Hathaway Activated Carbon, Inc.

Exhibit 0X-0.0

Xxxxxxxx Activated Carbon, Inc.

00 Xxxxxx Xxxx

XX Xxx 000

Xxxxx, Xxxxxxxxx 00000

Company Direct: (000) 000-0000

7% Convertible Preferred Stock Units 1 to 200,000

Subject to the terms and conditions of the shares of 7% Preferred Convertible Preferred Stock Units (the "Convertible Preferred Stock”) described in the Hathaway Activated Carbon, Inc. Offering Circular dated June 1st, 2017 (the "Offering"), I hereby subscribe to purchase the number of shares of 7% Convertible Preferred Stock set forth below for a purchase price of $100.00 per share. Enclosed with this subscription agreement is my check (Online “E-Check” or Traditional Papery Check) or money order made payable to "Hathaway Activated Carbon, Inc." evidencing $100.00 for each share of Convertible Preferred Stock Subscribed, subject to a minimum of ONE 7% Preferred Convertible Preferred Stock Unit ($100.00).

I understand that my subscription is conditioned upon acceptance by Hathaway Activated Carbon, Inc. Company Managers and subject to additional conditions described in the Offering Circular. I further understand that Hathaway Activated Carbon, Inc. Company Managers, in their sole discretion, may reject my subscription in whole or in part and may, without notice, allot to me a fewer number of shares of 7% Convertible Preferred Stock that I have subscribed for. In the event the Offering is terminated; all subscription proceeds will be returned with such interest as may have been earned thereon.

I understand that when this subscription agreement is executed and delivered, it is irrevocable and binding to me. I further understand and agree that my right to purchase shares of 7% Convertible Preferred Stock offered by the Company may be assigned or transferred to any third party without the express written consent of the Company.

I further certify, under penalties of perjury, that: (1) the taxpayer identification number shown on the signature page of this Offering Circular is my correct identification number; (2) I am not subject to backup withholding under the Internal Revenue Code because (a) I am exempt from backup withholding; (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and (3) I am a U.S. citizen or other U.S. person (as defined in the instructions to Form W-9).

SUBSCRIPTION AGREEMENT (the “Agreement”) with the undersigned Investor for

______________ 7% Convertible Preferred Stock Units of HATHAWAY ACTIVATED CARBON, INC, with no par value per share, at a purchase price of $100.00 (ONE HUNDRED DOLLARS AND ZERO CENTS) per share

(aggregate purchase price: $____________________).

Made by __________________________________, and between Hathaway Activated Carbon, Inc., a Delaware Stock Corporation (the “Company”), and the Investor whose signature appears below on the signature line of this Agreement (the “Investor”).

W I T N E S E T H:

WHEREAS, the Company is offering for sale up to TWO HUNDRED THOUSAND 7% Convertible Preferred Stock Units (the “Shares”) (such offering being referred to as the “Offering”).

NOW, THEREFORE, the Company and the Investor, in consideration of the mutual covenants contained herein and intending to be legally bound, do hereby agree as follows:

Purchase and Sale. Subject to the terms and conditions hereof, the Company shall sell, and the Investor shall purchase, the number of Shares indicated above at the price so indicated.

Method of Subscription. The Investor is requested to complete and execute this agreement online or to print, execute and deliver two copies of this Agreement to the Company, at Hathaway Activated Carbon, Inc.; 00 Xxxxxx Xxxx, XX XXX 000, Xxxxx, Xxxxxxxxx, along with a check payable to the order of Hathaway Activated Carbon, Inc. in the amount of the aggregate purchase price of the Shares subscribed (the “Funds”). The Company reserves the right in its sole discretion, to accept or reject, in whole or in part, any and all subscriptions for Shares.

Subscription and Purchase. The Offering will begin on the effective date of the Offering Statement and continue until the Company has sold all of the Shares offered hereby or on such earlier date as the Company may close or terminate the Offering.

Any subscription for Shares received will be accepted or rejected by the Company within 30 days of receipt thereof or the termination date of this Offering, if earlier. If any such subscription is accepted, in whole or part, the Company will promptly deliver or mail to the Investor (i) a fully executed counterpart of this Agreement, (ii) a certificate or certificates for the Shares being purchased, registered in the name of the Investor, and (iii) if the subscription has been accepted only in part, a refund of the Funds submitted for Shares not purchased. Simultaneously with the delivery or mailing of the foregoing, the Funds deposited in payment for the Shares purchased will be released to the Company. If any such subscription is rejected by the Company, the Company will promptly return, without interest, the Funds submitted with such subscription to the subscriber.

