Exhibit 10.3
Note Number:________________
Note Purchase Agreement
The undersigned hereby agrees to purchase, at par, $ _______________ in
aggregate principal amount of the following securities (the "Securities") of The
Xxxxxxx Group, Inc. (the "Company") offered pursuant to the Prospectus dated
_________ __, 2002 (as the same may be amended, modified or supplemented, the
"Prospectus"), receipt of which is hereby acknowledged:
Security: ________________________________________
Term: __________________________________________
Interest Rate: ____________________________________
Registration Code: ________________________________
The name(s) and address in which the Securities being purchased by the
undersigned are to be registered are as follows (all persons so named must
execute this Note Purchase Agreement):
____________________________________
____________________________________ Social Security or
Employer I.D. No. ___________________
____________________________________
____________________________________ Telephone Number ____________________
Each of the undersigned hereby agrees that all Securities purchased hereby are
subject to all the terms and conditions including, without limitation,
subordination of the indebtedness evidenced thereby, as set forth in the
Prospectus, and the Indenture, dated as of February 17, 1998, between the
Company and The Bank of New York, as Trustee, as supplemented by the Board
Resolutions of the Company dated ________, 2002.
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THIS SECURITY IS NOT A SAVINGS ACCOUNT OR AN OBLIGATION OF AN INSURED DEPOSITORY
INSTITUTION AND IS NOT INSURED BY THE FEDERAL DEPOSIT INSURANCE CORPORATION
(FDIC).
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By executing this Note Purchase Agreement, I (we), under penalty of perjury,
certify that: (1) the number shown on this form is my (our) correct taxpayer
identification number (T.I.N.) and (2) I (we) am (are) not subject to backup
withholding either because (a) I (we) am (are) exempt from backup withholding,
(b) I (we) have not been notified by the Internal Revenue Service that I (we) am
(are) subject to backup withholding as a result of a failure to report all
interest or dividends, or (c) the IRS has notified me (us) that I (we) am (are)
no longer subject to backup withholding. (If you have been notified by the IRS
that you are subject to backup withholding, delete the language in (2) above.)
INTEREST ELECTION FOR 6, 12, 36 and 60 MONTH TERM NOTES (CHECK ONE)
1. MONTHLY CHECK _____ x_________________________________
2. QUARTERLY CHECK _____
3. PAID AT MATURITY _____ x_________________________________
(This Note Purchase Agreement
must be executed by all persons
whose names appear on the
Securities purchased hereby.)
Date:_____________________________
Approval by Officer of Please note that if you have
The Xxxxxxx Group, Inc. purchased a 1, 6, 12, 36 or 60
month note, it will automatically
renew as provided in the
_____________________________________ Prospectus and the note form
unless you notify us that you
desire to redeem the note.
Title________________________________
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__________________________________
Title_____________________________
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