SUBSCRIPTION AGREEMENT
SUBSCRIPTION
AGREEMENT (this “Agreement”) made as of the last date set forth on the signature
page hereof between Protech Global Holdings Corp., a Delaware corporation (the
“Company”), and the undersigned (the “Subscriber”).
WITNESSETH:
WHEREAS,
the Company is conducting a private offering (the “Offering”) consisting of up
to 4,000,000 shares (the “Shares”) of common stock, $.0001 par value per share
(“Common Stock”), pursuant to Section 4(2) of the Securities Act of 1933, as
amended (the “Securities Act”) and Rule 506 promulgated thereunder;
and
WHEREAS,
the Subscriber desires to purchase that number of Shares set forth on the
signature page hereof on the terms and conditions hereinafter set
forth.
NOW,
THEREFORE, in consideration of the premises and the mutual representations and
covenants hereinafter set forth, the parties hereto do hereby agree as
follows:
I.
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SUBSCRIPTION FOR
SHARES AND REPRESENTATIONS BY
SUBSCRIBER
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1.1 Subject
to the terms and conditions hereinafter set forth and in the Confidential
Private Placement Memorandum dated November ___, 2008 (such memorandum, together
with all amendments thereof and supplements and exhibits thereto, the
“Memorandum”), the Subscriber hereby irrevocably subscribes for and agrees to
purchase from the Company such number of Shares, and the Company agrees to sell
to the Subscriber as is set forth on the signature page hereof, at a per share
price equal to $0.50 per Share. The purchase price is payable by wire
transfer of immediately available funds to:
Wire
instructions:
[INTENTIONALLY
OMITTED]
1.2 The
Subscriber recognizes that the purchase of the Shares involves a high degree of
risk including, but not limited to, the following: (a) the Company remains a
development stage business with limited operating history and requires
substantial funds in addition to the proceeds of the Offering; (b) an investment
in the Company is highly speculative, and only investors who can afford the loss
of their entire investment should consider investing in the Company and the
Shares; (c) the Subscriber may not be able to liquidate its investment; (d)
transferability of the Shares is extremely limited; (e) in the event of a
disposition, the Subscriber could sustain the loss of its entire investment; (f)
the Company has not paid any dividends since its inception and does not
anticipate paying any dividends in the foreseeable future; and (g) the Company
may issue additional securities in the future which have rights and preferences
that are senior to those of the Common Stock. Without limiting the
generality of the representations set forth in Section 1.5 below, the Subscriber
represents that the Subscriber has carefully reviewed the section of the
Memorandum captioned “Risk Factors.”
1.3 The
Subscriber represents that the Subscriber is an “accredited investor” as such
term is defined in Rule 501 of Regulation D (“Regulation D”) promulgated under
the Securities Act, as indicated by the Subscriber’s responses to the questions
contained in Article VII hereof, and that the Subscriber is able to bear the
economic risk of an investment in the Shares.
1.4 The
Subscriber hereby acknowledges and represents that (a) the Subscriber has
knowledge and experience in business and financial matters, prior investment
experience, including investment in securities that are non-listed, unregistered
and/or not traded on a national securities exchange nor on NASDAQ, or the
Subscriber has employed the services of a “purchaser representative” (as defined
in Rule 501 of Regulation D), attorney and/or accountant to read all of the
documents furnished or made available by the Company both to the Subscriber and
to all other prospective investors in the Shares to evaluate the merits and
risks of such an investment on the Subscriber’s behalf; (b) the Subscriber
recognizes the highly speculative nature of this investment; and (c) the
Subscriber is able to bear the economic risk that the Subscriber hereby
assumes.
1.5 The
Subscriber hereby acknowledges receipt and careful review of this Agreement, the
Memorandum (which includes the Risk Factors), including all exhibits thereto,
and any documents which may have been made available upon request as reflected
therein (collectively referred to as the “Offering Materials”) and hereby
represents that the Subscriber has been furnished by the Company during the
course of the Offering with all information regarding the Company, the terms and
conditions of the Offering and any additional information that the Subscriber
has requested or desired to know, and has been afforded the opportunity to ask
questions of and receive answers from duly authorized officers or other
representatives of the Company concerning the Company and the terms and
conditions of the Offering.
