HOMELAND ENERGY SOLUTIONS, LLC SUBSCRIPTION AGREEMENT Limited Liability Company Membership Units $1,000 per Unit Minimum Investment of 25 Units ($25,000) 5 Unit Increments Thereafter ($5,000)
EXHIBIT 4.2
HOMELAND ENERGY SOLUTIONS, LLC
Limited Liability Company Membership Units
$1,000 per Unit
Minimum Investment of 25 Units ($25,000)
5 Unit Increments Thereafter ($5,000)
5 Unit Increments Thereafter ($5,000)
The undersigned subscriber (“Subscriber”), desiring to become a member of Homeland Energy
Solutions, LLC (“Homeland Energy”), an Iowa limited liability company, with its principal place of
business at 000 Xxxxx Xxxx Xxxxxx, Xxx Xxxxxxx, Xxxx 00000 hereby subscribes for the purchase of
membership units of Homeland Energy, and agrees to pay the related purchase price, identified
below.
A. SUBSCRIBER INFORMATION. Please print your individual or entity name and address. If we accept
your subscription, the units will be titled in the name of the subscriber as it appears below.
Joint subscribers should provide both names. Your name and address will be recorded exactly as
printed below. Please provide your home, business and/or mobile telephone number. If desired,
please also provide your e-mail address.
1.
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Subscriber’s Printed Name | |||
2.
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Title, if applicable | |||
3.
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Subscriber’s Address | |||
Street | ||||
City, State, Zip Code | ||||
4.
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E-mail Address (optional) | |||
5.
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Home Telephone Number | |||
6.
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Business Telephone Number | |||
7.
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Mobile Telephone Number | |||
8.
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Subscriber’s Social Security Number | |||
9.
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Joint Subscriber’s Social Security Number | |||
10.
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Taxpayer Identification No. (Business Entities) | |||
B. NUMBER OF UNITS PURCHASED. You must purchase at least 25 units. Your ownership interest may not
exceed 49% of our outstanding membership units. We currently have 2,850 units outstanding.
Accordingly, assuming that we sell the minimum number of 55,000 units in this offering, you may not
purchase more than 26,950 units. The maximum number of units to be sold in the offering is 95,000.
units
C. PURCHASE PRICE. Indicate the dollar amount of your investment (minimum investment is
$25,000).
1. Total Purchase Price | = | 2. 1st Installment | + | 3. 2nd Installment | |||||
($1,000 per unit multiplied | (10% of Total Purchase Price) | (90% of Total Purchase Price) | |||||||
by number of units) | |||||||||
= | + |
D. GENERAL INSTRUCTIONS FOR SUBSCRIBERS:
You should read the Prospectus dated [DATE OF EFFECTIVENESS] (the “Prospectus”) in its entirety
including the exhibits for a complete explanation of an investment in Homeland Energy.
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INSTRUCTIONS IF YOU ARE SUBSCRIBING PRIOR TO THE COMPANY’S RELEASE OF FUNDS FROM ESCROW:
If you are subscribing prior to the Company’s release of funds from escrow, you must follow the
instructions contained in paragraphs 1 through 5 below:
1. Complete all information required in this Subscription Agreement, and date and sign the
Subscription Agreement on page 6 and the Member Signature Page to our Operating Agreement attached
to this Subscription Agreement as Exhibit A.
2. Immediately provide a personal (or business) check for the first installment of ten percent
(10%) of your investment amount. The check should be made payable to
“___, escrow agent for Homeland Energy Solutions, LLC.” You will
determine this amount in box C.2 on page 1 of this Subscription Agreement.
3. Execute the Promissory Note and Security Agreement on page 7 of this Subscription Agreement
evidencing your commitment to pay the remaining ninety percent (90%) due for the units. The
Promissory Note and Security Agreement is attached to this Subscription Agreement and grant
Homeland Energy, LLC a security interest in your units.
