CIATTI'S, INC.
SUBSCRIPTION AGREEMENT
For Fixed Term Notes
0000 Xxxx 00xx Xxxxxx, Xxxxx, Xxxxxxxxx 00000-0000
(000) 000-0000 extension 000 (000) 000-0000 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
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Name Social Security #
Beneficiary
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Name Social Security #
B. [_] Joint Tenants
(with right of -------------------------------- --------------------
survivorship) Name Social Security #
-------------------------------- --------------------
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 March xx, 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.
