SUBSCRIPTION AGREEMENT
iGeniSys, Inc
000 Xxxxx Xxxx Xxxx, Xxxxx 000
Xxxxxxx, XX 00000
Gentlemen:
By signing below, the undersigned hereby subscribes to purchase _____
shares of the Common Stock, $.001 par value, of iGeniSys, Inc., a Colorado
corporation (the "Company"). In payment of the purchase price for the shares
of Common Stock, I hereby deliver to the Company payment in the amount of
$_______________, representing the price per share of $1.50 multiplied by the
number of shares being purchased.
I acknowledge receipt of the Company's Prospectus dated _____________,
2000 and represent that I have made my investment decision solely on the basis
of information contained in the prospectus.
This will further confirm that no broker/dealer or member of the National
Association of Securities Dealers, Inc. has been involved in any manner
whatsoever in my investment of the Company except as follows:
Broker-Dealer Name:
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Address:
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Representative:
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SIGNATURE
Date:
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Name:
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Address:
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Telephone:
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Facsimile:
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Social Security Number:
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