EXHIBIT 10.7.1
AMERICAN CARD TECHNOLOGY, INC.
SUBSCRIPTION AGREEMENT
The undersigned hereby subscribes for the purchase of ____________ shares
of American Card Technology, Inc. a Delaware Corporation (the Company) at $17.00
per share in the aggregate amount of $_________________.
The undersigned herewith submits the undersigned's check payable to
American Card Technology, Incorporated in full payment for such shares. INCLUDE
CHECK PAYABLE TO AMERICAN CARD TECHNOLOGY, INC.
Please print names in which shares are to be registered ________________________
________________________
Investors Residence Address and Social Security or ________________________
Tax Identification Number(s). (Must be completed for ________________________
registration purposes; no post office boxes please). ________________________
City____________________
State & Zip_____________
Tax ID or SS No.________
Tax ID or SS No_________
Mailing Address to which notices and checks ________________________
Should be sent (if different from the Residence ________________________
Address) ________________________
City____________________
State & Zip_____________
TELEPHONE Home:___________________
Business:_______________
Manner in which title is held (check one):
1. ________ Community Property
2. ________ Joint Tenants With Right of Survivorship
3. ________ Separate Property
4. ________ Individual Ownership
5. ________ Partnership
6. ________ Tenants in Common
7. ________ Corporation
8. ________ Other (Specify) : ________________________________________
________________________________________
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Signature Date
