FORM OF SUBSCRIPTION AGREEMENT
EXHIBIT
99.1
FORM
OF SUBSCRIPTION AGREEMENT
For use
by Zion acting as Subscription Agent
INSERT
STOCKHOLDER DETAILS
ZION
OIL & GAS, INC.
SUBSCRIPTION
CERTIFICATE FOR RIGHTS OFFERING
FOR
HOLDERS OF RECORD ON _________, 2009
ZION OIL
& GAS, INC. (the “Company”) is conducting a rights offering (the “Rights
Offering”) that entitles the holders of the Company’s common stock, $0.01 par
value per share (the “Common Stock”), as of the close of business on _________,
2009 (the “Record Date”) to receive .375 of a subscription right
(each, a “Right”) for each share of Common Stock held of record on the Record
Date. No fractional shares or cash in lieu thereof will be issued or paid.
Instead, the number of Rights received will be rounded up to the next largest
whole number. Each whole Right entitles the holder to subscribe for and purchase
one share of Common Stock (the “Basic Subscription Right”) at a subscription
price of $5.00 per share.
Set forth
above is the number of shares to which the holder whose name and address is set
forth above is entitled to subscribe pursuant to the Basic Subscription Right.
If you exercise your rights in full, you may also exercise an over-subscription
right (the “Over-Subscription Right”) to purchase additional shares of Common
Stock that remain unsubscribed at the expiration of the Rights Offering, subject
to availability and allocation of shares among persons exercising this
Over-Subscription Right. If there is a change of address and you wish to
subscribe, please note the new address on Form 2. Your records will
be updated with the new information.
For
a more complete description of the terms and conditions of the Rights Offering,
please refer to the Company’s prospectus dated
, 2009 (the
“Prospectus”), which is incorporated herein by reference. Copies of the
prospectus are available upon request from the Dallas office, by phone at
0-000-000-0000 or 214-221-4610 or by e-mail at xxxxxx@xxxxxxx.xxx.
This
subscription certificate (the “Rights Certificate”) must be received by us with
payment in full by 5:00 p.m., New York City time, on [Expiration Date] (unless
extended in the sole discretion of the Company) (as it may be extended, the
“Expiration Date”). Any Rights not exercised prior to the Expiration Date will
be null and void. Any subscription for shares of Common Stock in the Rights
Offering made hereby is irrevocable.
The
Rights represented by this Rights Certificate may be exercised by duly
completing Form 1. Rights holders are advised to review the Prospectus
before determining whether to exercise their Rights. In addition, if
certificates representing the Common Stock are to be issued in a name other than
the registered holder or are to be sent to an address other than that shown
above, also complete Form 2.
SUBSCRIPTION
PRICE: $5.00 PER SHARE
The
registered owner whose name is inscribed hereon is entitled to subscribe for
shares of Common Stock upon the terms and subject to the conditions set forth in
the Prospectus and instructions relating to the use hereof.
Except in
limited circumstances described in the Prospectus, only you may exercise your
Rights.
Rights
holders should be aware that if they choose to exercise only part of their
Rights, they may not receive a new Rights Certificate in sufficient time to
exercise the remaining Rights evidenced thereby.
FORM 1
EXERCISE AND SUBSCRIPTION:
The undersigned hereby irrevocably exercises one or more Rights to
subscribe for shares of Common Stock as indicated below, on the terms and
subject to the conditions specified in the Prospectus, receipt of which is
hereby acknowledged.
Basic
Subscription Rights:
I subscribe
for
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shares at $5.00 each = $
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(no. of new shares)
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(subscription price)
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Over-Subscription
Rights:
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IF YOU
HAVE SUBSCRIBED FOR YOUR BASIC SUBSCRIPTION RIGHT AND WISH TO PURCHASE
ADDITIONAL SHARES PURSUANT TO THE OVER-SUBSCRIPTION RIGHT (TO THE EXTENT
AVAILABLE):
I wish to
subscribe for
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Shares at $5.00 each = $
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|||||
(no. of new shares)
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(subscription price)
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|||||
Total Amount Enclosed = $
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*
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I.
METHOD
OF PAYMENT (CHECK AND COMPLETE APPROPRIATE BOX(ES)):
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o
Check, bank draft, or money order payable to “Zion Oil & Gas ”
or
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o
Wire transfer directed to the account maintained by us (contact Zion for
wire instructions).