4. Deliver the original executed documents referenced in paragraphs 1 and 3 of these
instructions, together with a personal or business check as described in Paragraph 2 of these
instructions to:
Homeland Energy Solutions, LLC
000 Xxxxx Xxxx Xxxxxx
Xxx Xxxxxxx, Xxxx 00000
000 Xxxxx Xxxx Xxxxxx
Xxx Xxxxxxx, Xxxx 00000
5. Within 20 days of written notice from Homeland Energy that your subscription has been
accepted, you must remit an additional personal (or business) check for the second installment of
ninety percent (90%) of your investment amount made payable to “___,
escrow agent for Homeland Energy Solutions, LLC” in satisfaction of the Promissory Note and
Security Agreement. You will determine this amount in box C.3 on page 1 of this Subscription
Agreement. You must deliver this check to the same address set forth above in paragraph 4 within
twenty (20) days of the date of Homeland Energy’s written notice. If you fail to pay the second
installment pursuant to the Promissory Note and Security Agreement, Homeland Energy shall be
entitled to retain your first installment and to seek other damages, as provided in the Promissory
Note and Security Agreement. This means that if you are unable to pay the 90% balance of your
investment amount within 20 days of our notice, you may have to forfeit the 10% cash deposit.
Your funds will be placed in Homeland Energy’s escrow account at
___. The funds will be released to Homeland Energy or returned to you in
accordance with the escrow arrangements described in the Prospectus. Homeland Energy may, in its
sole discretion, reject or accept any part or all of your subscription. If Homeland Energy rejects
your subscription, your Subscription Agreement and investment will be promptly returned to you,
plus nominal interest, minus escrow fees. Homeland Energy may not consider the acceptance or
rejection of your subscription until a future date near the end of this offering.
INSTRUCTIONS IF YOU ARE SUBSCRIBING AFTER THE COMPANY’S RELEASE OF FUNDS FROM ESCROW: If
you are subscribing after the Company’s release of funds from escrow, you must follow the
instructions contained in paragraphs 1 through 3 below:
1. Complete all information required in this Subscription Agreement, and date and sign the
Subscription Agreement on page 6 and the Member Signature Page to our Operating Agreement attached
to this Subscription Agreement as Exhibit A.
2. Immediately provide your personal (or business) check for the entire amount of your
investment (as determined in box C.1 on page 1) made payable to “Homeland Energy Solutions, LLC.”
3. Deliver the original executed documents referenced in paragraph 1 of these instructions,
together with your personal or business check as described in paragraph 2 to:
Homeland Energy Solutions, LLC
000 Xxxxx Xxxx Xxxxxx
000 Xxxxx Xxxx Xxxxxx
0
Xxx Xxxxxxx, Xxxx 00000
If you are subscribing after we have released funds from escrow and we accept your investment,
your funds will be immediately at-risk as described in the Prospectus. Homeland Energy may, in its
sole discretion, reject or accept any part or all of your subscription. If Homeland Energy rejects
your subscription, your Subscription Agreement and investment will be returned to you promptly,
plus nominal interest, minus escrow fees. Homeland Energy may not consider the acceptance or
rejection of your subscription until a future date near the end of this offering.
You may direct your questions to either of our directors listed below or to Homeland Energy at
(000)000-0000.
NAME | POSITION | PHONE NUMBER | ||
Xxxxxxx Xxxxxxx
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President and Director | (000) 000-0000 | ||
Xxxxx Xxxxxxx
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Vice President and Director | (000) 000-0000 | ||
Xxx Xxxxx
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VP Project Development and Director | (000) 000-0000 | ||
Xxxxxxx Xxxxxxxxx
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Treasurer and Director | (000) 000-0000 | ||
Xxxxx Xxxxx
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Secretary and Director | (000) 000-0000 | ||
Xxxx Xxxxxxx
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Director | (000) 000-0000 | ||
Xxxxxx Core
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Director | (000) 000-0000 |
E. Additional Subscriber Information. Subscriber, named above, certifies the following under
penalties of perjury:
1. | Form of Ownership. Check the appropriate box (one only) to indicate form of ownership. If the subscriber is a Custodian, Corporation, Partnership or Trust, please provide the additional information requested. | |||||||
o | Individual | |||||||
o | Joint Tenants with Right of Survivorship (Both signatures must appear on page 6.) | |||||||
o | Corporation, Limited Liability Company or Partnership (Corporate Resolutions, Operating Agreement or Partnership Agreement must be enclosed.) | |||||||
o | Trust | |||||||
Trustee’s Name: | ||||||||
Trust Date: | ||||||||
o | Other: Provide detailed information in the space immediately below. | |||||||