Representations, Warranties and Covenants of the Investor. The Investor represents, warrants and agrees as follows:

(a)

Prior to making the decision to enter into this Agreement, the Investor acknowledges that the Investor processes sufficient information to understand the merits and risks associated with the investment in the Shares subscribed.

(b)

The Investor has such knowledge and experience in financial and business matters that the Investor is capable of evaluating the merits and risks of the investment in the Shares subscribed and the Investor believes that the Investor’s prior investment experience and knowledge of investments in low-priced securities (“xxxxx stocks”) enables the Investor to make an informal decision with respect to an investment in the Shares subscribed.

(c)

The Shares subscribed are being acquired for the Investor’s own account and for the purposes of investment and not with a view to, or for the sale in connection with, the distribution thereof, nor with any present intention of distributing or selling any such Shares.

(d)

The Investor’s overall commitment to investments is not disproportionate to his/her net worth, and his/her investment in the Shares subscribed will not cause such overall commitment to become excessive.

(e)

The Investor has adequate means of providing for his/her current needs and personal contingencies, and has no need for current income or liquidity in his/her investment in the Shares subscribed.

(f)

With respects to the tax aspects of the investment, the Investor will rely upon the advice of the Investor’s own tax advisors.

(g)

The Investor can withstand the loss of the Investor’s entire investment without suffering serious financial difficulties.

(h)

The Investor is aware that this investment involves a high degree of risk and that it is possible that his/her entire investment will be lost.

(i)

The Investor is a resident of the State set forth below the signature of the Investor on the last age of this Agreement.

Company Convertible Securities: All 7% Convertible Preferred Stock Units must be Converted to Company Common Stock either in the 3^rd, 4^th or 5^th year under the following terms and conditions at the Shareholders’ Option:

YEAR 3: (Shareholder Conversion Option)

At any time during the third year of the investment, the Shareholder may choose on the First Business Day of Each Month to convert each Unit of the Company’s 7% Convertible Preferred Stock for Common Stock of the Company at market price minus 5% of the Company’s Common Stock at time of conversion / closing. The closing price will be the weighted average price of the Common Stock Closing Price over the previous 60 days. Fractional interests will be paid to the shareholder by the Company in cash.

The Shareholder can sell the 7% Convertible Preferred Stock Shares back to the Company at any time after two years for the full-face value of the Shares plus any accrued interest, though the Company has no obligation to purchase the Shares.

Dividends on this 7% Convertible Preferred Stock will be payable on a cumulative basis when, as and if declared by the Board of Directors, or an authorized committee of the Board of Directors, at an annual rate of 7.00% on the stated value of $100.00 per share.

Should the Company not be listed on any Regulated Stock Exchange or OTC Market (“Over-the-Counter inter-dealer quotation system”), the shares shall convert to Common Stock in the Company at the “per share value” of the Company’s Common Stock as determined by an Independent Third Party Valuations Firm that is chosen by the Company’s Board of Directors.

YEAR 4: (Optional Conversion Option)

At any time during the fourth year of the investment, the Shareholder may choose on the First Business Day of Each Month to convert each unit of the Company’s 7% Convertible Preferred Stock for Common Stock of the Company at market price minus 10% of the Company’s Common Stock at time of conversion / closing. The closing price will be the weighted average price of the Common Stock Closing Price over the previous 60 days. Fractional interests will be paid to the shareholder by the Company in cash.

Should the Company not be listed on any Regulated Stock Exchange or OTC Market (“Over-the-Counter inter-dealer quotation system”), the shares shall convert to Common Stock in the Company at the “per share value” (minus any discounts) of the Company’s Common Stock as determined by an Independent Third Party Valuations Firm that is chosen by the Company’s Board of Directors.

YEAR 5: (Optional & Mandatory Conversion Options)

Optional: At any time during the fifth year of the investment, the Shareholder may choose on the First Day of Each Month to convert each unit of the Company’s Convertible 7% Preferred Stock for Common Stock of the Company at market price minus 15% of the Company’s Common Stock at time of conversion / closing. The closing price will be the weighted average price of the Common Stock Closing Price over the previous 60 days. Fractional interests will be paid to the shareholder by the Company in cash.

