FORM OF SUBSCRIPTION AGREEMENT
EXHIBIT
10.8
FORM
OF SUBSCRIPTION AGREEMENT
THIS
SUBSCRIPTION AGREEMENT (the “Agreement”) is made as of this 8th day of
September, 2006, by and between Foothills Resources, Inc., a Nevada corporation
(the “Company”) and the investor identified on the signature page to this
Agreement (the
“Investor”).
RECITALS:
WHEREAS,
the Company is offering pursuant to Rule 506 of Regulation D of the Securities
Act of 1933, as amended (the “Securities Act”), to accredited investors in a
private placement transaction (the “Offering”), up to 8,888,888 units (“Units”)
consisting of one share of the Company’s common stock, par value $0.001 per
share (“Common Stock”) and a warrant (the “Investor Warrants”) to purchase 0.5
shares of Common Stock for 5 years at the exercise price of $2.75 per whole
share of Common Stock;
WHEREAS,
to the extent that all 8,888,888 Units are sold, the Company will have the
option to sell up to an additional 6,666,667 Units in the Offering;
WHEREAS,
the Investor desires to subscribe for, purchase and acquire from the Company
and
the Company desires to sell and issue to the Investor the number of Units,
set
forth on the signature page of this Agreement (the “Investor’s Units”) upon the
terms and conditions and subject to the provisions hereinafter set
forth;
WHEREAS,
in connection with the purchase of the Investor’s Units, the Company and the
Investor will execute a Securities Purchase Agreement, signed by either the
Investor or on behalf of the Investor by Xxxxxxx Xxxxxx Xxxxxx Inc., as set
forth in Section 4 hereof, dated as of the date of this Agreement, whereby
the
Company will issue and sell to the Investor shares of Common Stock and Investor
Warrants to purchase shares of Common Stock, at a per share price and upon
the
terms and conditions set forth in the Securities Purchase Agreement and this
Agreement;
WHEREAS,
in connection with the purchase of the Investor’s Units, the Company and the
Investor will execute a Registration Rights Agreement, signed by either the
Investor or on behalf of the Investor by Xxxxxxx Xxxxxx Xxxxxx Inc., as set
forth in Section 4 hereof, dated as of the date of this Agreement, pursuant
to
which the Company will provide certain registration rights to the Investor
(the
“Registration Rights Agreement”); and
WHEREAS,
The Company and Signature Bank (the “Escrow Agent”) have entered into an Escrow
Agreement (the “Escrow Agreement”) to provide for the safekeeping of funds
received and documents executed in connection with the Offering.
NOW,
THEREFORE, for and in consideration of the mutual covenants and agreements
contained herein and for other good and valuable consideration, the receipt
and
sufficiency of which are hereby acknowledged, the parties hereto agree as
follows:
1. Purchase
and Sale of the Units.
Subject
to the terms and conditions of this Agreement and the satisfaction of the
Closing Conditions, the Investor subscribes for and agrees to purchase and
acquire from the Company and the Company agrees to sell and issue, to the
Investor, the Investor’s Units at the purchase price of $2.25 per Unit (the
“Purchase Price”).
2. The
Closing.
The
Offering will close upon receipt of acceptable subscriptions representing at
least 8,888,888 Units (the “Closing Date”) at either the offices of the Escrow
Agent or to the Company. On the Closing Date, the Escrow Agent shall deliver
the
funds held in escrow and the Placement Agent shall deliver the Transaction
Documents (as defined herein) as of the Closing Date pursuant to the terms
of
the Escrow Agreement. As soon as practicable after the Closing Date, the Company
shall issue and deliver, or shall cause the issuance and delivery of, a stock
certificate, registered in the name of the Investor and representing the shares
of Common Stock underlying the Investor’s Units and an Investor Warrant
registered in the name of the Investor representing the Investor’s right to
purchase the number of shares of Common Stock underlying the Investor’s Warrant.
To the extent that more than 8,888,888 Units are sold in the Offering, the
Company may conduct multiple closings of the Offering.
3. Subscription
Procedure.
To
complete a subscription for Units, the Investor must fully comply with the
subscription procedure provided in this Section on or before 5:00 p.m. Eastern
time on the Closing Date.
(a) Transaction
Documents.
Prior
to 5:00 p.m. Eastern time on the Closing Date, the Investor shall review,
complete and execute this Agreement, the Investor Questionnaire attached hereto
as Appendix
A
and the
Registration Rights Agreement, and deliver such agreements and questionnaire
to
the PlacementAgent at the address provided below. Executed agreements and
questionnaires may be delivered to the Placement Agent by facsimile using the
facsimile number provided below if the Investor immediately thereafter confirms
receipt of such transmission with the Placement Agent and delivers the original
copies of the agreements and questionnaire to the Placement Agent as soon as
practicable thereafter.
Escrow
Agent - Mailing Address and Facsimile Number:
Signature
Bank
000
Xxxxx
Xxxxxx
Xxx
Xxxx,
XX 00000
Facsimile
Number: 000-000-0000
Attention:
[Xxxx Xxxxxxxx]
Telephone
Number: 000-000-0000
Placement
Agent - Mailing Address and Facsimile Number:
Xxxxxxx
Xxxxxx Xxxxxx Inc.
