Exhibit 1.1
SUBSCRIPTION AGREEMENT
Pacific Spirit, Inc.
SUBSCRIPTION AGREEMENT
Gentlemen:
The Investor named below, by payment of the purchase price for such Common
Shares, by the delivery of a check payable to Pacific Spirit, Inc., hereby
subscribes for the purchase of the number of Common Shares indicated below
(minimum of twenty five thousand shares) of Pacific Spirit, Inc. at a purchase
of $0.05 per Share as set forth in the Prospectus.
By such payment, the named Investor further acknowledges receipt of the
Prospectus and the Subscription Agreement, the terms of which govern the
investment in the Common Shares being subscribed for hereby.
A. INVESTMENT: (1) Number of Shares
------------
(2) Total Contribution ($0.05/Share) $
----------
Date of Investor's check
------------
B. REGISTRATION:
(3) Registered owner:
-----------------------------
Co-Owner:
-----------------------------
(4) Mailing address:
-----------------------------
City, State & zip:
-----------------------------
(5) Residence Address (if different from above):
--------------------------------------------
(6) Birth Date: ______/______/______
(7) Employee or Affiliate: Yes No
------ ------
(8) Social Security: #: ______/______/______
U.S. Citizen [ ] Other [ ]
Co-Owner Social Security:
#: ______/______/______
U.S. Citizen [ ] Other [ ]
Corporate or Custodial:
Taxpayer ID #: ______/______/______
U.S. Citizen [ ] Other [ ]
(9) Telephone (H) ( )
--------------------------
C. OWNERSHIP [ ] Individual Ownership [ ] XXX or Xxxxx
[ ] Joint Tenants with Rights of Survivorship
[ ] Trust/Date Trust Established
-------------------
[ ] Pension/Trust (S.E.P.)
[ ] Tenants in Common [ ] Tenants by the Entirety
[ ] Corporate Ownership [ ] Partnership
[ ] Other
---------------------
D. SIGNATURES: By signing below, I/we represent that I/we meet the suitability
standards set forth in the Prospectus.
Registered Owner:
-----------------------------
Co-Owner:
-----------------------------
Print Name of Custodian or Trustee:
-----------------------------
Authorized Signature:
-----------------------------
Date:
-------------------
Signature:
-----------------------------
MAIL TO:
Pacific Spirit, Inc.
00000-00 X Xxxxxx
Xxxxxxxxx, X.X.
Phone: (000) 000-0000
-----------------------------------------------
FOR OFFICE USE ONLY:
Date Received:
------------------------------------------------
Date Accepted/Rejected
----------------------------------------
Subscriber's Check Amount:
--------------------------
Check No. Date Check
------------------ ----------------
Deposited
--------------------------------
MR #
-------------