2. | Subscriber’s Taxpayer Information. Check the appropriate box if you are a non-resident alien, a U.S. Citizen residing outside the United States, and/or subject to backup withholding. All individual subscribers should provide their Social Security Numbers. Trusts should provide the trust’s taxpayer identification number. Custodians should provide the minor’s Social Security Number. Other entities should provide the entity’s taxpayer identification number. | |||||||
o | Check box if you are a non-resident alien | |||||||
o | Check box if you are a U.S. citizen residing outside of the United States | |||||||
o | Check this box if you are subject to backup withholding | |||||||
Subscriber’s Social Security No. | ||||||||
Joint Subscriber’s Social Security No. | ||||||||
Taxpayer Identification No. | ||||||||
3. | Member Report Address. If you would like duplicate copies of member reports sent to an address that is different than the address identified in section A, please complete this section. | |||||||
Address: | ||||||||
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4. | State of Residence. | |||||||
State of Principal Residence: | ||||||||
State where driver’s license is issued: | ||||||||
State where resident income taxes are filed: | ||||||||
State(s) in which you have maintained your principal residence during the past three years: | ||||||||
a. | b. | c. | ||||||
5. | Suitability Standards. You cannot invest in Homeland Energy unless you meet one of the following suitability tests (a or b) set forth below. Please review the suitability tests and check the box next to the following suitability test that you meet. For husbands and wives purchasing jointly, the tests below will be applied on a joint basis. | |||||||
a. o | I (We) have annual income from whatever source of at least $45,000 and a net worth of at least $45,000, exclusive of home, furnishings and automobiles; or | |||||||
b. o | I (We) have a net worth of at least $100,000, exclusive of home, furnishings and automobiles; or | |||||||
c. o | I (We) have a net worth of $150,000, exclusive of home, home furnishings, and automobiles. | |||||||
6. | Agricultural Producer. Please indicate below whether the subscribing person or entity meets the following definition of an Agricultural Producer: Persons or entities, including farmers, ranchers, loggers, agricultural harvesters and fishermen, that engage in the production or harvesting of an agricultural product. Producers may or may not own the land or other production resources, but must have majority ownership interest in the agricultural product to which value is added as a result of the project. Examples of agricultural producers include but are not limited to: a cattle or hog feeder that has a majority interest in the livestock that is fed, slaughtered and sold as beef or pork products or corn grower that has a majority interest in the corn produced that is then converted into corn meal. | |||||||
a. o | I (we) qualify as an Agricultural Producer based on the above definition. | |||||||
b. o | I (we) do not qualify as an Agricultural Producer based on the above definition. | |||||||
7. | Subscriber’s Representations and Warranties. You must read and certify your representations and warranties by placing your initials where indicated and by signing and dating this Subscription Agreement. Joint subscribers are also required to initial and sign as indicated. |
(Initial here) (Joint initials) By signing below the subscriber represents and warrants to Homeland
Energy that he, she or it:
a. has received a copy of Homeland Energy’s Prospectus dated [DATE OF EFFECTIVENESS] and the exhibits thereto or has received notice that this sale has been made pursuant to a registration statement in which a final prospectus would have been required to have been delivered in the absence of Rule 172; | ||||
b. has been informed that the units of Homeland Energy are offered and sold in reliance upon a federal securities registration; state registrations in Florida, Illinois, Iowa, Kansas, Minnesota, Missouri, South Dakota and Wisconsin; and exemptions from securities registrations in various other states, and understands that the units to be issued pursuant to this subscription agreement can only be sold to a person meeting requirements of suitability; | ||||
c. has been informed that the securities purchased pursuant to this Subscription Agreement have not been registered under the securities laws of any state other than Florida, Illinois, Iowa, Kansas, Minnesota, Missouri, South Dakota and Wisconsin and that Homeland Energy is relying in part upon the representations of the undersigned Subscriber contained herein; | ||||
d. has been informed that the securities subscribed for have not been approved or disapproved by the SEC, or the Florida, Illinois, Iowa, Kansas, Minnesota, Missouri, South Dakota and Wisconsin Securities Departments or any other regulatory authority, nor has any regulatory authority passed upon the accuracy or adequacy of the Prospectus; |
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e. intends to acquire the units for his/her/its own account without a view to public distribution or resale and that he/she/it has no contract, undertaking, agreement or arrangement to sell or otherwise transfer or dispose of any units or any portion thereof to any other person; | ||||
