SUBSCRIPTION AGREEMENT
To
Xxxx’x, Inc.:
Please
issue share of Xxxx’x, Inc.’s common stock in the amounts and name(s) shown
below. The signature(s) affixed below acknowledge(s) that I/we have received
the
Prospectus dated August 2, 2005.
I/we
further current residence in the state of ___________________ and that the
broker dealer through whom I am making this purchase is Brookstreet Securities
Corporation. I/we understand that Xxxx’x, Inc. and Brookstreet Securities
Corporation will be relying on the above representations by me/us.
This
subscription represents my authorization to apply for payment of this
subscription, the cash equivalent balance present on account in my/our name(s)
at Brookstreet Securities Corporation or other selling agent as authorized
by
Brookstreet Securities Corporation’s allotment agent.
Please
apply $____________ as payment for ___________ shares at $4.00; Total
$__________* and Register the shares in the following name(s) and
amount(s):
(Please
Print)
Name(s):
___________________ ___________________ ___________________
Number
of
share(s): _________________
As:
(check
one)
Individual
Joint
Tenancy
Husband
& Wife as community property Tenants in Common
Corporation
Trust
Other:
______________________________________________
For
the person(s) who will be registered shareowners:
Mailing
Address (P.O. Box not acceptable):
___________________________________________
City:
____________________________________ State/Province: ______ Zip/Post Code:
______
Home
Phone: ______________________________ Work Phone:
_________________________
Social
Security or Taxpayer ID Number(s): ________________ ___________________
__________________
******************************************
No
subscription is effective until accepted by the underwriter and the issuer.
The
undersigned understands that this subscription may be accepted or rejected
in
whole or in part by Brookstreet Securities Corporation and Xxxx’x, Inc. in their
sole discretion and that this subscription is and shall be irrevocable unless
Brookstreet Securities Corporation and Xxxx’x, Inc. for any reason reject this
subscription.
*******************************************
___________________________________________
_______________________
Subscriber
Signature Date
___________________________________________
_______________________
Subscriber
Signature Date
___________________________________________ _______________________
Subscriber
Signature Date
___________________________________________ _______________________
BY:
Xxxxxxx Xxxxxxxx
Date
ITS:
Executive Vice President
Subscription
Accepted by Xxxx’x, Inc.:
___________________________________________ _______________________
BY:
Xxxxx
Xxxx Date
ITS:
President