1.6 (a) In
making the decision to invest in the Shares the Subscriber has relied solely
upon the information provided by the Company in the Offering
Materials. To the extent necessary, the Subscriber has retained, at
its own expense, and relied upon appropriate professional advice regarding the
investment, tax and legal merits and consequences of this Agreement and the
purchase of the Shares hereunder. The Subscriber disclaims reliance
on any statements made or information provided by any person or entity in the
course of Subscriber’s consideration of an investment in the Shares other than
the Offering Materials.
(b) The
Subscriber represents that (i) the Subscriber was contacted regarding the sale
of the Shares by the Company (or an authorized agent or representative thereof)
with whom the Subscriber had a prior substantial pre-existing relationship and
(ii) no Shares were offered or sold to it by means of any form of general
solicitation or general advertising, and in connection therewith, the Subscriber
did not (A) receive or review any advertisement, article, notice or other
communication published in a newspaper or magazine or similar media or broadcast
over television or radio, whether closed circuit, or generally available; or (B)
attend any seminar meeting or industry investor conference whose attendees were
invited by any general solicitation or general advertising.
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1.7 The
Subscriber hereby represents that the Subscriber, either by reason of the
Subscriber’s business or financial experience or the business or financial
experience of the Subscriber’s professional advisors (who are unaffiliated with
and not compensated by the Company or any affiliate or selling agent of the
Company, directly or indirectly), has the capacity to protect the Subscriber’s
own interests in connection with the transaction contemplated
hereby.
1.8 The
Subscriber hereby acknowledges that the Offering has not been reviewed by the
United States Securities and Exchange Commission (the “SEC”) nor any state
regulatory authority since the Offering is intended to be exempt from the
registration requirements of Section 5 of the Securities Act, pursuant to
Regulation D. The Subscriber understands that the Shares have not
been registered under the Securities Act or under any state securities or “blue
sky” laws and agrees not to sell, pledge, assign or otherwise transfer or
dispose of the Shares unless they are registered under the Securities Act and
under any applicable state securities or “blue sky” laws or unless an exemption
from such registration is available.
1.9 The
Subscriber understands that the Shares have not been registered under the
Securities Act by reason of a claimed exemption under the provisions of the
Securities Act that depends, in part, upon the Subscriber’s investment
intention. In this connection, the Subscriber hereby represents that
the Subscriber is purchasing the Shares for the Subscriber’s own account for
investment and not with a view toward the resale or distribution to
others. The Subscriber, if an entity, further represents that it was
not formed for the purpose of purchasing the Shares.
1.10 The
Subscriber understands that the Common Stock is not currently traded or quoted
on any market and that there is no market for the Common Stock. The
Subscriber understands that even if a public market develops for the Common
Stock, Rule 144 (“Rule 144”) promulgated under the Securities Act requires for
non-affiliates, among other conditions, a six months holding period prior to the
resale (in limited amounts) of securities acquired in a non-public offering
without having to satisfy the registration requirements under the Securities
Act. The Subscriber understands and hereby acknowledges that the
Company is under no obligation to register any of the Shares under the
Securities Act or any state securities or “blue sky” laws.
1.11 The
Subscriber consents to the placement of a legend on any certificate or other
document evidencing the Shares that such Shares have not been registered under
the Securities Act or any state securities or “blue sky” laws and setting forth
or referring to the restrictions on transferability and sale thereof contained
in this Agreement. The Subscriber is aware that the Company will make
a notation in its appropriate records with respect to the restrictions on the
transferability of such Shares. The legend to be placed on each certificate
shall be in form substantially similar to the following:
“The
securities represented by this certificate have not been registered under the
Securities Act of 1933, as amended and may not be sold, transferred, pledged,
hypothecated or otherwise disposed of in the absence of (i) an effective
registration statement for such securities under said act or (ii) an opinion of
company counsel that such registration is not required.”
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1.12 The
Subscriber understands that the Company will review this Agreement and is hereby
given authority by the Subscriber to call Subscriber’s bank or place of
employment or otherwise review the financial standing of the Subscriber; and it
is further agreed that the Company, at its sole discretion, reserves the
unrestricted right, without further documentation or agreement on the part of
the Subscriber, to reject or limit any subscription, to accept subscriptions for
fractional Shares and to close the Offering to the Subscriber at any time and
that the Company will issue stop transfer instructions to its transfer agent
with respect to such Shares.
