Exhibit 4.4
ZANETT, INC.
RENEWABLE UNSECURED SUBORDINATED NOTE SUBSCRIPTION AGREEMENT
To purchase a renewable unsecured subordinated note(s), please complete this
form and write a check made payable to ZANETT, INC. Send this form along with
your check and any other documents requested below to the selling agent for the
notes, XXXXXX XXXXXXXXXX LTD., 00000 XXXXXXX XXXXXXXXX, XXXXX 000, XXXXXXXXXXX,
XX 00000. If you have any questions, call the selling agent for the notes,
XXXXXX XXXXXXXXXX LTD., at 000-000-0000.
NOTE PURCHASE AMOUNT (minimum principal amount of $1,000 per note)
INTEREST PAYMENT SCHEDULE (please select one for each note)
Note Principal ---------------------------------------------------------
Term Amount Monthly* Quarterly Semi-Annually Annually Maturity
----------------------------------------------------------------------
Three Month $_________ [ ] [ ] N/A N/A [ ]
Six Month $_________ [ ] [ ] [ ] N/A [ ]
One Year $_________ [ ] [ ] [ ] [ ] [ ]
Two Year $_________ [ ] [ ] [ ] [ ] [ ]
Three Year $_________ [ ] [ ] [ ] [ ] [ ]
Four Year $_________ [ ] [ ] [ ] [ ] [ ]
Five Year $_________ [ ] [ ] [ ] [ ] [ ]
Ten Year $_________ [ ] [ ] [ ] [ ] [ ]
TOTAL $_________ *Monthly payment date (e.g. 1st, 15th, etc.)_____________
FORM OF OWNERSHIP (please select one)
[ ] INDIVIDUAL INVESTOR (with optional beneficiary) [ ] CUSTODIAN FOR A MINOR
[ ] JOINT TENANTS WITH RIGHT OF SURVIVORSHIP [ ] OTHER XXX, SEP, 401(k), 403(b),
Xxxxx, trust, corporation,
partnership,
etc.
(Please include with this form a trust resolution
or the appropriate corporation or partnership
documents authorizing you to make this
investment.)
NOTE PURCHASER
Full Name of Individual Investor/First Joint Tenant/Minor/Entity/Administrator/Trustee
_______________________________________________________________________________________________________
First Name Middle name Last name Social Security Number/Tax ID Number Birthdate (if
applicable)
Full Name of Beneficiary/Second Joint Tenant/Custodian (if applicable)
_______________________________________________________________________________________________________
First Name Middle name Last name Social Security Number/Tax ID Number Birthdate (not required
for custodians)
Other Family Zanett Note Investors ____________________________________________________________________
PRIMARY ADDRESS (Original correspondence will be sent to this address.)
__________________________________________________________________________________________
Individual Investor, XXX Administrator, Trustee, Custodian, Partnership, etc.
__________________________________________________________________________________________
Address
__________________________________________________________________________________________
City State Zip
__________________________________________________________________________________________
Daytime Phone (Include Area Code) Evening Phone (Include Area Code)
SECONDARY ADDRESS (Optional--copies of correspondence will be sent to this
address.)
__________________________________________________________________________________________
Beneficiary, XXX Owner, Joint Tenant, Partner, etc.
__________________________________________________________________________________________
Address
__________________________________________________________________________________________
City State Zip
__________________________________________________________________________________________
Daytime Phone (Include Area Code) Evening Phone (Include Area Code)
DIRECT DEPOSIT Zanett will electronically deposit your principal and interest
payments to the account listed on your Direct Deposit Form. Please complete and
sign the reverse side of this form for automatic deposit to either your checking
or savings account.
PASSWORD When you call Xxxxxx Xxxxxxxxxx to discuss your investment, you may be
asked to verify your identification by answering the following question. What is
your mother's maiden name?_____________________________________________________
CERTIFICATION Under penalties of perjury, I hereby declare and certify that: (i)
I am a bona fide resident of the state listed in the primary mailing address;
(ii) I have received and read the prospectus (and all documents incorporated by
reference into the prospectus) provided by Zanett, Inc. and understand the risks
associated with this investment; (iii) I have determined that this investment is
suitable for me; (iv) the notes are an obligation of Zanett, Inc. only and are
not bank certificates of deposit and are not guaranteed or insured by the FDIC
or any other entity; (v) the notes are illiquid and do not trade in a secondary
market; (vi) I risk the loss of my entire principal amount and all accrued but
unpaid interest when purchasing the notes; (vii) the social security number or
tax identification number listed above is correct; and (viii) I am not subject
to backup withholding, either because the Internal Revenue Service has not
notified me that I am subject to backup withholding as a result of a failure to
report all interest or dividends or I have been notified that I am no longer
subject to backup withholding. I understand that my purchase offer is subject to
the terms contained in the prospectus, may be rejected in whole or in part and
will not become effective until accepted by Zanett, Inc. or its selling agent.
_______________________________________________________________________________________________________________
Signature of Individual Investor/First Joint Tenant/Custodian/Authorized Person Date
_______________________________________________________________________________________________________________
Signature of Second Joint Tenant (if applicable) Date
Office Use Only ACTP____ DATE____ COMM____ ADVR____ SHDB____ SALU_____
