SUBSCRIPTION AGREEMENT – SUBORDINATED NOTES
AT&S HOLDINGS, INC.
SUBSCRIPTION AGREEMENT – SUBORDINATED NOTES
INVESTOR: Please indicate your investment order below. Fill in all terms and amounts. |
Enclosed is my check for the purchase of Subordinated Note(s). ($1,000 minimum per note) |
I have indicated below the amount I wish to invest for each term selected: |
Term | Amount $ | ||
Please check one of the following interest payment options: | Term | Amount $ | |
Monthly [ ] quarterly[ ] semi-annually[ ] annually[ ] at maturity[ ] | Term | Amount $ | |
Term | Amount $ | ||
Interest rates are established at the date of purchase and set forth in the current Prospectus and are fixed until maturity. | Total of all Note(s) | Amount $ | |
INVESTOR: Please print all information below to complete your order. |
REGISTRATION INFORMATION |
Registered owner: | SSN/EIN: | |
Telephone number (include area code): | Date of Birth: |
Street address: | |||
Street address: | |||
City: State: | Zip | ||
Second joint owner (if applicable): | SSN: | |
Beneficiary name: | SSN: |
Custodian’s name (only one allowed by law): |
Minor’s name (under Uniform Gifts to Minors Act): | Minor’s SSN: |
SIGNATURE VERIFICATION |
Under penalties of perjury, I certify that: |
1. The social security number shown on this form is correct. |
2. I have received the prospectus and read it and understand that AT&S Holdings, Inc. notes are not bank savings or deposit accounts and are not insured by the US Government or any instrumentality thereof. |
3. I am not subject to backup withholding either because I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a failure to report all interest and dividends, or the IRS has notified me that I am no longer subject to backup withholding. Only cross out subpart (3) if you are subject to backup withholding. |
4. I am a bona fide resident of Missouri, Kansas or Illinois. |
Signature of Registered Owner: |
Joint Signature (if applicable): |
PAYMENT INSTRUCTIONS: |
Make your checks payable to : |
AT&S HOLDINGS, INC. |
0000 Xxxxxxxxxx Xxxxxxxxxx | |
Xxxxxx Xxxx, Xxxxxxxx 00000 |
This application is neither an offer to sell nor an offer to buy Subordinated Notes. Such an offer can only be made by Prospectus. |