SUBSCRIPTION AGREEMENT
Denmark Bancshares, Inc.
000 Xxxx Xxxx Xxxxxx
P. O. Box 130 Denmark, Wisconsin 54208-0130
Attn: Xxxxxxx X. Xxxxxxx
Gentlemen:
The undersigned (the "subscriber") hereby offers to purchase and subscribes
for ____ shares of no par common stock (the "Shares") at $______ per Share of
Denmark Bancshares, Inc. (the "Company"). Upon fulfillment of the terms of this
Subscription Agreement, the undersigned agrees to become a shareholder of the
Company, with respect to the Shares.
This subscription is conditioned upon (i) the subscriber's completion,
execution and delivery to the Company of this Subscription Agreement accompanied
by the full purchase price for the Shares subscribed for herein, in the form of
a personal check, bank draft or money order, for $______ per Share subscribed
for payable to: Denmark State Bank (Denmark Bancshares Escrow Account), and (ii)
the acceptance by the Board of Directors of the Company of the subscriber's
Subscription Agreement.
The subscriber is a resident of the state of ______________________.
The subscriber acknowledges receipt of the prospectus dated August ___,
2003, with respect to the offering of Shares by the Company (the "Prospectus"),
and a copy of the Company's 2002 annual report.
The subscriber understands and acknowledges that this Subscription
Agreement (a) is irrevocable until ____________, 2003, and (b) may be accepted
or rejected, or accepted only in part, in the sole discretion of the Board of
Directors of the Company.
This Subscription Agreement has been signed in duplicate on the date set
forth below. Upon its acceptance by the Company, one copy will be given to the
subscriber, whereupon it shall become a binding agreement between the Company
and the subscriber, subject only to any conditions set forth in the Prospectus.
Date: _____________________, 2003 ________________________________________
Subscriber's Signature
________________________________________
Print Name
________________________________________
Social Security Number
________________________________________
________________________________________
Print Address for Correspondence
The Board of Directors of the Company will determine in its sole discretion
whether to accept this subscription.
DENMARK BANCHARES, INC.
Accepted ______ Rejected ______
Accepted with respect to ____ Shares By:_____________________________________
Dated: _____________________, 2003 ____________________________, (Title)
