SHAREHOLDERS RESIDING IN STATES IN WHICH THE OFFER IS NOT
QUALIFIED MAY NOT PARTICIPATE IN THIS OFFERING
Exhibit 4.2
SUBSCRIPTION AGREEMENT
For
Shares of Common Stock
of
FIRST IPSWICH BANCORP
TO: First Ipswich Bancorp [STICKER]
00 Xxxxxx Xxxxxx
Xxxxxxx, XX 00000
Subscription Rights
Subscriber is eligible to subscribe for the number of shares shown on the
sticker attached to this form above (the "Basic Shares") and ________ shares if
there is an oversubscription.
The undersigned hereby subscribes for the following shares of Common Stock
of First Ipswich Bancorp upon the terms specified in the Prospectus for the
Subscription Rights.
1. BASIC SUBSCRIPTION RIGHTS (Subject to a limitation of number of Basic
Shares shown above)
Shares Subscription
Subscribed Price Payment
_________________ x $13.00 = $__________
2. OVERSUBSCRIPTION- MUST HAVE SUBSCRIBED FOR ALL BASIC SHARES
Shares Subscription
Subscribed Price Payment
_________________ x $13.00 = $__________
TOTAL PAYMENT ENCLOSED $__________
(Total, payable to First Ipswich Bancorp, must accompany Subscription
Agreement)
The undersigned understands that this subscription shall be irrevocable.
Dated: , 2004 _________________________________
Subscriber's Signature
Subscriber's Telephone Number ________________________
Subscriber's State of Primary Residence ____________________
FULL INSTRUCTIONS CAN BE FOUND ON PAGES 17-19 OF THE PROSPECTUS.