Mandatory: On the last business day of the 5^th year of the investment, the Shareholder MUST convert each Unit of the Company’s 7% Convertible Preferred Stock for Common Stock of the Company at market price minus 15% of the Company’s Common Stock at time of conversion / closing. The closing price will be the weighted average price of the Common Stock Closing Price over the previous 60 days. Fractional interests will be paid to the shareholder by the Company in cash.

Should the Company not be listed on any Regulated Stock Exchange or OTC Market (“Over-the-Counter inter-dealer quotation system”), the shares shall convert to Common Stock in the Company at the “per share value” (minus any discounts) of the Company’s Common Stock as determined by an Independent Third Party Valuations Firm that is chosen by the Company’s Board of Directors.

The Company has the Right to convert the 7% Convertible Preferred Stock Shares to Common Shares of the Company should the Company be acquired or merged with another company (where the Company has less than 50% controlling interest). The Company has the Right to “Call In” all 7% Convertible Preferred Stock Shares at the value of the Common Stock Shares, less the appropriate percentage discount in the Year that the acquisition or merger occurs.

Notices. All notices, request, consents and other communications required or permitted hereunder shall be in writing and shall be delivered, or mailed first class, postage prepaid, registered or certified mail, return receipt requested:

If to any holder of any of the Shares, addressed to such holder at the holder’s last address appearing on the books of the Company, or

If to the Company, addressed to the Hathaway Activated Carbon, Inc; 00 Xxxxxx Xxxx, XX Xxx 000, Xxxxx, Xxxxxxxxx 00000 or such other address as the Company may specify by written notice to the Investor, and such notices or other communications shall for all purposes of this Agreement be treated as being effective on delivery, if delivered personally, or, if sent by mail, on the earlier of actual receipt or the third postal business day after the same has been deposited in a regularly maintained receptacle for the deposit of United States’ mail, addressed and postage prepaid as aforesaid.

Severability. If any provision of this Subscription Agreement is determined to be invalid or unenforceable under any applicable law, then such provision shall be deemed inoperative to the extent that it may conflict with such applicable law and shall be deemed modified to conform with such law. Any provision of this Agreement that may be invalid or unenforceable under any applicable law shall not affect the validity or enforceability of any other provision of this Agreement, and to this extent the provisions of this Agreement shall be severable.

Parties in Interest. This Agreement shall be binding upon and inure to the benefits of and be enforceable against the parties hereto and their respective successors or assigns, provided, however, that the Investor may not assign this Agreement or any rights or benefits hereunder.

Choice of Law. This Agreement is made under the laws of the State of Delaware, and for all purposes shall be governed by and construed in accordance with the laws of that State, including, without limitation, the validity of this Agreement, the construction of its terms, and the interpretation of the rights and obligations of the parties hereto.

10.

Headings. Sections and paragraph heading used in this Agreement have been inserted for convenience of reference only, do not constitute a part of this Agreement and shall not affect the construction of this Agreement.

11.

Execution in Counterparts. This Agreement may be executed an any number of counterparts and by different parties hereto in separate counterparts, each of which when so executed and delivered shall be deemed to be an original and all of which when taken together shall constitute but one and the same instrument.

12.

Survival of Representations and Warranties. The representations and warranties of the Investor in and with respect to this Agreement shall survive the execution and delivery of this Agreement, any investigation at any time made by or on behalf of any Investor, and the sale and purchase of the Shares and payment therefore.

13.

Arbitration: Except as expressly provided in this Subscription Agreement, any dispute, claim or controversy between or among any of the Investors or between any Investor or his/her/its Affiliates and the Company arising out of or relating to this Agreement or any subscription by any Investor to purchase Securities, or any termination, alleged breach, enforcement, interpretation or validity of any of those agreements (including the determination of the scope or applicability of this agreement to arbitrate), or otherwise involving the Company, will be submitted to arbitration in the county and state in which the Company maintains its principal office at the time the request for arbitration is made, before a sole arbitrator, in accordance with the laws of the state of Tennessee for agreements made in and to be performed in the state of Tennessee. Such arbitration will be administered by the Judicial Arbitration and Mediation Services (“JAMS”) and conducted under the provisions of its Comprehensive Arbitration Rules and Procedures. Arbitration must be commenced by service upon the other party of a written demand for arbitration or a written notice of intention to arbitrate, therein electing the arbitration tribunal. Judgment upon any award rendered by the arbitrator shall be final and may be entered in any court having jurisdiction thereof. No party to any such controversy will be entitled to any punitive damages. Notwithstanding the rules of JAMS, no arbitration proceeding will be consolidated with any other arbitration proceeding without all parties’ consent. The arbitrator shall, in the award, allocate all of the costs of the arbitration, including the fees of the arbitrator and the reasonable attorneys’ fees of the prevailing party, against the party who did not prevail.

