PERFORMANCE HOME BUYERS, LLC SENIOR SECURED RENEWABLE NOTE SUBSCRIPTION AGREEMENT
Exhibit 4.4
PERFORMANCE HOME BUYERS, LLC
To purchase a senior secured renewable note(s), please complete this form and write a check made
payable to PERFORMANCE HOME BUYERS, LLC (“PHB”). Send this form along with your check and any
other documents requested below to the selling agent for the notes, XXXXXX XXXXXXXXXX LTD., 00000
XXXXXXX XXXXXXXXX, XXXXX 000, XXXXXXXXXXX, XX 00000. If you have any questions, call the selling
agent for the notes, XXXXXX XXXXXXXXXX LTD., at 000-000-0000.
NOTE PURCHASE AMOUNT (minimum principal amount of $1,000 per note)
INTEREST PAYMENT SCHEDULE (please select one for each note) |
||||
| Note Term | Principal Amount | Monthly* | Quarterly | Semi-Annually | Annually | Maturity | ||||||||
Three Month |
$ | [ ] | [ ] | N/A | N/A | [ ] | ||||||||
Six Month |
$ | [ ] | [ ] | [ ] | N/A | [ ] | ||||||||
One Year |
$ | [ ] | [ ] | [ ] | [ ] | [ ] | ||||||||
Two Year |
$ | [ ] | [ ] | [ ] | [ ] | [ ] | ||||||||
Three Year |
$ | [ ] | [ ] | [ ] | [ ] | [ ] | ||||||||
Four Year |
$ | [ ] | [ ] | [ ] | [ ] | [ ] | ||||||||
Five Year |
$ | [ ] | [ ] | [ ] | [ ] | [ ] | ||||||||
Ten Year |
$ | [ ] | [ ] | [ ] | [ ] | [ ] | ||||||||
| TOTAL | $ | *Monthly payment date (e.g. 1st, 15th, etc.) | ||||||||||||
FORM OF OWNERSHIP (please select one)
[ ] Individual Investor (with optional beneficiary)
|
[ ] Custodian for a Minor | |
[ ] Joint Tenants with Right of Survivorship
|
[ ] Other XXX, SEP, 401(k), 403(b), Xxxxx, trust, corporation, partnership, etc.
(Please include with this form a trust
resolution or the appropriate corporation or
partnership documents authorizing you to make
this investment.) |
NOTE PURCHASER (please circle one)
Full Name of Individual Investor/First Joint Tenant/Minor/Entity/Administrator/Trustee
First Name
|
Middle name | Last name | Social Security Number/Tax ID Number | Date of Birth (if applicable) | ||||
Full Name of Beneficiary/Second Joint Tenant/Custodian (please circle one if applicable)
First Name
|
Middle name | Last name | Social Security Number/Tax ID Number | Date of Birth (not required for custodians) | ||||
Name(s) and Relationship of other Family PHB Note Investors
PRIMARY ADDRESS (Original correspondence will be sent to this address.)
City
|
State | Zip | ||
Daytime Phone (Include Area Code)
|
E-mail Address | |
SECONDARY ADDRESS (Optional—copies of correspondence will be sent to this address.)
City
|
State | Zip | ||
Daytime Phone (Include Area Code)
|
E-mail Address | |
DIRECT DEPOSIT PHB will electronically deposit your principal and interest payments directly into
the account listed in the Direct Deposit section on the reverse side of this form. Please complete
and sign the reverse side of this form for automatic deposit to either your checking or savings
account.
PASSWORD When you call Xxxxxx Xxxxxxxxxx to discuss your investment, you may be asked to verify
your identification by answering the following question.
What is your mother’s maiden name?
What is your mother’s maiden name?
CERTIFICATION Under penalties of perjury, I hereby declare and certify that: (i) I am a bona fide
resident of the state listed in the primary mailing address; (ii) I have received and read the
prospectus provided by Performance Home Buyers, LLC and understand the risks related to the notes
and to Performance Home Buyers, LLC; (iii) Xxxxxx Xxxxxxxxxx Ltd. has neither recommended this
investment to me nor given me investment, legal or tax advice regarding the notes and the
creditworthiness of Performance Home Buyers, LLC; (iv) I have independently determined that this
investment is suitable for me without relying on such advice from Xxxxxx Xxxxxxxxxx Ltd.; (v) the
notes are illiquid due to significant transfer restrictions and the lack of a secondary market;
(vi) I risk the loss of my entire principal amount and all accrued but unpaid interest when
purchasing the notes and have the financial ability to withstand these losses; (vii) I am
purchasing the notes to fulfill my investment objective of earning current taxable interest income;
(viii) the social security number or tax identification number listed above is correct; and (ix) I
am not subject to backup withholding, either because the Internal Revenue Service has not notified
me that I am subject to backup withholding as a result of a failure to report all interest or
dividends or I have been notified that I am no longer subject to backup withholding. I understand
that my purchase offer is subject to the terms contained in the prospectus, may be rejected in
whole or in part and will not become effective until accepted by Performance Home Buyers, LLC or
its selling agent.
Signature of Individual Investor/First Joint Tenant/Custodian/Authorized Person
|
Date | Signature of Second Joint Tenant (if applicable) | Date | |||
(Please complete reverse side)
Office Use Only ACTP_________ ACTP_________ DATE_________
DIRECT DEPOSIT
Direct Deposit Information (please check one)
[ ]
|
I currently receive direct deposit payments from an existing PHB note. Please deposit all principal and interest payments for this new note | |
[ ]
|
Please deposit my payments into the account listed below. (If this option is chosen, the account owner must attached to the bottom of this form either a VOIDED check, if this is a checking account, or a deposit slip, if this is a savings account. |
Account Owner Name(s) |
||||||||
| [ ] Checking | [ ] Savings | [ ] Other | ||||||
Bank Routing Number (9 digits)
|
Bank Name | Xxxxx Location |
Some financial institutions (e.g. brokerage firms, custodians, mutual savings banks, credit unions,
money market funds, etc.) also require “for further credit” information to correctly identify
direct deposit accounts. If your financial institution requires this additional information,
please list it below. If you are unsure if this additional information is required, please call
your financial institution.
For further credit:______________________________________________________________________________________
Direct Deposit Authorization
As the investor of record and authorized signatory of the account listed above, I hereby authorize
Performance Home Buyers, LLC, its affiliates, or its agents (collectively referred to hereinafter
as “PHB”) to deposit interest and principal payments owed to me, by initiating credit entries in
the account to my financial institution listed on this Form. Further, I authorize my financial
institution to accept and to credit any credit entries initiated by PHB to the listed account. In
the event of an erroneous credit entry, I also authorize PHB to debit the account for an amount not
to exceed the original amount of the erroneous credit.
This authorization is to remain in full force and effect until PHB and my financial institution
have received written notice from me of its termination in such time and in such manner as to
afford PHB and my financial institution reasonable opportunity to act on it. In the event the
listed account is closed, I will promptly notify PHB of an alternate account into which payments
can be made.
Authorized Signature
|
Date |
Mail to:
XXXXXX XXXXXXXXXX LTD.
00000 Xxxxxxx Xxxxxxxxx
Xxxxx 000
Xxxxxxxxxxx, Xxxxxxxxx 00000
XXXXXX XXXXXXXXXX LTD.
00000 Xxxxxxx Xxxxxxxxx
Xxxxx 000
Xxxxxxxxxxx, Xxxxxxxxx 00000
ATTACH VOIDED CHECK or DEPOSIT SLIP HERE
