EXHIBIT 99
SUBSCRIPTION AGREEMENT
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XXXXXX XXXXX MANAGEMENT, INC.
0000 Xxxxx Xx., Xxx. 000
Xxxxx Xxx, XX 00000
Gentlemen:
The undersigned has read and understands the matters set forth in your
prospectus dated August ____,2001. The undersigned represents as set forth below
and subscribes to purchase ________Shares at $0.50 per Share, for
$_______________, subject to your acceptance of this subscription. There is no
minimum contingency and proceeds may be utilized at the issuer's discretion. If
any checks are delivered to any NASD member, the member must promptly, by noon
of the next business day, transmit all checks received to the issuer or any
person entitled thereto. The undersigned, if an individual, is a resident of,
or, if a corporation, partnership or trust, has as its principal place of
business:
The State of New York_____
The State of Florida_____
The District of Columbia__________
Other State _____________
A State foreign to U.S.A._________________
Dated:______________.
Signature(s):
If not an individual: Sign Below Individual(s):
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__________________________________
Signature:
_______________________________________ __________________________________
Name of Corporation, Trust, Print or type name of Signer
or Partnership
__________________________________
P.O. Box or Street Address
_______________________________________ __________________________________
State where incorporated, City, State
organized, or domiciled
_______________________________________ SS#_______________________________
Print Signer's Capacity
_______________________________________ Tel:______________________________
City, State and Zip Code
Fax:______________________________
Tax ID Number___________________________
Telefax ________________________________
Phone Numbers _________________________
