SUBSCRIPTION AGREEMENT KOPJAGGERS, INC. SUBSCRIPTION AGREEMENT Gentlemen:
Exhibit 99.1
SUBSCRIPTION AGREEMENT KOPJAGGERS, 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 KOPJAGGERS, INC .hereby subscribes for the purchase of the number of Restricted Common Shares indicated below of KOPJEGGERS, INC.
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.
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A. | INVESTMENT: |
| (1) | Number of Shares ___________________________ |
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| (2) | Total Contribution $__________ |
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| Date of Investor’s check ___________ |
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B. | REGISTRATION: |
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| (3) | Registered owner: __________________________ |
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| Co-Owner: __________________________________ |
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| (4) | Mailing address: ___________________________ |
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| City, State & zip: _________________________ |
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| (5) | Residence Address (if different from above): |
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| ============================================ |
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| (6) | Birth Date: ______/______/______ |
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| (7) | Employee or Affiliate: Yes ______ No ______ |
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| (8) | Social Security: #: ______/______/______ |
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| U.S. Citizen o Other o |
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| Co-Owner Social Security: |
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| #: ______/______/______ |
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| U.S. Citizen o Other o |
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| Corporate or Custodial: |
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| Taxpayer ID #: ______/______/______ |
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| U.S. Citizen o Other o |
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| (9) | Telephone (H) ( ) ______________________ |
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C. | OWNERSHIP |
| o | Individual Ownership | o | XXX or Xxxxx | |
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| o | Joint Tenants with Rights of Survivorship | |||
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| o | Trust/Date Trust Established____________ | |||
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| o | Pension/Trust (S.E.P.) | |||
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| o | Tenants in Common | o | Tenants by the Entirety | |
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| o | Corporate Ownership | o | Partnership | |
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| o | Other_____________________ |
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D. | SIGNATURES |
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Registered Owner: _____________________________
Co-Owner: _____________________________
Print Name of Custodian or Trustee: _____________________________
Authorized Signature: _____________________________
Date: _____________________
Signature: ___________________________________
MAIL TO:
Kopjaggers, Inc. 00000 Xxxxx Xxxx,Xxxxxxxxx, XX 00000
Telephone: 000-000-0000
____________________________________________________________________
FOR OFFICE USE ONLY:
Date Received: ________________________________________________
Date Accepted/Rejected ________________________________________
Subscriber’s Check Amount: _______________________
Check No. ___________________ Date Check ________________
Deposited ________________________________
MR #________________