000
Xxxxxxx Xxx., 0xx
Xxxxx
Xxx
Xxxx,
XX 00000
Facsimile
Number: (000) 000-0000
Attention:
Xxxx Xxxx
Telephone
Number: (000) 000-0000
(b) Purchase
Price.
Simultaneously with the delivery of the Transaction Documents to the Escrow
Agent as provided herein, and in any event on or prior to 5:00 p.m. Eastern
time
on the Closing Date, the Investor shall deliver to the Escrow Agent the full
Purchase Price for the Investor’s Units by wire transfer of immediately
available funds pursuant to wire transfer instructions provided
below:
2
Escrow Agent - Wire Transfer Instructions: | ||
|
Bank:
|
Signature
Bank
|
000
Xxxxx Xxxxxx
|
||
Xxx
Xxxx, XX 00000
|
||
ABA
#:
|
000000000
|
|
Account
Name:
|
Signature
Bank as escrow agent for SMH/Foothills Res
|
|
Account:
|
1500654534
|
|
SWIFT#:
|
XXXXXX00
|
|
Ref:
|
Signature
Bank as escrow agent for SMH/Foothills Res
|
|
FBO:
|
____________________________________
|
|
(Investor
Name)
|
||
Signature
Bank Contact: Xxxx Xxxxxxxx (000) 000-0000
Bank
Contact: Xxxx Xxxx (000) 000-0000
|
(c)
Purchaser
Representative.
If the
Investor has retained the services of a purchaser representative to assist
in
evaluating the merits and risks associated with investing in the Units, the
Investor must deliver along with the Transaction Documents a purchaser
representative certificate in substantially the form attached hereto as
Appendix
B.
4. Securities
Purchase Agreement; Registration Rights Agreement; Power of
Attorney.
The
Investor agrees to be bound by the terms of the Securities Purchase Agreement
and Registration Rights Agreement among the Company and the purchasers of the
Units being offered pursuant to the Offering. The Investor hereby irrevocably
constitutes and appoints Xxxxxxx Xxxxxx Xxxxxx Inc., a Texas corporation
(“SMH”), as the Investor’s lawful agent and attorney-in-fact with full power of
substitution and full power and authority in the Investor’s name, place, and
stead to execute and deliver the Securities Purchase Agreement and Registration
Rights Agreement and to take such actions as may be necessary or appropriate
to
carry out the terms of the Securities Purchase Agreement and Registration Rights
Agreement. The power of attorney hereby granted will be deemed coupled with
an
interest, will be irrevocable, and will survive and not be affected by the
Investor’s subsequent death, incapacity, dissolution, insolvency, or termination
or any delivery by the Investor of an assignment in whole or in part of the
Investor’s shares of Common Stock. The foregoing power of attorney may be
exercised by SMH by signing jointly as attorney-in-fact for the Investor and
for
other subscribers for the Units in the Offering acting as attorney-in-fact
for
all of them. The Company may rely and act upon any writing believed in good
faith to be signed by SMH or any authorized representative of SMH, and may
assume that all actions of SMH and any authorized representative of SMH have
been duly authorized by the Investor.
5. Representations
and Warranties of the Investor.
The
Investor represents, warrants and covenants to the Company that:
(a)
Authorization.
All
action on the part of the Investor and, if applicable, its officers, directors,
managers, members, shareholders and/or partners necessary for the authorization,
execution, delivery and performance of the Securities Purchase Agreement and
the
Registration Rights Agreement, and the consummation of the transactions
contemplated herein and therein, has been taken. When executed and delivered,
each of the Transaction Documents will constitute the legal, valid and binding
obligation of the Investor, enforceable against the Investor in accordance
with
its terms, except as such may be limited by bankruptcy, insolvency,
reorganization or other laws affecting creditors’ rights generally and by
general equitable principles. The Investor has all requisite corporate or
limited partnership, as the case may be, power and authority to enter into
each
of the Transaction Documents, and to carry out and perform its obligations
under
the terms of hereof and thereof.
3
(b) Purchase
Entirely for Own Account.
The
Investor certifies and represents to the Company that the Securities to be
received by the Investor hereunder will be acquired for the Investor’s own
account, not as nominee or agent, and not with a view to the resale or
distribution of any part thereof in violation of the Securities Act, and the
Investor has no present intention of selling, granting any participation in
or
otherwise distributing the same, in violation of the Securities Act. The
Investor is not a registered broker dealer or an entity engaged in the business
of being a broker dealer. The Investor and the Company acknowledge that nothing
contained in this Section 4.2 shall be construed as a restriction or other
limitation on the Investor’s ability to sell or hedge the Securities purchased
hereunder at any time following the Closing Date other than for restrictions
or
limitations imposed by the Securities Act or applicable state securities laws.
(c) Reliance
on Exemptions.
The
Investor understands that the Securities are being offered and sold to it in
reliance upon specific exemptions from the registration requirements of federal
and state securities laws and that the Company is relying upon the truth and
accuracy of, and the Investor’s compliance with, the representations,
warranties, agreements, acknowledgements and understandings of the Investor
set
forth in this Agreement in order to determine the availability of such exemption
and the eligibility of the Investor to acquire the Securities.
(d) Investor
Status; Etc.