f. understands that there is no present market for Homeland Energy’s membership units, that the membership units will not trade on an exchange or automatic quotation system, that no such market is expected to develop in the future and that there are significant restrictions on the transferability of the membership units; | ||||
g. has been encouraged to seek the advice of his legal counsel and accountants or other financial advisers with respect to investor-specific tax and/or other considerations relating to the purchase and ownership of units; | ||||
h. has received a copy of the Homeland Energy Operating Agreement, dated March 9, 2006, and understands that upon closing the escrow by Homeland Energy, the subscriber and the membership units will be bound by the provisions of the Operating Agreement which contains, among other things, provisions that restrict the transfer of membership units; | ||||
i. understands that the units are subject to substantial restrictions on transfer under certain tax and securities laws along with restrictions in the Homeland Energy Operating Agreement, and agrees that if the membership units or any part thereof are sold or distributed in the future, the subscriber shall sell or distribute them pursuant to the terms of the Operating Agreement, and the requirements of the Securities Act of 1933, as amended, and applicable tax and securities laws; | ||||
j. meets the suitability test marked in Item E.5 above and is capable of bearing the economic risk of this investment, including the possible total loss of the investment; | ||||
k. understands that Homeland Energy will place a restrictive legend on any certificate representing any unit containing substantially the following language as the same may be amended by the Directors of Homeland Energy in their sole discretion: |
THE TRANSFERABILITY OF THE MEMBERSHIP UNITS REPRESENTED BY THIS
CERTIFICATE IS RESTRICTED. SUCH UNITS MAY NOT BE SOLD, ASSIGNED,
OR TRANSFERRED, AND NO ASSIGNEE, VENDEE, TRANSFEREE OR ENDORSEE
THEREOF WILL BE RECOGNIZED AS HAVING ACQUIRED ANY SUCH UNITS FOR
ANY PURPOSES, UNLESS AND TO THE EXTENT SUCH SALE, TRANSFER,
HYPOTHECATION, OR ASSIGNMENT IS PERMITTED BY, AND IS COMPLETED IN
STRICT ACCORDANCE WITH, APPLICABLE FEDERAL AND STATE LAW AND THE
TERMS AND CONDITIONS SET FORTH IN THE OPERATING AGREEMENT OF THE
COMPANY, AS AMENDED FROM TIME TO TIME.
THE SECURITIES REPRESENTED BY THIS CERTIFICATE MAY NOT BE SOLD,
OFFERED FOR SALE OR TRANSFERRED IN THE ABSENCE OF AN EFFECTIVE
REGISTRATION UNDER THE SECURITIES ACT OF 1933, AS AMENDED, AND
UNDER APPLICABLE STATE SECURITIES LAWS, OR AN OPINION OF COUNSEL
SATISFACTORY TO THE COMPANY THAT SUCH TRANSACTION IS EXEMPT FROM
REGISTRATION UNDER THE SECURITIES ACT OF 1933, AS AMENDED, AND
UNDER APPLICABLE STATE SECURITIES LAWS.
l. understands that, to enforce the above legend, Homeland Energy may place a stop transfer order with its registrar and stock transfer agent (if any) covering all certificates representing any of the membership units; | ||||
m. may not transfer or assign this Subscription Agreement, or any of the subscriber’s interest herein without the prior written consent of Homeland Energy; | ||||
n. has written his, her, or its correct taxpayer identification number under Item E.2 on this Subscription Agreement; | ||||
o. is not subject to back up withholding either because he, she or it has not been notified by the Internal Revenue Service (“IRS”) that he, she or it is subject to backup withholding as a result of a failure to report all interest or dividends, or the IRS has notified him, her or it that he is no longer subject to backup withholding (Note this clause (p) should be crossed out if the backup withholding box in Item E.2 is checked); |
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p. understands that execution of the attached Promissory Note and Security Agreement will allow Homeland Energy or its assigns to pursue the obligor for payment of the amount due thereon by any legal means, including, but not limited to, acquisition of a judgment against the obligor in the event that the subscriber defaults on that Promissory Note and Security Agreement; and | ||||
q. acknowledges that Homeland Energy may retain possession of certificates representing subscriber’s units to perfect its security interest in those units. |
Signature of Subscriber/Joint Subscriber: | ||||||
Date: |
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Individuals: | Entities: | |||||
Name of Individual Subscriber (Please Print) | Name of Entity (Please Print) | |||||
Signature of Individual | Print Name and Title of Officer | |||||
Name of Joint Individual Subscriber (Please Print) | Signature of Officer | |||||
Signature of Joint Individual Subscriber |
ACCEPTANCE OF SUBSCRIPTION BY HOMELAND ENERGY SOLUTIONS, LLC: | ||||||
Homeland Energy Solutions, LLC hereby accepts Subscriber’s subscription for units. | ||||||
Dated this day of , 200 . | ||||||
HOMELAND ENERGY SOLUTIONS, LLC | ||||||
By: |
||||||
Its: |
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PROMISSORY NOTE AND SECURITY AGREEMENT
Date of Subscription Agreement: , 200 .
