and Zip City, State, and Zip
____________________________________ ____________________________________
Telephone Telephone
____________________________________ ____________________________________
Social Security Number/Taxpayer Social Security Number/Taxpayer
Identification Number (if applicable) Identification Number (if applicable)
ORIGINAL: RETURN TO COMPANY
DUPLICATE: RETURN TO COMPANY
TRIPLICATE: SUBSCRIBER'S COPY