1.13 The
Subscriber hereby represents that the address of the Subscriber furnished by
Subscriber on the signature page hereof is the Subscriber’s principal residence
if Subscriber is an individual or its principal business address if it is a
corporation or other entity.
1.14 The
Subscriber represents that the Subscriber has full power and authority
(corporate, statutory and otherwise) to execute and deliver this Agreement and
to purchase the Shares. This Agreement constitutes the legal, valid
and binding obligation of the Subscriber, enforceable against the Subscriber in
accordance with its terms.
1.15 If
the Subscriber is a corporation, partnership, limited liability company, trust,
employee benefit plan, individual retirement account, Xxxxx Plan, or other
tax-exempt entity, it is authorized and qualified to invest in the Company and
the person signing this Agreement on behalf of such entity has been duly
authorized by such entity to do so.
1.16 The
Subscriber acknowledges that if he or she is a Registered Representative of an
FINRA member firm, he or she must give such firm the notice required by the
FINRA’s Rules of Fair Practice, receipt of which must be acknowledged by such
firm in Section 7.4 below.
1.17 The
Subscriber acknowledges that at such time, if ever, as the Shares are registered
(as such term is defined in Article V hereof), sales of the Shares will be
subject to state securities laws.
1.18 (a) The
Subscriber agrees not to issue any public statement with respect to the
Subscriber’s investment or proposed investment in the Company or the terms of
any agreement or covenant between them and the Company without the Company’s
prior written consent, except such disclosures as may be required under
applicable law or under any applicable order, rule or regulation.
(b) The
Company agrees not to disclose the names, addresses or any other information
about the Subscribers, except as required by law; provided, that the Company may
use the name of the Subscriber for any offering or in any registration statement
filed pursuant to Article V in which the Subscriber’s shares are
included.
1.19 The
Subscriber agrees to hold the Company and its directors, officers, employees,
affiliates, controlling persons and agents and their respective heirs,
representatives, successors and assigns harmless and to indemnify them against
all liabilities, costs and expenses incurred by them as a result of (a) any sale
or distribution of the Shares by the Subscriber in violation of the Securities
Act or any applicable state securities or “blue sky” laws; or (b) any false
representation or warranty or any breach or failure by the Subscriber to comply
with any covenant made by the Subscriber in this Agreement (including the
Confidential Investor Questionnaire contained in Article VII herein) or any
other document furnished by the Subscriber to any of the foregoing in connection
with this transaction.
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II.
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REPRESENTATIONS BY AND
COVENANTS OF THE COMPANY
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The
Company hereby represents and warrants to the Subscriber that:
2.1 Organization, Good Standing
and Qualification. The Company is a corporation duly
organized, validly existing and in good standing under the laws of the State of
California and has full corporate power and authority to conduct its
business.
2.2 Capitalization and Voting
Rights. The authorized, issued and outstanding capital stock
of the Company is as set forth in the Confidential Private Placement
Memorandum and all
issued and outstanding shares of the Company are validly issued, fully paid and
nonassessable. Except as set forth in the Offering Materials, there are no
outstanding options, warrants, agreements, convertible securities, preemptive
rights or other rights to subscribe for or to purchase any shares of capital
stock of the Company. Except as set forth in the Offering Materials
and as otherwise required by law, there are no restrictions upon the voting or
transfer of any of the shares of capital stock of the Company pursuant to the
Company’s Articles of Incorporation (the “Articles of Incorporation”), Bylaws or
other governing documents or any agreement or other instruments to which the
Company is a party or by which the Company is bound.
2.3 Authorization;
Enforceability. The Company has all corporate right, power and
authority to enter into this Agreement and to consummate the transactions
contemplated hereby. All corporate action on the part of the Company,
its directors and stockholders necessary for the (a) authorization execution,
delivery and performance of this Agreement by the Company; and (b)
authorization, sale, issuance and delivery of the Shares contemplated hereby and
the performance of the Company’s obligations hereunder has been
taken. This Agreement has been duly executed and delivered by the
Company and constitutes a legal, valid and binding obligation of the Company,
enforceable against the Company in accordance with its terms, subject to laws of
general application relating to bankruptcy, insolvency and the relief of debtors
and rules of law governing specific performance, injunctive relief or other
equitable remedies, and to limitations of public policy. The Shares,
when issued and fully paid for in accordance with the terms of this Agreement,
will be validly issued, fully paid and nonassessable. The issuance
and sale of the Shares contemplated hereby will not give rise to any preemptive
rights or rights of first refusal on behalf of any person which have not been
waived in connection with this offering.
