EXHIBIT 4.4
ONYX ACCEPTANCE CORPORATION
[ONYX LOGO]
RENEWABLE UNSECURED SUBORDINATED NOTE SUBSCRIPTION AGREEMENT
To purchase a renewable unsecured subordinated note(s), please
complete this form and write a check made payable to ONYX
ACCEPTANCE CORPORATION. Send the white copy of this form along
with your check and any other documents requested below to the
selling agent for the notes, XXXXXX XXXXXXXXXX LTD., 00000
XXXXXXX XXXXXXXXX, XXXXX 000, XXXXXXXXXXX, XX 00000. Keep the
yellow copy of this form for your records. If you have any
questions, call the selling agent for the notes, XXXXXX
XXXXXXXXXX AT 000-000-0000.
NOTE PURCHASE AMOUNT
INTEREST PAYMENT SCHEDULE (please select one for each note)
Note Principal ---------------------------------------------------------------------
Term Amount Monthly* Quarterly Semi-Annually Annually Maturity
----------------------------------------------------------------------------------------------------
Three Month $___________ [ ] N/A N/A N/A [ ]
Six Month $___________ [ ] [ ] N/A N/A [ ]
One Year $___________ [ ] [ ] [ ] [ ] [ ]
Two Year $___________ [ ] [ ] [ ] [ ] [ ]
Three Year $___________ [ ] [ ] [ ] [ ] [ ]
Four Year $___________ [ ] [ ] [ ] [ ] [ ]
Five Year $___________ [ ] [ ] [ ] [ ] [ ]
Ten Year $___________ [ ] [ ] [ ] [ ] [ ]
TOTAL $___________ *Monthly payment date (e.g. 1st, 15th, etc.)_____________________
FORM OF OWNERSHIP (please select one)
[ ] INDIVIDUAL INVESTOR (with optional beneficiary) [ ] CUSTODIAN FOR A MINOR
[ ] JOINT TENANTS WITH RIGHT OF SURVIVORSHIP [ ] OTHER XXX, SEP, 401(k), 403(b),
Xxxxx, trust, corporation, partnership, etc.
(Please include with this form a trust resolution
or the appropriate corporation or partnership documents
authorizing you to make this investment.)
NOTE PURCHASER
Full Name of Individual Investor/First Joint Tenant/Minor/Entity/Administrator/Trustee
___________________________________________________________________________________________________________________________________
First Name Middle Name Last Name Social Security Number/Tax ID Number Date of Birth (if applicable)
___________________________________________________________________________________________________________________________________
Please identify your immediate family members by name
Full Name of Beneficiary/Second Joint Tenant/Custodian (if applicable)
___________________________________________________________________________________________________________________________________
First Name Middle Name Last Name Social Security Number/Tax ID Number Date of Birth (not required for custodians)
PRIMARY ADDRESS (Original correspondence will be sent to this address.)
__________________________________________________________________________________________
Individual Investor, XXX Administrator, Trustee, Custodian, Partnership, etc.
__________________________________________________________________________________________
Address
__________________________________________________________________________________________
City State Zip
__________________________________________________________________________________________
Daytime Phone (Include Area Code) Evening Phone (Include Area Code)
SECONDARY ADDRESS (Optional--copies of correspondence will be sent to this
address.)
__________________________________________________________________________________________
Beneficiary, XXX Owner, Joint Tenant, Partner, etc.
__________________________________________________________________________________________
Address
__________________________________________________________________________________________
City State Zip
__________________________________________________________________________________________
Daytime Phone (Include Area Code) Evening Phone (Include Area Code)
PAYMENT ACCOUNT INFORMATION (All interest and principal payments on the notes
will be deposited directly into this account.)
Bank name___________Routing # ___________ Account # _________ Account Owner_____
PASSWORD
When you call Xxxxxx Xxxxxxxxxx to discuss your investment, you may be asked to
verify your identification by answering the following question. What is your
mother's maiden name?___________________________________________________________
CERTIFICATION Under penalties of perjury, I hereby declare and certify that: (i)
I am a bona fide resident of the state listed in the primary mailing address;
(ii) I have received and read the prospectus provided by Onyx Acceptance
Corporation and the risks associated with this investment; (iii) the notes are
an obligation of Onyx Acceptance Corporation only; (iv) the social security
number or tax identification number listed above is correct; and (v) I am not
subject to backup withholding, either because the Internal Revenue Service has
not notified me that I am subject to backup withholding as a result of a failure
to report all interest or dividends or I have been notified that I am no longer
subject to backup withholding. I understand that my purchase offer is subject to
the terms contained in the prospectus, may be rejected in whole or in part and
will not become effective until accepted by Onyx Acceptance Corporation or its
selling agent.
________________________________________________________________________________________________
Signature of Individual Investor/First Joint Tenant/Custodian/Authorized Person Date
________________________________________________________________________________________________
Signature of Second Joint Tenant (if applicable) Date
Office Use Only ACTP____ DATE____ COMM____ ADVR____ SHDB____ SALU_____