The
Investor certifies and represents to the Company that it is an “accredited
investor” as defined in Rule 501 of Regulation D promulgated under the
Securities Act and was not organized for the purpose of acquiring any of the
Shares. The Investor’s financial condition is such that it is able to bear the
risk of holding the Shares for an indefinite period of time and the risk of
loss
of its entire investment. The Investor has sufficient knowledge, sophistication
and experience in business and financial matters so as to be able to evaluate
the risks and merits of its investment in the Securities, and has so evaluated
the merits and risks of such investment.
(e) Independent
Investment Decision.
The
Investor has independently evaluated the merits of its decision to purchase
Securities pursuant to this Agreement, such decision has been independently
made
by the Investor and the Investor confirms that it has only relied on the advice
of its own business and/or legal counsel and not on the advice of any other
Investor’s business and/or legal counsel in making such decision.
(f) Disclosure
of Information.
The
Investor acknowledges that it has reviewed all disclosure materials provided
by
the Company in connection with this Agreement and has been afforded (a) the
opportunity to ask such questions as it has deemed necessary of, and to receive
answers from, representatives of the Company concerning the terms and conditions
of the offering of the Securities and the merits and risks of investing therein;
(b) access to publicly available information about the Company and the
Subsidiaries and their respective financial conditions, results of operations,
businesses, properties, management and prospects sufficient to enable it to
evaluate its investment; (c) the opportunity to obtain such additional public
information that the Company possesses or can acquire without unreasonable
effort or expense that is necessary to make an informed investment decision
with
respect to the investment. Neither such inquiries nor any other investigation
conducted by or on behalf of the Investor or its representatives or counsel
shall modify, amend or affect the Investor’s right to rely on the truth,
accuracy and completeness of the Company’s disclosures and the Company’s
representations and warranties contained herein.
4
(g) Securities
Not Registered.
The
Investor understands that the Securities have not been registered under the
Securities Act, by reason of their issuance by the Company in a transaction
exempt from the registration requirements of the Securities Act, and that the
Securities must continue to be held by the Investor unless a subsequent
disposition thereof is registered under the Securities Act or is exempt from
such registration. The Investor understands that the exemptions from
registration afforded by Rule 144 (the provisions of which are known to it)
promulgated under the Securities Act depend on the satisfaction of various
conditions, and that, if applicable, Rule 144 may afford the basis for sales
only in limited amounts.
(h) Acknowledgement
of Risk.
The
Investor acknowledges and understands that its investment in the Securities
involves a significant degree of risk and in the event of a disposition of
the
Securities, the Investor could sustain the loss of its entire investment.
(i) No
Conflict.
The
execution and delivery of the Transaction Documents by the Investor, and the
consummation of the transactions contemplated hereby and thereby, will not
conflict with or result in any violation of or default by the Investor (with
or
without notice or lapse of time, or both) under, or give rise to a right of
termination, cancellation or acceleration of any obligation or to a loss of
a
material benefit under (i) any provision of the organizational documents of
the
Investor or (ii) any agreement or instrument, permit, franchise, license,
judgment, order, statute, law, ordinance, rule or regulations, applicable to
the
Investor.
(j) Brokers.
The
Investor has not retained, utilized or been represented by any broker or finder
in connection with the transactions contemplated by this Agreement.
(k) Consents.
All
consents, approvals, orders and authorizations required on the part of the
Investor in connection with the execution, delivery or performance of this
Agreement and the consummation of the transactions contemplated herein by the
Investor have been obtained and are effective as of the date hereof.
(l) Short
Sale.
The
Investor represents that after the date that the Investor learned of the terms
of this transaction and prior to the date hereof, neither it nor any Person
over
which the Investor has direct control, have made any net short sales of, or
granted any option for the purchase of or entered into any hedging or similar
transaction with the same economic effect as a net short sale, in the Common
Stock.
(m) Employee
Benefit Plans.
If the
Investor is an employee benefit plan within the meaning of the Employee
Retirement Income Security Act of 1974, as amended (“ERISA”): (i) the
Investor and its plan fiduciaries are not affiliated with, and are independent
of the Company, and are informed of and understand the Company’s investment
objectives, policies, and strategies; (ii) the Investor represents that the
purchase of the Units will not involve any transaction that is subject to the
prohibition of Section 406 of ERISA or in connection with which a penalty could
be imposed under Section 502(i) of ERISA or a tax could be imposed pursuant
to
Section 4975 of the Internal Revenue Code of 1986, as amended (the “Code”);
(iii) the trustee or other plan fiduciary directing the investment, in
making the proposed investment, is aware of and has taken into consideration
the
diversification requirements of Section 404(a)(1)(C) of ERISA and has concluded
that the proposed investment in the Units is prudent and is consistent with
the
other applicable fiduciary responsibilities under ERISA; (iv) this
Agreement has been duly executed on the Investor’s behalf by a duly designated
Named Fiduciary (within the meaning of Section 402(a)(2) of ERISA); and
(v) if the Investor is an individual retirement account or employee benefit
plan not subject to Title I of ERISA, such as a governmental or church plan,
the
owner of the individual retirement account or other fiduciary directing the
investment of the plan has concluded that the proposed investment in the Units
is prudent and consistent with its fiduciary responsibilities, if
any.
5
6. Independent
Nature of Investor’s Obligations and Rights.
