EXCEL PUBLISHING, INC. - COMMON STOCK
SUBSCRIPTION AGREEMENT
Investment
I desire to purchase shares of Excel Publishing Inc at $0.10 per
share for a total of $
Make Checks Payable to: Bonneville Bank, Excel Publishing, Inc., Escrow Account
Subscriber Information: Please clearly print name(s) in which Shares are to be
acquired. All correspondence will go to the Investor Residence Address
Investor 1 (First, Middle I., Last):
Investor 2 (First, Middle I. Last):
REGISTRATION FOR THE INVESTMENT (HOW THE INVESTMENT SHOULD BE TITLED):
INVESTOR RESIDENCE ADDRESS 1: CHECK ONE OF THE FOLLOWING:
U.S. Citizen
Investor Residence Address 2:
Resident Alien
City, State ZIP Code Foreign
Resident; Country _______
U.S. Citizen residing outside the U.S.
Enter the taxpayer identification number. For most individual taxpayers, it is
their Social Security Number. Note: If the purchase is in more than one name,
the number should be that of the first person listed. For IRAs, Keoghs, and
qualified plans, enter both the Social Security Number and the Taxpayer
Identification Number for the plan.
SOCIAL SECURITY NUMBER TAXPAYER IDENTIFICATION NUMBER (IF APPLICABLE)
Form of Ownership (Individual, XXX, Trust, UGMA, Pension Plan, etc.)
Subscriber Signature: The undersigned has the authority to enter into this
subscription agreement on behalf of the person(s) or entity registered above.
Authorized Signature of Investor 1_____________________Date:____________________
Authorized Signature of Investor 2_____________________Date:____________________
Company's Acceptance (To be completed only by an authorized representative of
the Company.)
The foregoing subscription is accepted this ____________ day of________, _____
________________________________________
Authorized Representative of the Company
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