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2.4 No Conflict; Governmental
Consents.
(a) The
execution and delivery by the Company of this Agreement and the consummation of
the transactions contemplated hereby will not result in the violation of any
material law, statute, rule, regulation, order, writ, injunction, judgment or
decree of any court or governmental authority to or by which the Company is
bound, or of any provision of the Articles of Incorporation or Bylaws of the
Company, and will not conflict with, or result in a material breach or violation
of, any of the terms or provisions of, or constitute (with due notice or lapse
of time or both) a default under, any lease, loan agreement, mortgage, security
agreement, trust indenture or other agreement or instrument to which the Company
is a party or by which it is bound or to which any of its properties or assets
is subject, nor result in the creation or imposition of any lien upon any of the
properties or assets of the Company.
(b) No
consent, approval, authorization or other order of any governmental authority is
required to be obtained by the Company in connection with the authorization,
execution and delivery of this Agreement or with the authorization, issue and
sale of the Shares, except such filings as may be required to be made with the
SEC, FINRA, NASDAQ and with any state or foreign blue sky or securities
regulatory authority.
2.5 Licenses. Except
as otherwise set forth in the Memorandum, the Company has sufficient licenses,
permits and other governmental authorizations currently required for the conduct
of its business or ownership of properties and is in all material respects in
compliance therewith.
2.6 Litigation. The
Company knows of no pending or threatened legal or governmental proceedings
against the Company which could materially adversely affect the business,
property, financial condition or operations of the Company or which materially
and adversely questions the validity of this Agreement or any agreements related
to the transactions contemplated hereby or the right of the Company to enter
into any of such agreements, or to consummate the transactions contemplated
hereby or thereby. The Company is not a party or subject to the provisions of
any order, writ, injunction, judgment or decree of any court or government
agency or instrumentality which could materially adversely affect the business,
property, financial condition or operations of the Company. There is no action,
suit, proceeding or investigation by the Company currently pending in any court
or before any arbitrator or that the Company intends to initiate.
2.7 Disclosure. The
information set forth in the Offering Materials as of the date hereof contains
no untrue statement of a material fact nor omits to state a material fact
necessary in order to make the statements contained therein, in light of the
circumstances under which they were made, not misleading.
2.8 Investment
Company. The Company is not an “investment company” within the
meaning of such term under the Investment Company Act of 1940, as amended, and
the rules and regulations of the SEC thereunder.
2.9 Brokers. Neither
the Company nor any of the Company's officers, directors, employees or
stockholders has employed or engaged any broker or finder in connection with the
transactions contemplated by this Agreement and no fee or other compensation is
or will be due and owing to any broker, finder, underwriter, placement agent or
similar person in connection with the transactions contemplated by this
Agreement. The Company is not party to any agreement, arrangement or
understanding whereby any person has an exclusive right to raise funds and/or
place or purchase any debt or equity securities for or on behalf of the
Company.
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III.
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TERMS OF
SUBSCRIPTION
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3.1 All
funds paid hereunder shall be deposited with the Company in the account
identified in Section 1.1 hereof.
3.2 Certificates
representing the Common Stock purchased by the Subscriber pursuant to this
Agreement will be prepared for delivery to the Subscriber within 15 business
days following the closing at which such purchase takes place. The Subscriber
hereby authorizes and directs the Company to deliver the certificates
representing the Common Stock purchased by the Subscriber pursuant to this
Agreement directly to the Subscriber’s residential or business address indicated
on the signature page hereto.
IV.
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CONDITIONS TO
OBLIGATIONS OF THE
SUBSCRIBERS
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4.1 The
Subscriber’s obligation to purchase the Shares at the closing at which such
purchase is to be consummated is subject to the fulfillment on or prior to such
closing of the following conditions, which conditions may be waived at the
option of each Subscriber to the extent permitted by law:
(a) Covenants. All
covenants, agreements and conditions contained in this Agreement to be performed
by the Company on or prior to the date of such closing shall have been performed
or complied with in all material respects.