The
obligations of the Investor under this Agreement, the Securities Purchase
Agreement, the Registration Rights Agreement and the Investor Questionnaire
(collectively, the “Transaction Documents”) are several and not joint with the
obligations of any other purchaser of Units in the Offering, and the Investor
shall not be responsible in any way for the performance of the obligations
of
any other purchaser of Units in the Offering under any Transaction Document.
The
decision of the Investor to purchase the Investor’s Units pursuant to the
Transaction Documents has been made by the Investor independently of any other
purchaser of Units in the Offering. Nothing contained herein or in any
Transaction Document, and no action taken by any purchaser of Units pursuant
thereto, shall be deemed to constitute such purchasers as a partnership, an
association, a joint venture, or any other kind of entity, or create a
presumption that the purchasers of Units are in any way acting in concert or
as
a group with respect to such obligations or the transactions contemplated by
the
Transaction Documents. The Investor acknowledges that no other purchaser of
Units has acted as agent for the Investor in connection with making its
investment hereunder and that no other purchaser of Units will be acting as
agent of the Investor in connection with monitoring its investment in the Units
or enforcing its rights under the Transaction Documents. The Investor shall
be
entitled to independently protect and enforce its rights, including without
limitation the rights arising out of this Agreement or out of the other
Transaction Documents, and it shall not be necessary for any other purchaser
of
Units to be joined as an additional party in any proceeding for such
purpose.
7. Prospectus
Delivery Requirement.
The
Investor hereby covenants with the Company not to make any sale of the
Investor’s Units or the shares of Common Stock underlying the Investor’s Units
or the Investor Warrants or the shares of Common Stock underlying the Investor
Warrants without complying with the provisions hereof and of the Registration
Rights Agreement, and without effectively causing the prospectus delivery
requirement under the Securities Act to be satisfied (unless the Investor is
selling in a transaction not subject to the prospectus delivery requirement).
8. Stockholder
Approval.
The
Company represents and warrants to the Investor that a vote of the stockholders
of the Company will not be required to approve the issuance of the Investor’s
Units.
9. Non-Public
Information.
Subsequent to the Closing, the Company covenants and agrees that neither it
nor
any other person acting on its behalf will provide the Investor or its agents
or
counsel with any information that the Company believes constitutes material
non-public information, unless prior thereto the Investor shall have executed
a
written agreement regarding the confidentiality and use of such information.
The
Company understands and confirms that the Investor shall be relying on the
foregoing representations in effecting transactions in securities of the
Company.
10. Further
Assurances.
The
parties to this Agreement will, upon reasonable request, execute and deliver
all
such further assignments, endorsements and other documents as may be necessary
in order to perfect the purchase by the Investor of the Investor’s
Units.
6
11. Entire
Agreement; No Oral Modification.
This
Agreement and the other Transaction Documents contain the entire agreement
among
the parties hereto with respect to the subject matter hereof and supersede
all
prior agreements and understandings with respect thereto and this Agreement
may
not be amended or modified except in a writing signed by both of the parties
hereto.
12. Binding
Effect; Benefits.
This
Agreement shall inure to the benefit of and be binding upon the parties hereto
and their respective heirs, successors and assigns; however, nothing in this
Agreement, expressed or implied, is intended to confer on any other person
other
than the parties hereto, or their respective heirs, successors or assigns,
any
rights, remedies, obligations or liabilities under or by reason of this
Agreement.
13. Counterparts.
This
Agreement may be executed in any number of counterparts, for each of which
shall
be deemed to be an original and all of which together shall be deemed to be
one
and the same instrument. In the event that any signature is delivered by
facsimile transmission, such signature shall create a valid and binding
obligation of the party executing (or on whose behalf such signature is
executed) with the same force and effect as if such facsimile signature page
were an original thereof.
14. Governing
Law.
This
Agreement shall be governed by, and construed and enforced in accordance with,
the laws of the United States of America and the State of New York, both
substantive and remedial, without regard to New York conflicts of law
principles. Any
judicial proceeding brought against either of the parties to this agreement
or
any dispute arising out of this Agreement or any matter related hereto shall
be
brought in the courts of the State of New York, New York County, or in the
United States District Court for the Southern District of New York and, by
its
execution and delivery of this agreement, each party to this Agreement accepts
the jurisdiction of such courts.
15. Prevailing
Parties.
In any
action or proceeding brought to enforce any provision of this Agreement, or
where any provision hereof is validly asserted as a defense, the prevailing
party shall be entitled to receive and the non-prevailing party shall pay upon
demand reasonable attorneys’ fees in addition to any other remedy.
16. Notices.
All
communication hereunder shall be in writing and shall be mailed, delivered,
telegraphed or sent by facsimile or electronic mail, and such delivery shall
be
confirmed to the addresses as provided below:
if
to the
Company:
Foothills
Resources, Inc.
0000
Xxxxxxxxxx Xxxxxx, Xxxxx 000
Xxxxxxxxxxx,
Xxxxxxxxxx 00000
Attention:
W. Xxxx Xxxxxx, Chief Financial Officer
Facsimile:
(000) 000-0000
xxxxxxx@xxxxxxxxx-xxxxxxxxx.xxx
with
copy
to:
McGuireWoods
LLP
00
Xxxx
Xxxxxx Xxxxx, Xxxxx 0000
Xxxxxxx,
Xxxxxxxx 00000
Attention:
Xxxxxx Xxxxxxxxx
Facsimile:
(000) 000-0000
xxxxxxxxxx@xxxxxxxxxxxx.xxx
7
with
further copy to:
Xxxxxxx
Xxxxxx Xxxxxx Inc.
