EX-10.i.2
AMERICAN FAMILY COOKIES, INC.
SUBSCRIPTION AGREEMENT
The undersigned hereby acknowledges receipt of the Prospectus dated
________,2002 of American Family Cookies, Inc. and the undersigned hereby
subscribes in accordance with the terms and conditions specified in the
Prospectus to the following number of Shares.
(A) Number of Shares subscribed for ____________________.
(A) Price per Share: $2.00.
(A) Total subscription price (Line A x Line B) $_________________.
Enclosed is either (a) my check, bank draft or postal or express money
order, for the full subscription price stated on Line C above, which has been
made payable to "Continental Stock Transfer & Trust Company, as Escrow Agent"
for the benefit of American Family Cookies, Inc., or (b) the Swift of RABA wire
transfer confirmation assigned by my bank to my payment and confirmed to me by
my bank.
The wire instructions are as follows:
Name: Continental Stock Transfer & Trust Co. aaf American
Family Cookies, Inc.
Or: CST&T aaf American Family Cookies, Inc.
Bank: XX Xxxxxx Xxxxx Bank
Account: 530-053861
ABA#: 000000000
It is understood that this Subscription is subject to allotment and
American Family Cookies, Inc. reserves the right to reject all or any portion of
this subscription in its sole discretion for any reason whatsoever by refunding
all monies paid without interest. The cashing of any check, bank draft or postal
or express money order will not be deemed to be an acceptance in the whole or in
part of any subscription. In the event less than the minimum number of Shares
are sold within the time allotted for such sale, along with any permitted
extensions thereof, then the funds deposited in a special account will be
promptly refunded in full without interest to the subscriber by the Escrow
Agent, Continental Stock Transfer & Trust Company.
Dated:____________________, 2002
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Subscriber - Print or Type Name Telephone Number
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Address - (Street) Taxpayer Identification
Number
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City State Zip Code Subscriber - Signature
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Subscriber - Signature
(For joint subscribers)
THE SUBSCRIPTION AGREEMENT AND PAYMENT
FOR THE SHARES SHOULD BE RETURNED TO:
CONTINENTAL STOCK TRANSFER & TRUST COMPANY
00 XXXXXXX XXXXX
0XX XXXXX
XXX XXXX, XX 00000
ATTENTION: ESCROW DEPARTMENT
Please complete the following additional information
(Incomplete Agreements May Result in Processing Delay)
1. LEGAL FORM OF OWNERSHIP (CHECK ONE)
[ ] Individual Ownership
[ ] Joint Tenant with Right of Survivorship (both parties must sign)
[ ] Tenants in Common (both parties must sign)
[ ] Tenants by the Entireties (both parties must sign)
[ ] Community Property (both parties must sign)
[ ] Partnership
[ ] Corporation
[ ] Trust (date established)
[ ] Uniform Transfer to Minor Act, State of ________________.
[ ] Street Name (in the name of the Brokerage House or Clearing Agent)
IF A TAX-EXEMPT ENTITY, PLEASE INDICATE TYPE AND DATE:
[ ] XXX/XXXXX (date established)
[ ] Benefit Plan (date established)
[ ] Qualified Retirement Plan (date established)
2. REGISTRATION
Please print below the exact name(s) in which Shares are to be registered.
Include Trust name(s) if applicable.
3. REGISTRATION ADDRESS
Name:__________________________________
Address:_______________________________
City/States:___________________________
Zip:___________________________________
TELEPHONE NUMBER(S) FOR CALL-BACKS AND
PERSON(S) DESIGNATED TO CONFIRM FUNDS TRANSFER INSTRUCTIONS
If to Issuer:
NAME TELEPHONE NUMBER
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1. ____________________________ _______________________
2. ____________________________ _______________________
3. ____________________________ _______________________
If to Depositor see Subscription Agreement.
Telephone call-backs shall be made to each Issuer and Depositor if joint
instructions are required pursuant to this Subscription Agreement.
(Wire transfers of funds MUST identify the name of the subscriber or the name of
the person sending the wire transfer.)