(b) No Legal Order
Pending. There shall not then be in effect any legal or other
order enjoining or restraining the transactions contemplated by this
Agreement.
(c) No Law Prohibiting or
Restricting Such Sale. There shall not be in effect any law,
rule or regulation prohibiting or restricting such sale or requiring any consent
or approval of any person, which shall not have been obtained, to issue the
Shares (except as otherwise provided in this Agreement).
V.
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MISCELLANEOUS
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5.1 Any
notice or other communication given hereunder shall be deemed sufficient if in
writing and sent by registered or certified mail, return receipt requested, or
delivered by hand against written receipt therefor, addressed as
follows:
if to the
Company, to it at:
0000 XX
000xx Xxxxxx,
Xxxxx 000
Xxxxx
Xxxxx Xxxxx, Xxxxxxx 00000
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With a
copy to (which shall not constitute notice):
Sichenzia
Xxxx Xxxxxxxx Xxxxxxx LLP
00
Xxxxxxxx, 00xx
Xxxxx
Xxx Xxxx,
XX 00000
Attn: Xxxxxx
Xxxxxxx, Esq.
if to the
Subscriber, to the Subscriber’s address indicated on the signature page of this
Agreement.
Notices
shall be deemed to have been given or delivered on the date of mailing, except
notices of change of address, which shall be deemed to have been given or
delivered when received.
5.2 Except
as otherwise provided herein, this Agreement shall not be changed, modified or
amended except by a writing signed by the parties to be charged, and this
Agreement may not be discharged except by performance in accordance with its
terms or by a writing signed by the party to be charged.
5.3 Subject
to the provisions of Section 5.11, this Agreement shall be binding upon and
inure to the benefit of the parties hereto and to their respective heirs, legal
representatives, successors and assigns. This Agreement sets forth
the entire agreement and understanding between the parties as to the subject
matter hereof and merges and supersedes all prior discussions, agreements and
understandings of any and every nature among them.
5.4 Upon
the execution and delivery of this Agreement by the Subscriber, this Agreement
shall become a binding obligation of the Subscriber with respect to the purchase
of Shares as herein provided, subject, however, to the right hereby reserved by
the Company to enter into the same agreements with other subscribers and to add
and/or delete other persons as subscribers.
5.5 NOTWITHSTANDING
THE PLACE WHERE THIS AGREEMENT MAY BE EXECUTED BY ANY OF THE PARTIES HERETO, THE
PARTIES EXPRESSLY AGREE THAT ALL THE TERMS AND PROVISIONS HEREOF SHALL BE
CONSTRUED IN ACCORDANCE WITH AND GOVERNED BY THE LAWS OF THE STATE OF CALIFORNIA
WITHOUT REGARD TO SUCH STATE’S PRINCIPLES OF CONFLICTS OF LAW. IN THE
EVENT THAT A JUDICIAL PROCEEDING IS NECESSARY, THE SOLE FORUM FOR RESOLVING
DISPUTES ARISING OUT OF OR RELATING TO THIS AGREEMENT IS THE COURTS STATE OF
CALIFORNIA IN AND FOR THE COUNTY OF LOS ANGELES OR THE FEDERAL COURTS FOR SUCH
STATE AND COUNTY, AND ALL RELATED APPELLATE COURTS, THE PARTIES HEREBY
IRREVOCABLY CONSENT TO THE JURISDICTION OF SUCH COURTS AND AGREE TO SAID
VENUE.
5.6 In
order to discourage frivolous claims the parties agree that unless a claimant in
any proceeding arising out of this Agreement succeeds in establishing his claim
and recovering a judgment against another party (regardless of whether such
claimant succeeds against one of the other parties to the action), then the
other party shall be entitled to recover from such claimant all of its/their
reasonable legal costs and expenses relating to such proceeding and/or incurred
in preparation therefor.
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5.7 The
holding of any provision of this Agreement to be invalid or unenforceable by a
court of competent jurisdiction shall not affect any other provision of this
Agreement, which shall remain in full force and effect. If any
provision of this Agreement shall be declared by a court of competent
jurisdiction to be invalid, illegal or incapable of being enforced in whole or
in part, such provision shall be interpreted so as to remain enforceable to the
maximum extent permissible consistent with applicable law and the remaining
conditions and provisions or portions thereof shall nevertheless remain in full
force and effect and enforceable to the extent they are valid, legal and
enforceable, and no provisions shall be deemed dependent upon any other covenant
or provision unless so expressed herein.