000
Xxxxxxx Xxx., 0xx
Xxxxx
Xxx
Xxxx,
XX
Attention:
Xxxx Xxxx
Facsimile:
(000) 000-0000
Xxxx.xxxx@xxxxxxxx.xxx
if
to the
Investor:
to
the
address set forth on the signature page of this Agreement
17. Headings.
The
section headings herein are included for convenience only and are not to be
deemed a part of this Agreement.
[SIGNATURE
PAGES FOLLOW]
8
IN
WITNESS WHEREOF, the parties hereto have executed this Subscription Agreement
as
of the date first written above.
COMPANY
|
|
Foothills
Resources, Inc.
|
|
By:
__________________________
|
|
Name:
Xxxxxx X. Tower
|
|
Its:
Chief Executive Officer
|
[SIGNATURE
PAGE OF INVESTOR FOLLOWS]
9
IN
WITNESS WHEREOF, the parties hereto have executed this Subscription Agreement
as
of the date first written above.
INVESTOR
(individual)
|
INVESTOR
(entity)
|
______________________________________
|
____________________________________
|
Signature
|
Name
of Entity
|
______________________________________
|
____________________________________
|
Print
Name
|
Signature
|
Address
of Principal Residence:
|
|
_____________________________________
|
Print
Name: __________________________
|
_____________________________________
|
|
_____________________________________
|
Title:
________________________________
|
Social
Security Number:
|
Address
of Executive Offices:
|
_____________________________________
|
|
|
_____________________________________
|
Telephone
Number:
|
_____________________________________
|
_____________________________________
|
_____________________________________
|
Facsimile
Number:
|
IRS
Tax Identification Number:
|
_____________________________________
|
__________________________________
|
Telephone
Number:
|
|
__________________________________
|
|
Facsimile
Number:
|
|
____________________________________
|
|
|
X
|
$2.25
|
=
|
$ |
|
|||
Number
of Units
|
Price
per Unit
|
Purchase
Price
|
10
REMITTANCE
INSTRUCTIONS
For
Investor: ___________________________________________
Please Print Name of Investor
Amount
of
Investment: $______________
Please
check one of the options below to indicate your method of payment, sign and
date
the form, and return it to Xxxxxxx Xxxxxx Xxxxxx, with remittance if
appropriate. Your
remittance must be received no later than August 8,
2006,
unless the date for payment is extended.
_____
|
I
have an account with Xxxxxxx Xxxxxx Xxxxxx and wish to pay the amount
of
my investment from such account:
|
To
Xxxxxxx Xxxxxx Xxxxxx Inc.: Please accept this letter as your authorization
to
pay $_________ to “Signature Bank as escrow agent for SMH/Foothills Res” from my
account number __________.
_____
|
Attached
is my check payable to “Signature Bank as escrow agent for SMH/Foothills
Res” in the amount of my
investment.
|
_____
|
I
will wire the amount of my investment on (date not later than August
8,
2006), using the following wiring
instructions:
|
Bank:
|
Signature
Bank
|
|
000
Xxxxx Xxxxxx
|
||
Xxx
Xxxx, XX 00000
|
||
ABA
#:
|
000000000
|
|
Account
Name:
|
Signature
Bank as escrow agent for SMH/Foothills Res
|
|
Account:
|
1500654534
|
|
SWIFT#:
|
XXXXXX00
|
|
Ref:
|
Signature
Bank as escrow agent for SMH/Foothills Res
|
|
FBO:
|
____________________________________
|
|
(Investor
Name)
|
Signed:
___________________________________________________________ Dated:
____________
Please return this form to Xxxxxxx Xxxxxx Xxxxxx with your executed subscription
documents.
11
APPENDIX
A
Investor
Questionnaire
(See
Attached)
CONFIDENTIAL
INVESTOR
QUESTIONNAIRE
Foothills
Resources, Inc.
Foothills
Resources, Inc.
0000
Xxxxxxxxxx Xxxxxx, Xxxxx 000
Xxxxxxxxxxx,
Xxxxxxxxxx 00000
Attention:
W. Xxxx Xxxxxx, Chief Financial Officer
The
information contained herein is being furnished to Foothills Resources, Inc.
(the “Company”) to determine whether the undersigned’s subscription to purchase
units (the “Units”) consisting of shares of the Company’s common stock, $0.001
par value per share (the “Common Stock”) and warrants to acquire Common Stock
(together with the Units referred to as the “Securities”) may be accepted by the
Company in compliance with the requirements of Sections 3(b), 4(2) and 4(6)
of
the Securities Act of 1933, as amended (the “Securities Act”), and Regulation D
promulgated thereunder (“Regulation D”). The undersigned acknowledges and
understands that (i) the Company will rely on the information provided by the
undersigned contained herein for purposes of determining compliance with and
the
availability of exemptions, provided under Regulation D, from the registration
requirements of the Securities Act and (ii) the issuance of the Securities
will
not be registered under the Securities Act in reliance upon such
exemptions.
