EXHIBIT 1.1
IMPORTANT: PLEASE READ CAREFULLY BEFORE SIGNING, THIS DOCUMENT
REQUIRES SIGNIFICANT REPRESENTATIONS BY A PURCHASER
SUBSCRIPTION AGREEMENT
MediaComm Broadcasting Systems, Inc.
d/b/a Xxxxxxx.xxx
000 X. Xxxxxx Xxxxxx, #00
Xxxxxxxxx, Xxxxxxxx 00000
Gentlemen:
1. The undersigned hereby tenders this subscription for the purchase of
_______ shares of the common stock of MediaComm Broadcasting Systems, Inc.,
d/b/a/ Xxxxxxx.xxx for the sum of $_______, upon the terms and conditions
as set forth below. A check, wire transfer or certified funds payable to
"Xxxxxxx.xxx Escrow Account" in the amount of $_______ is delivered
herewith. The undersigned understands that this subscription for the shares
may be rejected for any reason and that, in the event this subscription is
rejected, the funds delivered herewith will be promptly returned, without
interest thereon or deduction therefrom.
2. The undersigned hereby warrants and represent that (he/she/it) received
the Prospectus of Xxxxxxx.xxx dated _______ ___, ____, prior to this
subscription for shares of the common stock of Xxxxxxx.xxx offered by that
Prospectus.
The undersigned further warrants and represents that (he/she/it) has been
given access to full and complete information regarding Xxxxxxx.xxx and has
used such access to the satisfaction of undersigned for the purpose of
obtaining such information regarding Xxxxxxx.xxx that undersigned requested
and that undersigned was given every opportunity to ask questions of and
receive answers from representatives of Xxxxxxx.xxx concerning the affairs
of Xxxxxxx.xxx and the terms and conditions of this offering made by the
Prospectus and to obtain whatever information undersigned wished.
3. Undersigned acknowledges and agrees that undersigned's funds paid for
the within subscription for shares of the common stock of Xxxxxxx.xxx will
be paid into an Escrow Account at the Peak National Bank, Lakewood,
Colorado together with the subscription funds of other purchasers of the
shares of common stock of Xxxxxxx.xxx offered by the Prospectus until such
time as there shall have been deposited to said Escrow Account the sum of
$450,000 from sale of said shares during the stipulated offering period. At
such time as $450,000 shall have been so deposited undersigned understands
that undersigned's funds together with the funds of all other purchasers of
such shares will be remitted by said bank to Xxxxxxx.xxx.
Undersigned acknowledges and agrees that if the sum of $450,000 shall not
have been deposited into the Escrow Account during the offering period
specified in the Prospectus, the funds of undersigned held in said Escrow
Account will be refunded to undersigned without payment of any interest
thereon to undersigned or deduction of any amount therefrom and this
subscription shall be cancelled.
4. The undersigned directs that certificates of the shares of common stock
of Xxxxxxx.xxx subscribed for herein be issued in the following numbers and
names:
Names Number of Certificates
The undersigned further directs that the title to said shares is to be held
by the following legal persons:
Place an "X" in the proper space below:
(a) individual
(b) joint tenancy
(c) community property
(d) tenancy in common
(e) partnership
(f) corporation
(g) trust
(h) other (specify)
SIGNATURES
Dated:
INDIVIDUAL Address to Which Correspondence
Should be Directed
----------------------------- ----------------------------------------
Signature (Individual)
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Signature (all record holders ----------------------------------------
should sign) City, State and Zip Code
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Names(s) Typed or Printed Tax Identification or Social Security Number
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Telephone Number
CORPORATION, PARTNERSHIP, TRUST OR OTHER ORGANIZATION
Address to Which Correspondence
Should be Directed
----------------------------- ----------------------------------------
Name of Organization
----------------------------------------
By: ----------------------------------------
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Signature ----------------------------------------
City, State and Zip Code
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Title Tax Identification or Social Security Number
Its:
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Telephone Number
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Name Typed or Printed
*If shares are being subscribed for by an organization, the Certificate of
Signatory must also be completed.
CERTIFICATE OF SIGNATORY
To be completed if Shares are being subscribed for by an organization.
I, ___________________________, am the _________________________ of
________________________________________ (the organization).
I certify that I am empowered and duly authorized by the Organization to
execute and carry out the terms of the Subscription Agreement to purchase and
hold the Shares, and certify further that the Subscription Agreement has been
duly and validly executed on behalf of the Organization and constitutes a legal
and binding obligation of the organization.
IN WITNESS WHEREOF, I have hereto set my hand this _____ day of _________,
____.
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Signature
ACCEPTANCE
This Subscription Agreement is accepted as of ______________, ____.
MEDIACOMM BROADCASTING SYSTEMS, INC.
d/b/a Xxxxxxx.xxx
By:
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Name
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Title
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Date