NOTICE: BY EXECUTING THIS SUBSCRIPTION AGREEMENT, SUBSCRIBER IS AGREEING TO HAVE ALL DISPUTES, CLAIMS, OR CONTROVERSIES ARISING OUT OF OR RELATING TO THIS AGREEMENT DECIDED BY NEUTRAL BINDING ARBITRATION, AND SUBSCRIBER IS GIVING UP ANY RIGHTS HE, SHE OR IT MAY POSSESS TO HAVE THOSE MATTERS LITIGATED IN A COURT OR JURY TRIAL. BY EXECUTING THIS SUBSCRIPTION AGREEMENT, SUBSCRIBER IS GIVING UP HIS, HER OR ITS JUDICIAL RIGHTS TO DISCOVERY AND APPEAL EXCEPT TO THE EXTENT THAT THEY ARE SPECIFICALLY PROVIDED FOR IN THIS SUBSCRIPTION AGREEMENT. IF SUBSCRIBER REFUSES TO SUBMIT TO ARBITRATION AFTER AGREEING TO THIS PROVISION, SUBSCRIBER MAY BE COMPELLED TO ARBITRATE UNDER FEDERAL OR STATE LAW. SUBSCRIBER CONFIRMS THAT HIS, HER OR ITS AGREEMENT TO THIS ARBITRATION PROVISION IS VOLUNTARY.

NOTICE: SUBSCRIBERS TO THIS OFFERING UNDERSTAND THAT THEY HAVE NOT WAIVED ANY RIGHT THAT THEY MAY HAVE UNDER ANY APPLICABLE FEDERAL SECURITIES LAWS.

THE PARTIES HEREBY KNOWINGLY, VOLUNTARILY AND INTENTIONALLY WAIVE ANY RIGHT TO A TRIAL BY JURY IN RESPECT TO ANY LITIGATION BASED HEREIN, OR ARISING OUT OF, UNDER OR IN CONNECTION WITH THIS AGREEMENT, ANY OTHER DOCUMENTS CONTEMPLATED TO BE EXECUTED IN CONJUNCTION HEREWITH, OR ANY COURSE OF CONDUCT, COURSE OF DEALING, STATEMENTS (WHETHER VERBAL OR WRITTEN) OR ACTIONS OF ANY PARTY.

14.

Recovery of Litigation Fees. In Connection with any litigation, mediation, arbitration, special proceeding or other proceeding arising out of this Agreement, the prevailing party shall be entitled to recover its litigation-related costs and reasonable attorneys’ fees through and including any appeals and post-judgment proceedings.

15.

Limited Liability. In no event shall any party be liable for any incidental, consequential, punitive or special damages by reason of its breach of this Agreement. The liability, if any, of the Company and its Managers, Directors, Officers, Employees, Agents, Representatives, and Employees to the undersigned under this Agreement for claims, costs, damages, and expenses of any nature for which they are or may be legally liable, whether arising in negligence or other tort, contract, or otherwise, shall not exceed, in the aggregate the undersigned’s investment amount.

16.

Additional Information. Cash for Preferred Shares purchased through this Offering may be presented by check to an officer of the Company, mailed to the Company, or Electronic Funds Transfer (EFT) to the Company’s bank. Those coordinates:

Hathaway Activated Carbon, Inc.

X.X. Xxx 000, 00 Xxxxxx Xxxx

Xxxxx, Xxxxxxxxx 00000 XXX

Bank’s Name: Bank of Frankewing, Xxxxxxxxxx, Xxxxxxxxx 00000

Bank’s POC: Mr. Xxxxx Xxxxxx, President. Phone: (000) 000-0000

Bank Account Number: 0000000

Bank’s ABA Routing: 000000000

Bank’s SWIFT: XXXXXX00

IN WITNESSES WHEREOF, the parties hereto have executed this Subscription Agreement as of the day and year first above written.

	Hathaway Activated Carbon, Inc.