All
information provided by the undersigned is furnished for the sole use of the
Company for the purposes described above and will be held in confidence by
the
Company, except that this Investor Questionnaire and/or the information may
be
furnished to such other parties as the Company, or their counsel or other
authorized representatives, deem necessary or desirable to establish compliance
with federal or state securities laws. For further information, or if you have
questions concerning the Company or the sale of Securities, please contact:
Xxxxx X. Xxxxx, McGuireWoods, LLP, (000) 000-0000.
In
accordance with the foregoing, the undersigned makes the following
representations and warranties:
PART
ONE
INVESTMENT
EXPERIENCE AND PURPOSE
TO
BE COMPLETED BY EVERY PROSPECTIVE INVESTOR
1.
|
Investment
Experience.
This item is presented in alternative form. Please initial, in the
space
provided below, the alternative that applies to
you.
|
_____ |
ALTERNATIVE
ONE:
The undersigned has such knowledge and experience in financial
and
business matters so as to be capable of evaluating the relative
merits and
risks of an investment in the Securities; the undersigned is not
using an
Investor Representative (as defined below) in connection with such
evaluation. The undersigned offers as evidence of knowledge and
experience
in these matters the information requested in this Investor
Questionnaire.
|
_____ |
ALTERNATIVE TWO*:
The undersigned will use an investor representative (“Investor
Representative”) acceptable to the Company in connection with evaluating a
potential investment in the Securities. The undersigned acknowledges
that
the following person will be acting as Investor Representative
in
connection with evaluating the merits and risks of an investment
in the
Securities.
Name
of Investor Representative:
__________________________________
The
undersigned represents and warrants that the
above-named Investor Representative has furnished the undersigned
with an
investor representative questionnaire and that the undersigned
and the
above-named Investor Representative together have such knowledge
and
experience in financial and business matters that they are capable
of
evaluating the merits and risks of an investment in the
Securities.
|
(*IF
YOU
HAVE INITIALED ALTERNATIVE TWO, THE INVESTOR QUESTIONNAIRE MUST BE ACCOMPANIED
BY A COMPLETED AND SIGNED INVESTOR REPRESENTATIVE QUESTIONNAIRE.)
2.
|
Purpose
of Investment.
Except as indicated below, any purchase of the Securities will be
solely
for the account of the undersigned, and not for the account of any
other
person or with a view to any resale, division or distribution thereof.
|
EXCEPTIONS
(If
exceptions provide details and attach additional pages if necessary)
PART
TWO
GENERAL
INFORMATION
TO
BE COMPLETED BY EVERY PROSPECTIVE INVESTOR
1.
|
Name:
|
||||
(exact
name as it should appear in the records of the
Company
and any registration statement in which you are a named “selling
stockholder”)
|
|||||
2.
|
Address
of record:
|
||||
3.
|
Telephone
number:
|
|
FAX:
|
4.
|
Social
Security or Taxpayer ID number:
|
2
5.
|
Describe
any preexisting business or personal relationship between the prospective
investor and any director or officer of the Company:
|
PART
THREE
INDIVIDUAL
INVESTOR
TO
BE COMPLETED ONLY BY PROSPECTIVE INVESTORS WHO ARE
INDIVIDUALS
1. |
Select
the representation provided below that applies:
|
___
|
(a)
|
My
individual net worth, or joint net worth with my spouse, exceeds
$1,000,000.
|
|
___
|
(b)
|
My
individual income (without my spouse) was in excess of $200,000 in
each of
the two most recent years or joint income with my spouse was in excess
of
$300,000 in each of those years, and I reasonably expect an income
reaching the same income level in the current year. For purposes
of this
Investor Questionnaire, individual income means adjusted gross income,
as
reported for federal income tax purposes, less any income attributable
to
a spouse or to property owned by a spouse, increased by the following
amounts (but not including any amounts attributable to a spouse or
to
property owned by a spouse): (i) the amount of any tax exempt interest
income received, (ii) the amount of losses claimed as a limited partner
in
a limited partnership, (iii) any deduction claimed for depletion,
(iv)
deductions for alimony paid, (v) amounts contributed to an XXX or
Xxxxx
retirement plan, and (vi) any amount by which income from long-term
capital gains has been reduced in arriving at adjusted gross income
pursuant to the provisions of Section 1202 of the Internal Revenue
Code.
|
2.
|
Educational
background of prospective investor:
|
3.
|
Professional
licenses or registrations, including bar admissions, accounting
certification, real estate brokerage licenses, and SEC or state
broker-dealer registrations:
|
4.
|
Employment,
during the past five years (and the inclusive dates of
each):
|
Employment/
Occupation:
|
||
Nature
of Responsibility:
|
||
From
- To:
|
3
Employment/
Occupation:
|
||
Nature
of Responsibility:
|
||
From
- To:
|
Employment/
Occupation:
|
||
Nature
of Responsibility:
|
||
From
- To:
|
Employment/
Occupation:
|
||
Nature
of Responsibility:
|
||
From
- To:
|
5.
|
The
prospective investor has previously purchased securities sold in
reliance
on the exemption from registration under the Securities Act provided
by
Regulation D:
|
Yes
|
No
|
6.
