The Flower Valet
SUBSCRIPTION AGREEMENT
1. INVESTMENT:
(a) The undersigned subscribes for shares of Common Stock of The
Flower Valet at $0.10 per share.
(b) Total subscription price ($0.10 times number of shares): = $
____________________.
2. INVESTOR INFORMATION:
____________________ _______________ _______________________
Name (type or print) Social Sec. No. Address
____________________ _______________ _______________________
Name (type or print) Social Sec. No. Address
Mailing Address: _____________________________________________________________
Street City State Zip
Business Phone ( ) Home Phone ( )
3. TYPE OF OWNERSHIP: (You must check one box)
1.[ ] Individual 6.[ ] Joint Tenants with rights of Survivorship
2.[ ] Tenants in Common 7.[ ] Custodian for _________________
3.[ ] Community Property 8. [ ] Uniform Gifts to Minors Act of the
State of _____________
4.[ ] Partnership 9.[ ] Corporation ______________________________
5.[ ] Trust 10.[ ] Other (explain) _________________________
4. RECEIPT OF DISCLOSURE DOCUMENT:
By executing this subscription agreement the undersigned acknowledges
receipt of a current Prospectus, as supplemented to the date of this
Subscription Agreement, in which the terms and conditions of the offering of
Common Stock and the risks associated therewith are described.
5. TERMINATION OF THE OFFERING:
The undersigned understands that the Company may terminate the offering
at any time and for any reason. If the offering is so terminated, and the
Company is holding subscriptions that have not been accepted by an authorized
representative of the Company, together with the un-accepted subscription
agreements, then in that event the subscriptions so held shall be returned
without any interest earned thereon.
6. REPRESENTATION AND WARRANTS:
By executing this subscription agreement, the undersigned represents and
warrants to the Company that:
(a) Subscriber is buying the Common Stock for Subscriber's own account or is
buying for the account or benefit of a member or members of Subscriber's
immediate family or in a fiduciary capacity for the account of another
person or entity and is not purchasing as an agent for another.
Furthermore, if Subscriber is purchasing for the account of another
person or entity, Subscriber has full authority to execute this
Subscription Agreement in such capacity and on behalf of such person or
entity.
(b) Subscriber is 18 years of age or over (You must check box) [ ] Yes
[ ] No
(c) Subscriber has received, read, and understands the Prospectus dated:
_________________, 2002.
(d) Subscriber can afford the entire loss of the purchase price hereto
should there be such a loss.
7. ACCEPTANCE OF SUBSCRIPTION:
The undersigned hereby confirms Subscriber's understanding that the
Company has the full right to accept or reject this subscription, providing
that the Company must accept or reject the subscription by
__________________, 2002. In case of rejection of a subscription,
contributions of such persons will promptly be returned to such persons
without interest thereon.
Please make a copy of your completed Subscription Agreement
Signatures:
Executed this______day of____________2002 at_____________________,_________
City State
X X
Signature (investor or Signature (investor or
authorized signature) authorized signature)
MAKE CHECK PAYABLE TO: THE FLOWER VALET IMPOUND ACCOUNT
SEND SUBSCRIPTION AGREEMENT AND CHECK TO: THE FLOWER VALET
0000 X. Xxxxxxxx Xxxx, Xxxxx X-X0
Xxx Xxxxx, XX 00000
Accepted for the Company this day of , 2002
By________________________________ Title________________________________
