ACQUISITION CAPITAL GROUP, INC. SUBSCRIPTION AGREEMENT
Gentlemen:
The
Investor named below, by payment of the purchase price for such Common Shares,
by the delivery of a check payable to ACQUISITION CAPITAL GROUP, hereby
subscribes for the purchase of the number of Common Shares indicated below of
Acquisition Capital Group, at a purchase of $0.30 per Share as set forth in the
Prospectus.
By such
payment, the named Investor further acknowledges receipt of the Prospectus and
the Subscription Agreement, the terms of which govern the investment in the
Common Shares being subscribed for hereby.
| A. INVESTMENT: | (1) | Number of Shares ___________________________ | |
| (2) | Total Contribution ($0.30/Share) $__________ | ||
| Date of Investor's check ___________ | |||
| B. REGISTRATION: | |||
| (3) | Registered owner: __________________________ | ||
| Co-Owner: __________________________________ | |||
| (4) | Mailing address: ___________________________ | ||
| City, State & zip: _________________________ | |||
| (5) | Residence Address (if different from above): | ||
| (6) | Birth Date: ______/______/______ | ||
| (7) | Employee or Affiliate: Yes ______ No ______ | ||
| (8) | Social Security: #: ______/______/______ | ||
| U.S. Citizen o Other o | |||
| Co-Owner Social Security: | |||
| #: ______/______/______ | |||
| U.S. Citizen o Other o | |||
| Corporate or Custodial: | |||
| Taxpayer ID #: ______/______/______ | |||
| U.S. Citizen o Other o | |||
| (9) | Telephone (H) ( ) ______________________ | ||
| C. OWNERSHIP | o | Individual Ownership o XXX or Xxxxx | |
| o | Joint Tenants with Rights of Survivorship | ||
| o | Trust/Date Trust Established_______________ | ||
| o | Pension/Trust (S.E.P.) | ||
| o |
Tenants in
Common o Tenants by
th
Entirety
|
||
| o | Corporate Ownership o Partnership | ||
| o | Other_____________________ |
D. SIGNATURES
Registered
Owner: _____________________________
Co-Owner: _____________________________
Print
Name of Custodian or Trustee: _____________________________
Authorized
Signature: _____________________________
Date:
_____________________
Signature:
___________________________________
MAIL
TO:
00
Xxxxxxx Xxxxxx
Xxxxxxxxxxx,
XX 00000
Telephone:
000-000-0000
____________________________________________________________________
FOR
OFFICE USE ONLY:
Date
Received: ________________________________________________
Date
Accepted/Rejected ________________________________________
Subscriber's
Check Amount: _______________________
Check No.
___________________ Date Check ________________
Deposited
________________________________
MR
#________________
____________________________________________________________________
We have
not authorized any dealer, salesperson or other person to give any information
or represent anything not contained in this prospectus. You must not rely on any
unauthorized information. This prospectus does not offer to sell or buy any
shares in any jurisdiction where it is unlawful. The information in this
prospectus is current only as of the date of this prospectus.
