SUPREME HOSPITALITY SUBSCRIPTION AGREEMENT Gentlemen:
EXHIBIT 99.3 SUBSCRIPTION AGREEMENT
Gentlemen:
The Investor named below, by payment of the purchase price for such Preferred Shares, by the delivery of a check payable to SUPREME HOSPITALITY, hereby subscribes for the purchase of the number of Preferred Shares indicated below of SUPREME HOSPITALITY, at a purchase of $6.30 per Share as set forth in the Prospectus.
Following is a brief summary of this offering:
PREFERRED SHARES
Securities being offered Up to 1,000,000 shares of convertible
preferred stock, par value $0.0001
Convertible The preferred shares are convertible one (1)
preferred share for three (3) common shares
any time after twelve months of purchase and
automatically on its thirty- six month
anniversary.
Offering price per share $6.30
Offering period The shares are being offered for a period
not to exceed two years.
Use of proceeds We will use the proceeds to fund the
Company's plan of operation.
There is no minimum number of shares that we have to sell. There will be no
escrow account. All money received from the offering will be immediately used by
us and there will be no refunds. The minimum number of shares that you can
purchase is 1,000.
By payment, the named Investor further acknowledges receipt of the Prospectus
and the Subscription Agreement, the terms of which govern the investment in the
Preferred Shares being subscribed for hereby.
A. INVESTMENT:
(1)Number of Shares _______________________________________
(The minimum number of shares that you can purchase is
1,000.)
(2) Total Contribution ($6.30/Share) $_____________________
(3) Date of Investor's check ______________________________
B. REGISTRATION:
(1) Registered owner: ____________________________________
(2) Co-Owner: _____________________________________________
(3) Mailing address: ______________________________________
City, State & zip: _______________________________________
(4) Residence Address (if different from above):
Address: __________________________________________________
City, State & zip: ________________________________________
(5) Birth Date: ______/______/______
(6) Employee or Affiliate: Yes ______ No ______
(7) Social Security: #: ______/______/______
(8) U.S. Citizen [ ] Other [ ]
(9) Co-Owner Social Security #: ______/______/______
(10) Co-Owner U.S. Citizen [ ] Other [ ]
(11) Corporate or Custodial: Taxpayer ID #: ______/______/______
(12) U.S. Citizen [ ] Other [ ]
(13) Telephone (H) (________________)______________________
C. OWNERSHIP:
[ ] Individual Ownership [ ] XXX or Xxxxx
[ ] Joint Tenants with Rights of Survivorship
[ ] Trust/Date Trust Established_______________
[ ] Pension/Trust (S.E.P.)
[ ] Tenants in Preferred [ ] Tenants by the Entirety
[ ] Corporate Ownership [ ] Partnership
[ ] Other _________________________________________________
D. SIGNATURES: By signing below, I/we represent that I/we meet the suitability
standards set forth in the prospectus.
Registered Owner: ________________________________________
Co-Owner: ________________________________________
Print Name of Custodian or Trustee: _____________________________
Authorized Signature: ____________________________________
Date: _____________________
Signature: ___________________________________
MAIL TO:
C/O XX. Xxxxx X. Xxxx
00000 Xxxxxxx Xxxxx
Xxxxxxxx, Xxxxxxxxxx 00000
(000) 000-0000
................................................................................ FOR OFFICE USE ONLY: Date Received: _________________________________________________ Date Accepted/Rejected: ________________________________________ Subscriber's Check Amount: _____________________________________ Check No. ___________________ Date Check ________________ Deposited ________________________________ MR #________________ _________________________________________________________________ _________________________________________________________________ No dealer, salesperson or any other person is authorized to give any information or to make any representations in connection with this prospectus and, if given or made, such information or representations must not be relied upon as having been authorized by us. This prospectus does not constitute an offer to sell or a solicitation of an offer to buy any security other than the securities offered by this prospectus, or an offer to sell or solicitation of an offer to buy any securities by anyone in any jurisdiction in which such offer or solicitation is not authorized or is unlawful. The delivery of this prospectus shall not, under any circumstances, create any implication that the information herein is correct as of any time subsequent to the date of the prospectus.
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SUPREME HOSPITALITY |
PROSPECTUS
SUPREME HOSPITALITY
00000 Xxxxxxx Xxxxx, Xxxxxxxx, Xxxxxxxxxx 00000 (909) 506-3435
Effective date _____________________
Prospectus # _______________________
