Exhibit 4.2
CIATTI'S, INC.
SUBSCRIPTION AGREEMENT
For Fixed Term Notes
0000 Xxxx 00xx Xxxxxx, Xxxxx, Xxxxxxxxx 00000-0000
(000) 000-0000 extension 205 (800) 952-2809 extension 205
INVESTMENT INFORMATION:
Enclosed is $ _______________ for the purchase of Subordinated Note(s) as
follows (minimum investment is $1,000 per note. Please make checks payable to
Ciatti's, Inc.):
One-Year Fixed Term Note $ _______________ (desired amount of investment)
Three-Year Fixed Term Note $ _______________ (desired amount of investment)
OWNERSHIP INFORMATION: (Select ONE of A, B, C, or D)
Ownership of Notes will be registered exactly as written below.
A. / / Individual ------------------------------------- -------------------
Name Social Security #
Beneficiary ------------------------------------- -------------------
Name Social Security #
B. / / Joint Tenants ------------------------------------- -------------------
(with right of Name Social Security #
survivorship) ------------------------------------- -------------------
Name Social Security #
C. / / Uniform Transfers ------------------------------------- ------------------- -----------------
to Minors Act Minor's Name Social Security # Date of Birth
------------------------------------- -------------------
Custodian's Name (only one allowed by law) Social Security #
D. / / Corporation ------------------------------------- -------------------
Name Taxpayer I.D. #
MAILING ADDRESS (Note Certificates and interest payments will be mailed only to
the first address listed):
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Xxxxxx Xxxxxxx Xxxxxx address of Joint Tenant, if any
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City State/ZIP Day Telephone # City State/ZIP
SIGNATURE:
I certify that (i) I am a resident of the State of Minnesota, (ii) I have received and read Ciatti's, Inc.'s Prospectus dated
October 8, 1997, (iii) the number shown on this form is the correct Tax Identification Number of Social Security Number, and (iv) I
am not subject to backup withholding as a result of a failure to report all interest or dividends, or the IRS has notified me that I
am no longer subject to backup withholding. I understand that Ciatti's, Inc. may reject my offer to purchase a Note in whole or in
part, and my offer to purchase Notes will not become effective until accepted by Ciatti's, Inc.
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SIGNATURE OF OWNER, JOINT TENANT OR CUSTODIAN. DATE SIGNATURE OF JOINT TENANT, IF ANY. DATE
The offer to sell securities is made by Prospectus only.