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If the
Rights being executed pursuant to the Basic Subscription Rights do not account
for all of the Rights represented by the Rights Certificate (check only
one):
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o
Deliver to the undersigned a new Rights Certificate evidencing the
remaining Rights to which the undersigned is
entitled.
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o
Do not deliver any new Rights Certificate to
me.
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o
Check here if Rights are being exercised pursuant to the Notice of
Guaranteed Delivery delivered to Zion prior to the date hereof and
complete the following:
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Name(s) of
Registered Holder(s)
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Window
Ticket Number (if any)
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Date
of Execution of Notice of Guaranteed Delivery
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Name
of Institution Which Guaranteed Delivery
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*
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If
the aggregate Subscription Price enclosed or transmitted is insufficient
to purchase the total number of shares indicated in the “Total” line
above, or if the number of shares being subscribed for is not specified,
the Rights holder exercising this Rights Certificate shall be deemed to
have subscribed for the maximum amount of shares that could be subscribed
for upon payment of such amount. If the aggregate Subscription Price paid
by you exceeds the amount necessary to purchase the number of Underlying
Shares for which you have indicated an intention to subscribe (such excess
being the “Subscription Excess”), then you will be deemed to have
exercised the Over-Subscription Rights to the full extent of the excess
payment tendered, to purchase, to the extent available, that number of
whole shares of Common Stock equal to the quotient obtained by dividing
the Subscription Excess by the Subscription Price. To the extent any
portion of the aggregate Subscription Price enclosed or transmitted
remains after the foregoing procedures, such funds shall be mailed to the
subscriber without interest or deduction as soon as
practicable.
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Subscriber’s
Signature
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Telephone
No.
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( )
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FORM 2
SPECIAL
ISSUANCE OR DELIVERY INSTRUCTIONS
(a)
To be completed ONLY if the certificate representing the Common Stock is to be
issued in a name other than that of the registered holder. DO NOT FORGET TO COMPLETE THE
GUARANTEE OF SIGNATURE(S) SECTION BELOW.
Issue
Shares to:
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Soc.
Sec. #/Tax ID #:
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||||
Address:
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(b)
To be completed ONLY if the certificate representing the Common Stock is to be
sent to an address other than that shown above. See the Instructions. DO NOT FORGET TO COMPLETE THE
GUARANTEE OF SIGNATURE(S) SECTION BELOW.
Name:
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Address:
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ACKNOWLEDGMENT—THE
SUBSCRIPTION ORDER FORM IS NOT VALID UNLESS YOU
SIGN BELOW
I/We
acknowledge receipt of the Prospectus and understand that after delivery to the
Company we may not modify or revoke this Subscription Certificate. Under
penalties of perjury, I/we certify that the information contained herein,
including the social security number or taxpayer identification number given
above, is correct.
The
signature below must correspond with the name of the registered holder exactly
as it appears on the books of the Company’s transfer agent without any
alteration or change whatsoever.
Signature(s) of
Registered Holder:
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Date:
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If
signature is by trustee(s), executor(s), administrator(s), guardian(s),
attorney(s)-in-fact, agent(s), officer(s) of a corporation or another
acting in a fiduciary or representative capacity, please provide the following
information (please print).
Name:
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Capacity:
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Soc.
Sec. #/Tax ID #:
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|||||||
Address:
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Phone:
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The
Rights are not transferable in any way, except to affiliates of the recipient
and except by operation of law. Evidence satisfactory to the Company that any
such permitted transfer is proper must be delivered to Zion Oil & Gas prior
to the Expiration Date by mail, by hand or by overnight courier to 0000 Xxxxxx
Xx., Xxxxx 000, Xxxxxx, XX 00000.
GUARANTEE
OF SIGNATURES
All
Rights Holders who specify special issuance or delivery instructions must have
their signatures guaranteed by an Eligible Institution, as defined in
Rule 17Ad-15 of the Securities Exchange Act of 1934, as
amended.
Name
of Firm
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Authorized
Signature
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Address
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Name
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City,
State, Zip Code
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Title
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Area
Code and Telephone Number
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YOU
MUST HAVE YOUR SIGNATURE GUARANTEED IF YOU WISH TO HAVE YOUR SHARES DELIVERED TO
AN ADDRESS OTHER THAN YOUR OWN OR TO A SHAREHOLDER OTHER THAN
YOURSELF.