QI Systems Inc. Subscription Agreement PP2007-04
PP2007-04
Private
Placement Offering
SUBSCRIPTIONS
WILL BE ACCEPTED ONLY FROM “ACCREDITED INVESTORS” AS DEFINED IN RULE 501 OF
REGULATION D UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “SECURITIES ACT”)
The
undersigned agrees to purchase Units of QI Systems, Inc. (“QI SYSTEMS”) at a
purchase price of $0.07 per Unit in the Private Placement Offering dated
February 26, 2007. Each Unit consists of one share of common stock with a $0.001
par value ("Shares") and one warrant to purchase an additional share of common
stock at the additional purchase price of $0.20 per share which is exercisable
one hundred eighty (180) days after the close of the offering. Such warrant
to
purchase an additional share of common stock shall expire two (2) years from
the
closing of the Offering. If the Subscription stated below is accepted by QI
SYSTEMS, the undersigned hereby executes and agrees to all the terms of offering
and that the undersigned is an “Accredited Investor” as defined in Rule 501 of
Regulation D under the Securities Act.
PLEASE,
MAKE ALL CHECKS PAYABLE TO
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Purchaser:
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Subscription
$:
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#
of shares:
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||||||
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(Signature
/ Title, if applicable)
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Tax
Year Ends:
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Date:
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,
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Tax
I.D.# or SS#:
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| Mailing Address: | Residence Address: | |||||
| Telephone Number: | Telephone Number: |
THIS
IS A SPECULATIVE INVESTMENT SUITABLE ONLY FOR THOSE ACCREDITED INVESTORS CAPABLE
OF SUSTAINING A TOTAL LOSS.
Accepted
this ________ day of _______________________, _____________
QI
Systems, Inc.
BY:
_______________________________________
THE
SHARES SUBSCRIBED FOR HEREBY HAVE NOT BEEN REGISTERED WITH THE SECURITIES AND
EXCHANGE COMMISSION OR ANY STATE SECURITIES COMMISSION AND MAY NOT BE SOLD
OR
TRANSFERRED IN THE ABSENCE OF AN EFFECTIVE REGISTRATION STATEMENT UNDER THE
SECURITIES ACT OF 1933 AND ANY APPLICABLE STATE SECURITIES LAWS OR AN OPINION
OF
COUNSEL ACCEPTABLE TO THE COMPANY THAT SUCH REGISTRATION IS NOT
REQUIRED.
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