	By:

	Name:

	Title:

	Investor:



	Signature of Investor



	Name of Investor



	Title of Investor

INVESTOR CONTACT INFORMATION


Full Legal Name:

Primary Mailing Address:

City, State, Country and Postal Code:

Asset Manager/Other Party:

Mgr/Other Party Mailing Address:

City, State, Country and Postal Code:

Primary Phone Number:

Alternate Phone Number:

Primary E-Mail Address:

Secondary E-Mail Address:

AFFIDAVIT

Affiant:
	Investor’s Printed Name Here

Under penalties of perjury, Affiant answers to the following questions:

I have received a complete copy of the Offering Circular dated June 1, 2017 and have thoroughly read it. I do understand the Offering Circular and all of the elements contained within (Jointly Owned shares must have a questionnaire completed for each prospective joint owner).

(__) YES

(__) NO

Accredited Investor Qualification - Choose One Answer:

(__) I made $200,000 or more in the last two years and expect to make at least $200,000 this year.

(__) My household income was $300,000 or more in the last two years and it is expected to be at least $300,000 this year.

(__) I have a net worth either on my own or jointly with my spouse of $1,000,000 or more excluding my home.

(__) None of the above.

Investor Suitability Questionnaire - Choose One Answer for each of the next FOURTEEN Questions:

Income Tax Bracket:

(__) 15% or less

(__) 15-27%

(__) 28% or more

When do you expect to need the funds from your Investments?

(__) Less than one year

(__) 1-3 years

(__) 3-5 years

(__) 6-10 years

(__) 11+ years

Net Worth (excluding your home):

(__) $1 to $5,000 (__) $5,001 to $10,000 (__) $10,001 to $50,000

(__) $50,000 to $100,000 (__) $100,001 to $500,000 (__) $500,001 to $999,999

(__) $1,000,000 to $5,000,000 (__) Greater than $5M

Annual Income:

(__) Less than $15,000 (__) $15,001 to $25,000 (__) $25,001 to $50,000 (__) $50,001 to $100,000

(__) $100,001 to $150,000 (__) $150,000 to $199,000 (__) $200,000 to $300,000

(__) More than $300,000

Household Income:

(__) Less than $15K (__) $15,001 to $25,000 (__) $25,001 to $50,000 (__) $50,001 to $100,000

(__) $100,001 to $150,000 (__) $150,001 to $199,999 (__) $200,000 to $300,000

(__) More than $300,000

Past Private Equity or Private Debt Investments:

(__) None

(__) One Investment

(__) 2-5 Investments

(__) Six or Move Investments

Employment Status:

(__) Student

(__) Self-Employed

(__) Employed in Same Field Less than Five Years

(__) Employed in Same Field Five Years or More

(__) Retired

(__) Unemployed

Education:

(__) None (__) GED (__) High School

(__) College 2 Year (__) College 4 Year (__) Masters/PHD

Annual Expenses:

(__) $50,000 or Less (__) $50,001 to $100,000 (__) $100,001 to $250,000 (__) $250,001 to $500,000

(__) Over $500,000

10.

Liquid Net Worth:

(__) $1 to $5,000 (__) $5,001 to $10,000 (__) $10,001 to $50,000 (__) $50,001 to $100,000

(__) $100,001 to $500,000 (__) $500,001 to $999,999 (__) $1,000,000 to $5,000,000

(__) Greater than $5,000,000

11.

Marital Status:

(__) Single (__) Married

(__) Domestic Partner

(__) Divorced

(__) Widowed

12.

Number of Dependents:

(__) One

(__) Two to Three

(__) Four to Five

(__) Greater than Five

13.

Are you or any of your immediate family employed by or associated with the Securities Industry?

(__) YES

(__) NO

14.

Are you an officer, director or 10% (or more) shareholder in a publicly-owned company?

(__) YES

(__) NO

Signature Page Follows.

No Further Answers Provided by the Affiant.

Signature of Investor

ACKNOWLEDGEMENT

State of ___________________________

County of __________________________

On this ____ day of _______________, 20_____, before me personally

appeared ________________________________________________

To me known to be the person described in and who executed the foregoing instrument, and acknowledged that he/she executed the same as his/her free act an deed, for the purposes therein set forth.

Notary Public: ________________________________

Signature: ____________________________________

My Commission Expires: _____________________, 20_______

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Hathaway Activated Carbon, Inc.

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