|
Investor’s
investment objectives:
|
Income
|
Other,
please state:
|
|||||
Appreciation
|
7.
|
Prior
investments made by prospective investor which evidence prospective
investors investing experience in transactions similar to this offering:
|
Nature
of Investment:
|
||
Amount
Invested:
|
Nature
of Investment:
|
||
Amount
Invested:
|
Nature
of Investment:
|
||
Amount
Invested:
|
4
PART
FOUR
CORPORATE
INVESTOR
TO
BE COMPLETED BY PROSPECTIVE INVESTORS
WHO
ARE CORPORATIONS (AND OTHER ENTITIES)
1. Type
of organization (partnership, corporation, etc.):
|
||
2. Date
and State of organization:
|
||
3. Select
the representation provided below that applies:
|
(a)
|
(___)
a bank as defined in Section 3(a)(2) of the Securities Act, or any
savings
and loan association or other institution as defined in Section 3(a)(5)(A)
of the Securities Act acting in either an individual or fiduciary
capacity;
|
(___)
a
broker or dealer registered pursuant to Section 15 of the Securities and
Exchange Act of 1934;
(___)
a
Small Business Investment Company licensed by the U. S. Small Business
Administration under Section 301(c) or (d) of the Small Business Investment
Act
of 1958;
(___)
an
investment company registered under the Investment Company Act of 1940 or a
business development company as defined in Section 2(a)(48) of that Act;
or
(___)
an
insurance company as defined in Section 2(13) of the Securities
Act;
(b)
|
(___)
a private business development company as defined in Section 202(a)(22)
of
the Investment Advisers Act of
1940;
|
(c)
|
(___)
a corporation, partnership, limited liability company, Massachusetts
or
similar business trust, or an organization described in Section 501(c)(3)
of the Internal Revenue Code, not formed for the specific purpose
of
acquiring the securities offered with total assets in excess of
$5,000,000;
|
(d)
|
(___)
any trust, with total assets in excess of $5,000,000, not formed
for the
specific purpose of acquiring the securities offered, whose purchase
is
directed by a "sophisticated person" as such term is described in
Rule
506(b)(2)(ii) of Regulation D;
|
(e)
|
(___)
an employee benefit plan within the meaning of the Employee Retirement
Income Security Act of 1974 with investment decisions made by a plan
fiduciary, as defined in Section 3(21) of such act, which is a bank,
an
insurance company, a savings and loan association, or a registered
investment advisor;
|
(___)
an
employee benefit plan with total assets in excess of $5,000,000; or
(___)
an
employee benefit plan that is a self-directed plan (such as a self-directed
individual retirement account, Xxxxx or SEP plan) with investment decisions
made
solely by persons that are “accredited investors”
as such
term is defined in Rule 501(a) of Regulation D;
or
(f)
|
(___)
an entity in which all of the equity owners are “accredited investors” as
such term is defined in Rule 501(a) of Regulation D. Note: prospective
investor must submit an individual Investor Questionnaire for each
equity
owner.
|
5
List
all equity owners of the entity:
|
|||
4.
|
Attach
a copy of the following documents of the prospective investor’s: (a)
Articles of Incorporation, Certificate of Incorporation, or other
applicable formation document and (b) consent or resolutions of the
prospective investor’s Board of Directors, or other applicable document,
authorizing the investment by the organization in the Securities
and
providing the signatory hereto authority to execute on behalf of
the
prospective investor.
|
PART
FIVE
REPRESENTATIONS
AND WARRANTIES
TO
BE COMPLETED BY EVERY PROSPECTIVE INVESTOR
1.
|
The
undersigned understands and acknowledges that the Company will be
relying
on the accuracy and completeness of the information provided by the
prospective investor in this Investor Questionnaire and the undersigned
represents and warrants to the Company as
follows:
|
(a)
|
The
information is complete and correct and may be relied upon by the
Company
in determining whether the offer and sale of Securities in this offering
in which the undersigned proposes to participate is exempt from the
registration requirements of the Securities
Act;
|
(b)
|
The
undersigned will notify the Company immediately of any material change
in
any information provided by the prospective investor in this Investor
Questionnaire occurring prior to the completion of the Offering;
and
|
(c)
|
The
undersigned has adequate means of providing for the undersigned’s current
needs and personal contingencies, has no need for liquidity in its
investment in the Securities, and is able to bear the economic risk
of an
investment the undersigned in the Securities of the size contemplated
by
the prospective investor. In making this statement, the undersigned
represents that at the present time has sufficient means to provide
for
its needs in the event of a complete loss of such
investment.
|
PART
SIX
REGISTRATION
STATEMENT INFORMATION
TO
BE COMPLETED BY EVERY PROSPECTIVE INVESTOR
1.
|
Are
you, or is your organization, a broker-dealer registered under Section
15
of the Securities Exchange Act of
1934?
|
_______________
YES
|
_______________
NO
|
6
2. |
Are
you, or is your organization, an affiliate of a
broker-dealer?
|
_______________
YES
|
_______________
NO
|
If
the
answer is yes, please explain the nature of any such relationship:
3.
|
Have
you had any position, office or other material relationship, or has
your
organization has any material relationship, within the past three
years
with the Company or its affiliates?
|
_______________
YES
|
_______________
NO
|
If
the
answer is yes, please explain the nature of any such relationship:
4.
|
Please
describe all other securities of the Company that you beneficially
own or
that your organization beneficially
owns.
|
5.
|
Have
you made or are you aware of any arrangements relating to the distribution
of the shares of the Company’s Common Stock under any registration
statement?
|
_______________
YES
|
_______________
NO
|
If
the
answer is yes, please describe the nature and amount of such arrangements:
7
IN
WITNESS WHEREOF, the undersigned prospective investor has executed this Investor
Questionnaire this ___ day of __________, 2006.
