EXHIBIT 4
FORM OF SUBSCRIPTION AGREEMENT AND INSTRUCTIONS
SFG MORTGAGE AND INVESTMENT COMPANY, INC.
SUBSCRIPTION INSTRUCTIONS
SUBSCRIPTION AGREEMENT DATED , 1999
Any person considering subscribing for the Debentures
should carefully read and review a current Prospectus.
THE DATE PRINTED ON THE FRONT OF THE PROSPECTUS AND AT THE TOP OF THE
SUBSCRIPTION
AGREEMENT CAN BE NO LATER THAN 9 MONTHS OLD. IF THE DATE IS MORE THAN
9 MONTHS OLD, NEW MATERIALS ARE AVAILABLE AND MUST BE UTILIZED.
1. Enter the total dollar amount being invested on LINE 1.
2. Indicate whether this is an initial investment or an additional investment
in LINE 2.
3. If this is an addition to an existing account, list Debenture holder # in
LINE 2.
4. Enter the Social Security Number OR Taxpayer ID Number, as applicable, on
LINE 3 and check the appropriate box to indicate ownership type. For XXX
accounts, the Taxpayer ID Number of the Custodian should be entered in LINE
3.
5. Enter the name of the investor on LINE 5. For UGMA/UTMA (MINOR), enter the
Minor name on LINE 5, followed by "Minor", and enter the custodian name
where indicated. For TRUSTS, enter the Trust name on LINE 5 and the
Trustee(s) name(s) on the Custodian line. For CORPORATIONS, PARTNERSHIPS,
AND ESTATES, enter the entity name on LINE 5, and officer or contact person
name on the Custodian line. Investors who are not individuals must furnish
a copy of organizing or other documents evidencing the authority of such
entity to invest in the Fund (for example, trusts must furnish a copy of
the trust agreement, corporations must furnish a corporate resolution or
bylaws).
6. Enter the legal address (which is the residence or domicile address used
for tax purposes) of the investor on LINE 6. (No P.O. Boxes)
7. If the mailing address is different from the legal address, enter on LINE
7.
8. If an XXX account, enter Custodian's name and address on LINE 8.
9. The investor must sign and date LINE 9. If it is a joint account, both
investors must sign. In the case of IRAs, the Custodian's signature is also
required.
10. The Account Executive must sign and date in LINE 10. Some broker/dealers
may also require signature by the office manager.
11. The name of the selling firm, account executive name, account executive
number, and address and phone number must be entered in LINE 11.
THE CLIENT SHOULD RETURN THIS SUBSCRIPTION AGREEMENT AND PAYMENT TO HIS/HER
ACCOUNT EXECUTIVE.
Subscription agreements, payment, and any other required documents should be
sent by the account executive to either
1) the administration office of the selling firm, if firm procedures
require, or
2) to the custodial firm if one is required (sending document early in the
month is best if it is to reach SFG Mortgage and Investment Company, Inc.
by month end), or
3) to SFG Mortgage and Investment Company, Inc., 000 Xxxxxx Xxxxxx XX,
Xxxxxx, XX 00000
If payment is being made by wire transfer, account executive should contact
either his or her firm's administration department or SFG Mortgage and
Investment Company, Inc. for instructions. Payments made by check must be
received at least 3 business days prior to the last business day of the month.
Subscriptions close on the last business day of each month. However, the
selling firm's administration department may have an earlier cut-off for
subscriptions.
If account executives have specific questions about the subscription
process, please call SFG Mortgage and Investment Company, Inc. at 425-271-3550.
SFG MORTGAGE AND INVESTMENT COMPANY, INC.--SUBSCRIPTION AGREEMENT
IMPORTANT: READ REVERSE SIDE BEFORE SIGNING
INVESTMENT DEBENTURES, SERIES I
The investor named below, by execution and delivery of this Subscription
Agreement, by payment of the purchase price and by enclosing a check for the
amount of the subscription, hereby subscribes for the purchase of an Investment
Debenture, Series I to be issued by SFG Mortgage and Investment Company, Inc.
(the "Company") to the subscriber upon acceptance of this Subscription
Agreement.
The named investor further acknowledges receipt of the Prospectus of the Company
dated ___________, 1999.
CHECKS SHOULD BE MADE PAYABLE TO:_SFG MORTGAGE AND INVESTMENT COMPANY, INC.
