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Exhibit 10(i)(c)
CAUTION: THIS FORM IS ONLY FOR USE BY RESIDENTS OF AR, CA, CT, DE, IN, IA, KS,
KY, ME, MD, MA, MI, MN, MS, MO, NV, NH, OK, OR, PA, SC, WV AND WI. RESIDENTS OF
AK, DC, HI, ID, MT, NE, NM, ND, RI, SD, UT, VT, WA, AND WY ARE NOT PERMITTED TO
PURCHASE SHARES IN THIS OFFERING.
INSTRUCTIONS TO
SOPHISTICATED INVESTOR SUBSCRIPTION AGREEMENT
FOR
FANZ ENTERPRISES, INC.
Persons interested in purchasing shares of Common Stock, $.01 par value
per share, ("Shares") of FanZ Enterprises, Inc. (the "Company") must :
1. FULLY complete and sign the attached Subscription Agreement (the
"Agreement");
PLEASE COMPETE THE ENTIRE FORM. INCOMPLETE FORMS WILL BE
RETURNED TO YOU.
2. Include a check made payable to "FIRSTAR BANK, N.A., ESCROW ACCOUNT
FOR FANZ ENTERPRISES, INC." (Please note the minimum amount of
$250.00.)
3. Send the completed and signed AGREEMENT AND CHECK to:
FanZ Enterprises, Inc.
0000 Xxxxxx Xxxxx
Xxxxxx, XX 00000
If and when accepted by the Company, the Agreement shall constitute a
subscription for Shares of the Company. THE MINIMUM INVESTMENT IS $250.00 (25
SHARES).
The Company reserves the right to reject in its entirety any
subscription that 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 the Agreement, your
payment (or a pro rata portion of your payment, if subscription is rejected only
in part), with interest if your check or funds are deposited in the escrow
account.
A copy of the accepted Agreement will be returned to you as your
receipt, and a stock certificate will be issued to you shortly thereafter.
PLEASE COMPLETE AND RETURN THE
ATTACHED PAGE WITH YOUR CHECK
NOTE: Before completing the attached subscription agreement, you should
carefully and completely read the Company's Prospectus. In making
your investment decision, you should rely only on the information
in the Company's Prospectus and not on any other information.
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SOPHISTICATED INVESTOR SUBSCRIPTION AGREEMENT
FOR
FANZ ENTERPRISES, INC.
I/we hereby irrevocably tender this Agreement for the purchase of
_________ Shares (25 SHARES MINIMUM) at $10.00 per Share. With this Agreement,
I/we tender payment in the amount of $_______ ($10.00 per Share; $250.00 MINIMUM
INVESTMENT) 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 the Company's Prospectus dated
___________________ 2001.
b. I am/we are bona fide resident(s) of , .
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(State) (Country)
c. I/we HAVE / DO NOT HAVE (please circle one) either (i) an annual gross income of $65,000 or more
and a minimum net worth of $65,000 (excluding the value of automobiles, homes and home furnishings)
OR (ii) a minimum net worth of $150,000 (excluding the value of automobiles, homes and home
furnishings).(1)
Form/Type of Ownership for Shares Being Purchased ( MUST check one):
___ Individual ___ Minor with adult custodian ___ Tenants-in-Common
___ Existing Partnership under the Uniform Gift ___ Joint Tenants
___ Corporation To Minors Act ___ Trust
For the person(s) who will be registered shareholder(s) (MUST FULLY COMPLETE):
Name of shareholder as you would like it to appear on stock certificate:
------------------------------------------
Name(s): Telephone:
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Street Address:
------------------------------------------------- Social Security or
Taxpayer ID No.:
------------------
City: State: Zip: Date of Birth:
----------------------- ---- ------------ -----------------------------
Signature: Date:
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ACCEPTED BY: FANZ ENTERPRISES, INC.
By: Title: Date:
---------------------------------------- ---------------------------- --------------
Method of Payment: ________________________ Item No. ____________________
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(1) The state securities agencies of AK, CA, CT, DE, IN, IA, KS, KY, ME, MD, MA,
MI, MN, MS, MO, NV, NH, OK, OR, PA, SC, WV, WI. have restricted the sale of
these securities to only residents of these states who meet the sophistication
requirements of the North American Securities Administrators Association. If you
do not meet the income / net worth requirements in section (c) above, you may
NOT purchase Shares at this time.
