SUBSCRIPTION AGREEMENT
Exhibit 99.1
Xxxx Gold Corp.
000 Xxxxxxxx Xxxxxx, Xxxxx 0000
Xxxxxxxxx, Xxxxxxx Xxxxxxxx
Xxxxxx X0X 0X0
Dear Sirs:
Concurrent with execution of this Agreement, the undersigned (the "Purchaser") is purchasing __________________________________________________ (__________) units consisting of one share of Common Stock, one Redeemable C Warrant and shares of common stock issuable upon exercise of Redeemable C Warrants of XXXX GOLD CORP. (the "Company") at a price of $0.30 per unit (the "Subscription Price").
Purchaser hereby confirms the subscription for and purchase of said number of units and hereby agrees to pay herewith the Subscription Price for such Units.
Purchaser further confirms that Xx. Xxx Xxxxxx solicited him/her/it to purchase the units of Common Stock of the Company and no other person participated in such solicitation other than Xx. Xxxxxx.
MAKE CHECK PAYABLE TO: XXXX GOLD CORP.
Executed this ___ day of ____________, 2004.
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Signature of Purchaser |
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Address of Purchaser |
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Printed Name of Purchaser |
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PLEASE ENSURE FUNDS ARE IN US DOLLARS
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X $0.30 |
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US$ |
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Number of Units Purchased |
Total Subscription Price |
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Form of Payment: |
Cash:___________ |
Check #: _____________ |
Other: _________________ |
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XXXX GOLD CORP. |
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By: |
__________________________ |
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Title: |
__________________________ |
