Preliminary Subscription Agreement
Exhibit
99.9
000
Xxxxx
Xxxxxx
X.X.
Xxx
000
Xxxxxxxxxx,
Xxxxxxx 00000
Attn:
Xxxxxx X. Xxxxx
Ladies
and Gentlemen:
I
hereby
subscribe to purchase the number of shares of 9% Series A Convertible Preferred
Stock (the “shares”) of WGNB Corp. (the “Company”) indicated below.
I
have
received a copy of the Company's prospectus, dated [ ], 2008. I understand
that
my purchase of the Company's stock involves significant risk, as described
under
“Risk Factors” in the prospectus. I also understand that no federal or state
agency has made any finding or determination regarding the fairness of the
Company's offering of the shares, the accuracy or adequacy of the prospectus,
or
any recommendation or endorsement concerning an investment in the
shares.
I
am not
sending the purchase price for the shares I wish to buy at this time. After
I
receive the prospectus supplement announcing the results of the Company’s rights
offering to its shareholders, if I still wish to purchase shares, I will send
the Company an acknowledgment of subscription and a check in the amount of
$8.00
multiplied by the number of shares I wish to buy. My check will be made payable
to “WGNB Corp.”
WHEN
THE
COMPANY RECEIVES MY ACKNOWLEDGMENT OF SUBSCRIPTION AND MY CHECK, THIS
SUBSCRIPTION AGREEMENT WILL BECOME FINAL AND BINDING AND WILL BE IRREVOCABLE
UNTIL THE OFFERING IS CLOSED.
NUMBER
OF
SHARES
(MINIMUM
100 SHARES): ___________
TOTAL
SUBSCRIPTION PRICE
(AT
$8.00
PER SHARE): ___________
*
PLEASE
PRINT OR TYPE EXACT NAME(S) IN WHICH UNDERSIGNED DESIRES SHARES TO BE
REGISTERED:
_______________________________________________________
*
DO NOT
SEND THE PURCHASE PRICE FOR YOUR SHARES AT THIS TIME.
1
SUBSTITUTE
W-9
Under
the
penalty of perjury, I certify that: (1) the Social Security number or Taxpayer
Identification Number given below is correct; and (2) I am not subject to backup
withholding.
INSTRUCTION:
YOU MUST CROSS OUT (2) ABOVE IF YOU HAVE BEEN NOTIFIED BY THE INTERNAL REVENUE
SERVICE THAT YOU ARE SUBJECT TO BACKUP WITHHOLDING BECAUSE OF UNDERREPORTING
INTEREST OR DIVIDENDS ON YOUR TAX RETURN.
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DATE
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SIGNATURE(S)*
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| AREA CODE AND TELEPHONE NO. |
PLEASE
INDICATE FORM OF OWNERSHIP YOU DESIRE FOR THE SHARES (INDIVIDUAL, JOINT TENANTS
WITH RIGHT OF SURVIVORSHIP, TENANTS IN COMMON, TRUST, CORPORATION, PARTNERSHIP,
CUSTODIAN, ETC.):
____________________________________________
SOCIAL
SECURITY OR FEDERAL TAXPAYER
IDENTIFICATION
NO.
TO
BE
COMPLETED BY THE COMPANY
Accepted
as of ___, 2008, as to ______________ shares.
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By:
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Signature
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Print
Name
|
* When
signing as attorney, trustee, administrator, or guardian, please give your
full
title as such. If a corporation, please sign in full corporate name by president
or other authorized officer. In case of joint tenants, each joint owner must
sign.
2