5.8 It
is agreed that a waiver by either party of a breach of any provision of this
Agreement shall not operate, or be construed, as a waiver of any subsequent
breach by that same party.
5.9 The
parties agree to execute and deliver all such further documents, agreements and
instruments and take such other and further action as may be necessary or
appropriate to carry out the purposes and intent of this Agreement.
5.10 This
Agreement may be executed in two or more counterparts each of which shall be
deemed an original, but all of which shall together constitute one and the same
instrument.
5.11 Nothing
in this Agreement shall create or be deemed to create any rights in any person
or entity not a party to this Agreement, except for the holders of Registrable
Securities.
[REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK]
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VI.
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CONFIDENTIAL INVESTOR
QUESTIONNAIRE
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6.1 The
Subscriber represents and warrants that he, she or it comes within one category
marked below, and that for any category marked, he, she or it has truthfully set
forth, where applicable, the factual basis or reason the Subscriber comes within
that category. ALL INFORMATION IN RESPONSE TO THIS SECTION WILL BE
KEPT STRICTLY CONFIDENTIAL. The undersigned agrees to furnish any
additional information which the Company deems necessary in order to verify the
answers set forth below.
Category
A ___
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The
undersigned is an individual (not a partnership, corporation, etc.) whose
individual net worth, or joint net worth with his or her spouse, presently
exceeds $1,000,000.
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Explanation. In
calculating net worth you may include equity in personal property and real
estate, including your principal residence, cash, short-term investments,
stock and securities. Equity in personal property and real
estate should be based on the fair market value of such property less debt
secured by such property.
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Category
B ___
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The
undersigned is an individual (not a partnership, corporation, etc.) who
had an income in excess of $200,000 in each of the two most recent years,
or joint income with his or her spouse in excess of $300,000 in each of
those years (in each case including foreign income, tax exempt income and
full amount of capital gains and losses but excluding any income of other
family members and any unrealized capital appreciation) and has a
reasonable expectation of reaching the same income level in the current
year.
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Category
C ___
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The
undersigned is a director or executive officer of the Company which is
issuing and selling the Shares.
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Category
D ___
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The
undersigned is a bank; a savings and loan association; insurance company;
registered investment company; registered business development company;
licensed small business investment company (“SBIC”); or employee benefit
plan within the meaning of Title 1 of ERISA and (a) the investment
decision is made by a plan fiduciary which is either a bank, savings and
loan association, insurance company or registered investment advisor, or
(b) the plan has total assets in excess of $5,000,000 or (c) is a self
directed plan with investment decisions made solely by persons that are
accredited investors. (describe entity)
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Category
E ___
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The
undersigned is a private business development company as defined in
section 202(a)(22) of the Investment Advisors Act of 1940. (describe
entity)
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Category
F ___
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The
undersigned is either a corporation, partnership, Massachusetts business
trust, or non-profit organization within the meaning of Section 501(c)(3)
of the Internal Revenue Code, in each case not formed for the specific
purpose of acquiring the Shares and with total assets in excess of
$5,000,000. (describe entity)
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Category
G ___
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The
undersigned is a trust with total assets in excess of $5,000,000, not
formed for the specific purpose of acquiring the Shares, where the
purchase is directed by a “sophisticated investor” as defined in
Regulation 506(b)(2)(ii) under the Act.
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Category
H ___
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The
undersigned is an entity (other than a trust) in which all of the equity
owners are “accredited investors” within one or more of the above
categories. If relying upon this Category alone, each equity
owner must complete a separate copy of this
Agreement. (describe entity)
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Category
I ___
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The
undersigned is not within any of the categories above and is therefore not
an accredited investor.
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The
undersigned agrees that the undersigned will notify the Company at any
time on or prior to the closing in the event that the representations and
warranties in this Agreement shall cease to be true, accurate and
complete.