$1,000 per Unit
Minimum Investment of 25 Units ($25,000); Units Sold in 5 Unit Increments Thereafter ($10,000 each)
Number of Units Subscribed | ||||
Total Purchase Price ($1,000 per unit multiplied by number of units subscribed) | ||||
( ) | Less Initial Payment (10% of Principal Amount) | |||
Principal Balance | ||||
FOR VALUE RECEIVED, the undersigned hereby promises to pay to the order of Homeland Energy
Solutions, LLC, an Iowa limited liability company (“Homeland Energy”), at its principal office
located at 000 Xxxxx Xxxx Xxxxxx, Xxx Xxxxxxx, Xxxx 00000, or at such other place as required by
Homeland Energy, the Principal Balance set forth above in one lump sum to be paid without interest
within 20 days following the call of the Homeland Energy Board of Directors, as described in the
Subscription Agreement. In the event the undersigned fails to timely make any payment owed, the
entire balance of any amounts due under this full recourse Promissory Note and Security Agreement
shall be immediately due and payable in full with interest at the rate of 12% per annum from the
due date and any amounts previously paid in relation to the obligation evidenced by this Promissory
Note and Security Agreement may be forfeited at the discretion of Homeland Energy.
The undersigned agrees to pay to Homeland Energy on demand, all costs and expenses incurred to
collect any indebtedness evidenced by this Promissory Note and Security Agreement, including,
without limitation, reasonable attorneys’ fees. This Promissory Note and Security Agreement may
not be modified orally and shall in all respects be governed by, construed, and enforced in
accordance with the laws of the State of Nebraska.
The provisions of this Promissory Note and Security Agreement shall inure to the benefit of
Homeland Energy and its successors and assigns, which expressly reserves the right to pursue the
undersigned for payment of the amount due thereon by any legal means in the event that the
undersigned defaults on obligations provided in this Promissory Note and Security Agreement.
The undersigned waives presentment, demand for payment, notice of dishonor, notice of protest, and
all other notices or demands in connection with the delivery, acceptance, performance or default of
this Promissory Note and Security Agreement.
The undersigned grants to Homeland Energy, and its successors and assigns (“Secured Party”), a
purchase money security interest in all of the undersigned’s membership units of Homeland Energy
now owned or hereafter acquired. This security interest is granted as non-exclusive collateral to
secure payment and performance on the obligation owed Secured Party from the undersigned evidenced
by this Promissory Note and Security Agreement. The undersigned further authorizes Secured Party to
retain possession of certificates representing such membership units and to take any other actions
necessary to perfect the security interest granted herein.
Dated: , 200 .
OBLIGOR/DEBTOR: | JOINT OBLIGOR/DEBTOR: | |||||||||
Printed or Typed Name of Obligor | Printed or Typed Name of Joint Obligor | |||||||||
By:
|
By: | |||||||||
(Signature) | (Signature) | |||||||||
Officer Title if Obligor is an Entity | ||||||||||
Address of Obligor |
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Exhibit A
MEMBER SIGNATURE PAGE
ADDENDUM TO THE
OPERATING AGREEMENT
OF HOMELAND ENERGY SOLUTIONS, LLC
OPERATING AGREEMENT
OF HOMELAND ENERGY SOLUTIONS, LLC
The undersigned does hereby warrant, represent, covenant and agree that: (i) the undersigned,
as a condition to becoming a Member in Homeland Energy Solutions, LLC, has received a copy of the
Operating Agreement dated March 9, 2006, and, if applicable, all amendments and modifications
thereto; (ii) the undersigned shall be subject to and comply with all terms and conditions of such
Operating Agreement in all respects, as if the undersigned had executed said Operating Agreement on
the original date thereof; and (iii) the undersigned is and shall be bound by all of the provisions
of said Operating Agreement from and after the date of execution of this Addendum.
Individuals: | Entities: | |||||
Date | Date | |||||
Name of Individual Member (Please Print) | Name of Entity (Please Print) | |||||
Signature of Individual | Print Name and Title of Officer | |||||
Name of Joint Individual Member (Please Print) | Signature of Officer | |||||
Signature of Joint Individual Member | ||||||
Agreed to and accepted on behalf of the Company and its Members: |
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HOMELAND ENERGY SOLUTIONS, LLC | ||||||
By: |
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Its: |
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Date: |
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