Up to 15,000,000 Shares
Travco, Inc.
Subscription Agreement
To________________
Please issue shares of your common stock in the amounts and
name(s) shown below. My signature acknowledges that I have read
the Prospectus dated _______________, 2001, and am aware of the
risk factors contained therein. I represent that I have relied
solely upon the contents of the Prospectus in making an
investment decision with regard to the shares offered thereby,
and I have not relied on any other statements made by or with
regard to the Company in connection with its anticipated
operations or financial performance.
All proceeds will be held in a segregated non-interest bearing
account until the minimum offering amount ($20,000) are received.
Thereafter, all funds will be immediately disbursed to the
Company for the uses set forth in the Use of Proceeds section of
the Prospectus.
(Signature) _________________________________ (Date) ______________
(Signature) _________________________________ (Date) ______________
Enclosed is payment for __________ shares at $0.02 per share;
Total: $___________
Make checks payable to: Travco, Inc. Investment Account
Register the shares in the following name(s) and amount(s):
(Please Print)
Name(s): _________________________________________
Number of share(s): _______________
As (check one):
[ ] Individual [ ] Joint Tenancy [ ] Husband & Wife as
community property
[ ] Tenants in Common [ ] Corporation [ ] Trust
[ ] Other: _______________________________
For the person(s) who will be registered shareowners:
Mailing Address:____________________________________
City, State, Zip:___________________________________
Telephone:__________________________________________
Enter the taxpayer identification number. For most individual
taxpayers, it is their Social Security Number. Note: if the
purchase is in more than one name, the number should be that of
the first person listed. For IRAs , Keoghs, and qualified plans,
enter both the Social Security Number and the Taxpayer
Identification Number for the plan.
Social Security Number:______________________________________
Taxpayer ID Number (if applicable):__________________________
Please attach any instructions for mailing the certificates or
shareowner communications
other than to the registered shareowner at this address.
No Subscription Is Effective Until Acceptance.
Subscription Accepted by Travco, Inc.
By:___________________________________________
Xxxx X. Xxxxxxx, President