Subscription Agreement for Placement of Avicena Group, Inc. Units
Exhibit 10.17
for Placement of Avicena Group, Inc. Units
By its execution and delivery of this subscription agreement, the undersigned Subscriber hereby joins in and agrees to purchase the aggregate number of Units set forth below:
| 102,000 | Units, each consisting on One Share of Series C Preferred Stock and one Warrant (exercisable for $0.01 to purchase One additional Share of Common Stock) at $1.00 per Unit, for an aggregate purchase price of: | $102,000 |
| /s/ Xxxxxx Xxxxxxx | August 15, 2004 | |||
| Signature | Date | |||
Xxxxxx Xxxxxxx
Investor or Investing Entity Name
| X/x Xxxxx Xxxx Xxx Xxxxxxxxx Xxx. Xxxxxxxxx, XX 00000 |
(617) 250-5161 | __________________________ | ||
| Investor’s Address | Telephone | Fax |
| Please wire your subscription to: Xxxxxxxx & Xxxxxx, Ltd. Client Escrow Account | ||||
| ACCOUNT NAME: | Xxxxxxxx & Xxxxxx Ltd. |
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| ACCOUNT NUMBER: BANK NAME: ABA ROUTING NUMBER: |
1894668 Northern Trust Bank 000000000 |
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| REMARKS: | Avicena Private Placement |
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| Note: | Call Xxxx Xxxxxx at (000) 000-0000 |
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Please indicate the name of the investor or investing entity on the wire transfer so that we may more easily identify the transferor. Funds should be wired in US Dollars. In addition, please note that the wire transfer fees may be taken out of the funds that are wired and that sufficient funds should be wired to cover these fees. This form should be telefaxed to the following with the original to follow by mail.
| Xx. Xxxx Xxxxxx Fax: 000-000-0000
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| Agreed and accepted to as to 102,000 Units at $1.00 per share:
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| By: |
/s/ Xxxxxx Xxxxxxx | |
| Name: |
Xxxxxx Xxxxxxx | |
| Title: |
President | |
| Date: |
August 15, 2004 | |