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6.2 SUITABILITY (please
answer each question)
(a)
For an
individual Subscriber, please describe your current employment, including the
company by which you are employed and its principal business:
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(b)
For an
individual Subscriber, please describe any college or graduate degrees held by
you:
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(c)
For all
Subscribers, please list types of prior investments:
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(d) For
all Subscribers, please state whether you have participated in other private placements
before:
YES_______
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NO_______
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(e) If
your answer to question (d) above was “YES”, please indicate frequency of such
prior participation in private placements
of:
Public
Companies
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Private
Companies
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Public
or Private Companies
with
no, or insignificant,
assets and
operations
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Frequently
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Occasionally
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Never
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(f) For
individual Subscribers, do you expect your current level of income to
significantly decrease in the foreseeable future:
YES_______
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NO_______
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(g) For
trust, corporate, partnership and other institutional Subscribers, do you expect
your total assets to significantly decrease in the foreseeable
future:
YES_______
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NO_______
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(h) For
all Subscribers, do you have any other investments or contingent liabilities
which you reasonably anticipate could cause you to need sudden cash requirements
in excess of cash readily available to you:
YES_______
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NO_______
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(i) For
all Subscribers, are you familiar with the risk aspects and the non-liquidity of
investments such as the securities for which you seek to subscribe?
YES_______
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NO_______
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(j)
For all Subscribers, do you understand that there is no guarantee of financial
return on this investment and that you run the risk of losing your entire
investment?
YES_______
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NO_______
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6.3 MANNER IN WHICH TITLE IS TO
BE HELD. (circle one)
(a)
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Individual
Ownership
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(b)
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Community
Property
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(c)
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Joint
Tenant with Right of
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Survivorship
(both parties
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must
sign)
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(d)
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Partnership*
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(e)
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Tenants
in Common
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(f)
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Company*
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(g)
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Trust*
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(h)
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Other*
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*If
Securities are being subscribed for by an entity, the attached Certificate of
Signatory must also be completed.
6.4 FINRA
AFFILIATION.
Are you
affiliated or associated with an FINRA member firm (please check
one):
Yes_______
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No_______
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If Yes,
please describe:
*If
Subscriber is a Registered Representative with an FINRA member firm, have the
following acknowledgment signed by the appropriate party:
The
undersigned FINRA member firm acknowledges receipt of the notice required by
Article 3, Sections 28(a) and (b) of the Rules of Fair Practice.
_________________________________
Name of
FINRA Member Firm
By:
______________________________
Authorized Officer
Date:
____________________________
6.5 The
undersigned is informed of the significance to the Company of the foregoing
representations and answers contained in the Confidential Investor Questionnaire
contained in this Article VII and such answers have been provided under the
assumption that the Company will rely on them.
[REMAINDER
OF PAGE INTENTIONALLY LEFT BLANK]
13
NUMBER
OF SHARES _________ X $0.50 = $_________ (the “Purchase Price”)
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Signature
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Signature
(if purchasing jointly)
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Name
Typed or Printed
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Name
Typed or Printed
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Title
(if Subscriber is an Entity)
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Title
(if Subscriber is an Entity)
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Entity
Name (if applicable)
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Entity
Name (if applicable
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Xxxxxxx
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Xxxxxxx
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Xxxx,
Xxxxx xxx Xxx Xxxx
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Xxxx,
Xxxxx and Zip Code
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Telephone-Business
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Telephone-Business
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Telephone-Residence
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Telephone-Residence
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Facsimile-Business
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Facsimile-Business
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Facsimile-Residence
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Facsimile-Residence
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Tax
ID # or Social Security #
|
Tax
ID # or Social Security #
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Name
in which securities should be issued:
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Dated: __________________,
2006
This
Subscription Agreement is agreed to and accepted as of ________________,
2008.
By:
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||
Name:
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Xxxxxx
Xxxxx Xxxxx
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||
Title:
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President
and Chief Executive
Officer
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14
CERTIFICATE
OF SIGNATORY
(To be
completed if Shares are
being
subscribed for by an entity)
I,
____________________________, am the ____________________________ of
__________________________________________ (the “Entity”).
I certify
that I am empowered and duly authorized by the Entity to execute and carry out
the terms of the Subscription Agreement and to purchase and hold the Shares, and
certify further that the Subscription Agreement has been duly and validly
executed on behalf of the Entity and constitutes a legal and binding obligation
of the Entity.
IN
WITNESS WHEREOF, I have set my hand this ________ day of _________________,
2008
_______________________________________
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||
(Signature)
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15