SUBSCRIPTION AGREEMENT
Filtering Associates, Inc.
0000 Xxxxx Xxxxxx, Xxxxx X
Xxxxxxx Xxxxx, Xxxxxxxxxx 00000
The undersigned has received and read the prospectus dated ____________, 2002
("Prospectus"), and hereby subscribes for _____________ shares of $.001 par
value common stock of Filtering Associates, Inc., a Nevada corporation
("Company"), for a subscription price of $0.05 per share ("Offered Shares"). The
undersigned hereby agrees that this subscription shall be irrevocable and shall
survive the death or disability of the undersigned. Payment of the purchase
price for the Offered Shares is due upon subscription.
The undersigned acknowledges that (i) the Company has the right to accept or
reject this subscription in whole or in part, (ii) this subscription shall be
deemed to be accepted by the Company only when the Company signs this
Subscription Agreement; and (iii) the undersigned has relied only on that
information specified in the Prospectus.
Number of Offered Shares: _________________. Subscription Amount: ___________
(number of Offered Shares multiplied by $0.05)
Make check payable to: "Filtering Associates, Inc."
Please print name(s) or title, residence address, and SSN or Tax ID for which
the Offered Shares are to be registered.
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Name
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Xxxxxx
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Xxxx Xxxxx Zip Code
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SSN or Tax ID No. (For joint ownership, both parties must provide a Social
Security Number or similar tax identification)
Indicate type of ownership:
[ ] Individual Ownership [ ] Joint Tenants with Right of Survivorship
[ ] Community Property [ ] Tenants in Common
[ ] Tenants by the Entirety [ ] Corporate Ownership
[ ] Partnership Ownership [ ] Custodian for a Minor
[ ] Trust (see below) [ ] XXX or Pension Plan
Date Trust Established:
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Name of Trustee or other Administrator
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EACH SUBSCRIBER REPRESENTS THAT:
(a) The information contained herein is complete and accurate and may be
relied upon, and
(b) The undersigned will notify the Company immediately of any material
change in any such information occurring prior to the acceptance of
the undersigned's subscription.
IN WITNESS WHEREOF, the undersigned has executed this Subscription Agreement as
of this ______ day of ____________ 2002.
FOR INDIVIDUALS:
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Print Name
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Signature
NAME AND SIGNATURE OF JOINT TENANT OR TENANT IN COMMON
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Print Name
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Signature
FOR TRUSTS, CORPORATIONS, PARTNERSHIPS
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Print Name of Entity
By:
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Print name and capacity (Trustee, President or General Partner) of person making
investment decision
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Signature
Agreed to and accepted:
By: Filtering Associates, Inc.,
a Nevada corporation
By:
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Xxxxxxx Xxxx
Its: President