1.) Total $ Amount 2.) Initial Investment Additional Investment
(Check One)
Debenture Holder Number
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3.) - -
Social Security Number Taxpayer ID #
4.) Legal Form of Ownership (please check only one):
/ / Individual Ownership (one signature required) / / Corporation (authorized agent must sign)
/ / Joint Tenants with Right of Survivorship (all / / Partnership (all partners must sign; commonly a
parties
must sign; commonly used in situations where business or investment group)
spouses are investing and wish to pass to / / Trust (trustee must sign)
surviving spouse free of probate) / / Other (please specify)
/ / Tenants-in-Common (all parties must sign;
each investor has an undivided interest)
5.) REGISTERED OWNER:
----------------------------------------------------- ----------------------------------------------------------
Name Custodian Name (if any)
6.) Residence Address
7.) Mailing Address
(If Different)
8.) Custodian Address
9.) INVESTORS MUST SIGN
X X
Signature of Investor Date Telephone No. Signature of Joint Investor Date Telephone No.
EXECUTING AND DELIVERING THIS SUBSCRIPTION AGREEMENT AND POWER OF ATTORNEY SHALL
IN NO RESPECT BE DEEMED TO CONSTITUTE A WAIVER OF ANY RIGHTS UNDER THE
SECURITIES EXCHANGE ACT OF 1933 OR UNDER THE SECURITIES EXCHANGE ACT OF 1934.
UNITED STATES INVESTORS ONLY
I have checked the following box if I am subject to backup withholding under the
provisions of Section 3406(a)(I)(C) of the Internal Revenue Code: / /. Under
penalties of perjury, by signature above I hereby certify that the Social
Security Number or Taxpayer ID Number next to my name is my true, correct and
complete Social Security Number or Taxpayer ID Number and that the information
given in the immediately preceding sentence is true, correct and complete.
NON-UNITED STATES INVESTORS ONLY
Under penalties of perjury, by signature above I hereby certify that (a) I am
not a citizen or resident of the United States or (b) (in the case of an
investor which is not an individual) the investor is not a United States
corporation, partnership, estate or trust.
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10.) ACCOUNT EXECUTIVE MUST SIGN
I hereby certify that I have informed the investor of all pertinent facts
relating to the risks, liquidity, marketability, management and control of the
Company with respect to an investment in the Debentures, as set forth in the
Prospectus dated ___________, 1999. I have also informed the investor of the
unlikelihood of a public trading market developing of the Debentures.
I have reasonable grounds to believe, based on information obtained from this
investor concerning his/her investment objectives, other investments, financial
situation and needs and any other information known by me, that investment in
the Debentures is suitable for such investor in light of his/her financial
position, net worth and other suitability characteristics.
The Account Executive MUST sign below in order to substantiate compliance with
Article 111, Section 34 of the NASD's Rules of Fair Practice.
X X
ACCOUNT EXECUTIVE SIGNATURE DATE OFFICE MANAGER SIGNATURE DATE
(if required by Selling Agent, as the case may be, procedures)
11.) SELLING FIRM A.E. NAME
A.E PHONE A.E. FAX A.E. NUMBER
A.E. ADDRESS
(FOR CONFIRMATIONS) STREET (P.O. BOX NOT ACCEPTABLE) CITY STATE ZIP CODE
SFG MORTGAGE AND INVESTMENT COMPANY, INC.
INVESTMENT DEBENTURES, SERIES I
------------------------
SUBSCRIPTION AGREEMENT
SFG Mortgage and Investment Company, Inc.
000 Xxxxxx Xxxxxx XX
Xxxxxx, XX 00000
Dear Sirs:
1. SUBSCRIPTION FOR INVESTMENT DEBENTURES, SERIES I. I hereby subscribe
for the principal amount of Investment Debentures, Series I ("Debentures") to be
issued by SFG Mortgage and Investment Company, Inc. (the "Company") set forth on
the face of this Subscription Agreement (minimum $2,000), at the face amount of
the Debentures as set forth in the Prospectus of the Company dated ,
1999 (the "Prospectus"). The undersigned's check payable to SFG Mortgage and
Investment Company, Inc., in the full amount of the undersigned's subscription
(additional investments in excess of the required minimum investment may be made
in increments of $500.00), accompanies the Subscription Agreement. If this
subscription is rejected, all funds remitted by the undersigned herewith will be
returned, together with any interest actually earned thereon, if any. The
Company may, in its sole and absolute discretion, accept or reject this
subscription in whole or in part. All subscriptions once submitted are
irrevocable. All Debentures are offered subject to prior sale.
2. REPRESENTATIONS AND WARRANTIES OF SUBSCRIBER. I have received and
reviewed the Prospectus.
3. IRREVOCABILITY; GOVERNING LAW. I hereby acknowledge and agree that I am
not entitled to cancel, terminate or revoke this subscription or any of my
agreements hereunder after the Subscription Agreement has been submitted (and
not rejected) and that this subscription and such agreements shall survive my
death or disability, but shall terminate with the full redemption or payment of
all my Debentures. This Subscription Agreement shall be governed by and
interpreted in accordance with the laws of the State of Washington.
READ AND COMPLETE REVERSE SIDE
