INVESTOR SUBSCRIPTION AGREEMENT
FOR
XXXXXXXXXXXXXX.XXX, INC.
Persons interested in purchasing shares ("Shares") of Common Stock of
XxxXxxxxXxXxxx.xxx, Inc.(the "Company") must complete, execute, and deliver this
Subscription Agreement (the "Agreement") along with their check made payable to
XxxXxxxxXxXxxx.xxx, Inc. Escrow Account, First American Stock Transfer, NA,
Escrow Agent to:
XxxXxxxxXxXxxx.xxx, Inc.
000 Xxxxxxx Xxxxx
Xx. Xxxxx, Xxxxx 00000
If and when accepted by the Company, this Agreement shall constitute a
subscription for shares of Common Stock, $.01 par value per share, of the
Company. The minimum investment is $1,100 (200 Shares).
The Company reserves the right to reject in its entirety any subscription which
is tendered or to allocate to any prospective purchaser a smaller number of
Shares than the prospective purchaser has subscribed to purchase. In such event,
the Company will return to you this Agreement your payment (or a pro rata
portion of your payment, if such subscription is rejected only in part), without
interest or deduction.
An accepted copy of this Agreement will be returned to you as your receipt, and
a stock certificate will be issued to you shortly thereafter.
I/we hereby irrevocably tender this Agreement for the purchase of ________
Shares at $5.50 per Share. With this Agreement, I/we tender payment in the
amount of $________ ($5.50 per Share) for the Shares subscribed.
In connection with this investment in the Company, I/we represent and warrant as
follows:
a. Prior to tendering payment for the Shares, I/we received and reviewed
the Company's Offering Circular dated ___________ 2000, and have relied
on no other information or materials in reaching my/our investment
decision.
b. I am/we are bona fide resident(s) of
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(State) (Country)
Please register the Shares which I am/we are purchasing as follows:
Name:
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As (check one):
Individual Tenants-in-Common
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Existing Partnership Joint Tenants
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Corporation Trust
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Minor with adult custodian
Under the Uniform Gift
to Minors Act
For the person(s) who will be registered shareholder(s):
Name Telephone
Street Address Social Security or Taxpayer ID number
City State Zip Date of Birth
Signature Date
ACCEPTED BY: XXXXXXXXXXXXXX.XXX, INC.
By: Date:
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Its:
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