EXHIBIT 99
Up to 5,000,000 Shares
Xxxxxx Xxxxxx Marketing, Inc.
Subscription Agreement
To________________
Please issue shares of your common stock in the amounts and
name(s) shown below. My signature acknowledges that I have read
the Prospectus dated _______________, 2002, and am aware of the
risk factors contained therein.
All proceeds will be immediately disbursed to the Company for the
uses set forth in the Use of Proceeds section of the Prospectus.
------------------------------------- -----------------
(Signature) (Date)
------------------------------------- -----------------
(Signature) (Date)
Enclosed is payment for __________ shares at $_____ per share;
Total: $___________
Make checks payable to: Xxxxxx Xxxxxx Marketing, Inc.
Register the shares in the following name(s) and amount(s):
(Please Print)
Name(s):___________________________________________________________
Number of share(s): _______________
As (check one):
[ ] Individual [ ] Joint Tenancy [ ] Husband & Wife as
community property
[ ] Tenants in Common [ ] Corporation [ ] Trust
[ ] Other:____________________________________________________
70
For the person(s) who will be registered shareowners:
Mailing Address:___________________________________________________
City, State, Zip:__________________________________________________
Telephone:_________________________________________________________
Facsimile:_________________________________________________________
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 ID Number (if applicable):________________________________
Please attach any instructions for mailing the certificates or
shareowner communications other than to the registered shareowner
at this address.
No Subscription Is Effective Until Acceptance.
Subscription Accepted by Xxxxxx Xxxxxx Marketing, Inc.
By:_____________________________
Xxx Xxxxxx, President
71