INDIVIDUALS:
|
ENTITIES:
|
|
Print
Name
|
Print
Name of Entity
|
|
Signature
|
Print
Name of Authorized Signatory
|
|
Signature
of Authorized Signatory
|
||
Signature
(if Joint Tenants or
Tenants in Common)
|
Capacity
in which Authorized Signatory has Signed on Behalf of
Entity
|
8
APPENDIX
B
Purchaser
Representative Questionnaire
(See
Attached)
FOOTHILLS
RESOURCES, INC.
PURCHASER
REPRESENTATIVE QUESTIONNAIRE
Foothills
Resources, Inc.
0000
Xxxxxxxxxx Xxxxxx, Xxxxx 000
Xxxxxxxxxxx,
Xxxxxxxxxx 00000
Attention:
W. Xxxx Xxxxxx, Chief Financial Officer
Facsimile:
(000) 000-0000
Re:
Purchase
of Shares of Common Stock of Foothills Resources, Inc.
Ladies
and Gentlemen:
The
following information is furnished to you so that you may determine whether
the
undersigned client ______________________________________, (the “Purchaser”),
together with the undersigned and other purchaser representatives, if any,
has
such knowledge and experience in financial and business matters that he is
capable of evaluating the merits and risks of an investment in the common stock,
par value $0.001 per share (the “Common Stock”), of Foothills Resources, Inc.
(“Foothills”) as required under Regulation D, promulgated by the Securities and
Exchange Commission (“Regulation D”). I understand that you will rely upon the
information contained herein for purposes of such determination, and that the
Common Stock will not be registered under the Securities Act of 1933, as amended
(the “Securities Act”), and the applicable securities laws of any state or
foreign jurisdiction, in reliance upon the exemption from registration provided
by Section 4(2) of the Securities Act and/or Rule 506 of Regulation
D.
All
information contained herein will be treated confidentially. However, I agree
that you may present this Questionnaire to such persons as you deem appropriate
if called upon to establish that the proposed offer and sale of the Common
Stock
is exempt from registration under the Securities Act and the applicable
securities laws of any state or foreign jurisdiction.
I
am
acting as Purchaser Representative for the Purchaser in connection with the
Purchaser's prospective investment in Foothills, and, in that connection, I
furnish you with the following representations and information:
1.
|
Name
(please
print):_______________________________________________________
|
||
2.
|
Age:_________
|
||
3.
|
Profession
(or Business and Title, if applicable):
|
||
______________________________________________________________ | |||
______________________________________________________________ | |||
4.
|
(a)
|
Business
Address:_________________________________________________
|
|
(b)
|
Telephone
Number:
________________________________________________
|
5. Details
of any training or experience in financial, business, or tax matters that
qualify me to act in the capacity of Purchaser Representative (include current
and prior employment, business or professional education, professional licenses
now held, and, if applicable, participating in evaluation of similar investments
in the past):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
6. I
have
not, during the past 10 years, (i) been convicted, indicted, or investigated
in
connection with any past or present criminal proceeding (excluding traffic
violations and other minor offenses); or (ii) been the subject of any order,
judgment, or decree of any court of competent jurisdiction permanently or
temporarily enjoining the undersigned from acting as an investment adviser,
underwriter, broker, or dealer in securities or as an affiliated person,
director, or employee of an investment company, bank, savings and loan
association or insurance company, or from engaging in or continuing any conduct
or practice in connection with any such activity or in connection with the
purchase or sale of any security, or been the subject of any order of a federal
or state authority barring or suspending for more than 60 days the undersigned's
right to be engaged in any such activity, or to be associated with persons
engaged in any such activity, which order has not been reversed or
suspended.
7. I
am not
an Affiliate (as defined in Regulation D), director, officer or other employee
of Foothills, or a beneficial owner of 10 percent or more of the equity interest
in Foothills, except as follows: (if none, so state)
______________________________________________________.
8. I
have
such knowledge and experience in financial, business, and tax matters so as
to
be capable, together with the Purchaser, of evaluating the relative merits
and
risks of an investment in Foothills.
9. There
is
no material relationship (as defined in Regulation D) between me or my
affiliates and Foothills or its affiliates which now exists or is mutually
understood to be contemplated or which has existed at any time during the
previous two years, nor has any compensation been received or will any
compensation be received as a result of any such relationship except as follows:
(if none, so state) _____________________________________________.
10. I
agree
to advise you promptly of any material changes in the foregoing information
that
may occur prior to termination of the offering relating to the purchase of
the
Common Stock of FTRS.
Very
truly yours,
|
|
|
|
(Purchaser
Representative)
|
|
|
|
Print
Name
|
Dated:_______________________,
2006