SUBSCRIPTION AGREEMENT
for
ERGOVISION, INC.
Ergovision, Inc.
Xxx Xxxxxxxxx Xxxxx
Xxxxxxxxx, Xxx Xxxx 00000
Attn: Xxxx X. Xxxxx
President & CEO
Gentlemen:
The undersigned hereby subscribes to purchase ________* shares of Common
Stock, $.001 par value (the "Shares"), of Ergovision, Inc. (the "Company") for a
cash purchase price of $1.00 per Share. The undersigned herewith tenders to the
Company a check or money order made payable to the order of "Ergovision, Inc."
in the amount of $______________________, the total purchase price for all of
the Shares subscribed for. The undersigned represents and warrants that the
undersigned is a bona fide resident of the State of the undersigned's residence
address indicated on the reverse side. This Subscription Agreement is made on
the following terms and conditions:
1. Acceptance and Delivery of Stock Certificate. The undersigned
acknowledges that acceptance of the subscription made hereby is in the Company's
discretion. Promptly following the Company's acceptance of such subscription,
the Company is to return to the undersigned a copy of this Subscription
Agreement (as accepted by the Company) as a receipt. A physical stock
certificate representing Shares purchased is to be transmitted to the registered
holder at the address indicated on the reverse side within thirty (30) days of
the Company's receipt of this Subscription Agreement. The offering is being made
on a "best efforts" basis. Except for the 1,000 Share minimum that must be
purchased by any one investor, there is no minimum number of Shares to be sold
in the Offering. There is no provision for the escrow or refund of any monies if
less than all or a stated number of Shares are sold. As a result, the Company
may immediately utilize funds received from sales of Shares to subscribers from
whom the Company accepts subscriptions.
2. Information about the Company. The undersigned acknowledges that: (a)
prior to signing this Subscription Agreement, the undersigned received and
reviewed the Company's Offering Circular dated April 15, 1997; (b) if the
undersigned has requested the opportunity, the undersigned or a representative
of the undersigned has had a reasonable opportunity to ask questions and receive
answers from the officers of the Company and to obtain any additional
information desired, and all such questions have been answered to the
undersigned's satisfaction; and (c) if requested by the undersigned, all
documents, records and books of the Company pertaining to this investment have
been made available for inspection by the undersigned or a representative of the
undersigned during reasonable business hours at the Company's business offices.
3. High Degree of Risk. The undersigned has reviewed the risk factors
described in the Offering Circular and acknowledges that an investment in the
Shares is a speculative investment and involves a high degree of risk, and that
the Company makes no assurances whatever concerning the present or prospective
value of the Shares. The undersigned understands that the price per share of the
Shares has been arbitrarily determined by the Company and bears no relationship
to its assets, earnings, book value or other accepted criteria of value.
4. Pennsylvania Residents. If a Pennsylvania resident, the undersigned
agrees not to sell any of the Shares within a period of twelve months after the
date of the Company's acceptance of this subscription.
Please register the Shares subscribed for as follows:
Name:_______________________________________ Date:__________________
As (check one):
|_| Individual |_| Tenants-in-Common |_| Existing Partnership
|_| Joint Tenants |_| Corporation |_| Trust
|_| Minor with adult custodian under the Uniform Gift to Minors Act
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Signature of Subscriber Signature of Co-Subscriber
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Name of Subscriber (Printed) Name of Co-Subscriber (Printed)
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Subscriber Tax I.D. or Co-Subscriber Tax I.D. or
Social Security Number Social Security Number
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Residence Address
--------------------------------------
City or Town
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State Zip Code
( )
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Telephone, including area code
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ACCEPTED BY ERGOVISION, INC.
By:________________________________ Date_________________________________
NOTE: Please sign your name or names exactly as you wish the Shares to be
registered. For Shares which are to be owned jointly or as tenants-in-common,
each owner should sign. If signing for a trust, partnership or corporation,
please indicate the name of such entity and the capacity in which you are
acting. If executed by a trust, a majority of the trustees; if executed by a
partnership, a general partner or by a corporation, a duly authorized officer
should sign this Subscription Agreement.
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