MAC FILMWORKS, INC.
SUBSCRIPTION AGREEMENT
The Investor named below, by payment of a wire transfer or check
payable to MAC FILMWORKS, INC. - ESCROW ACCOUNT, hereby subscribes for units.
Each unit consists of consists of one share of common stock and seven redeemable
warrants, each to purchase one share of common stock of Mac Filmworks, Inc.
("Units"). By such payment, the named Investor acknowledges receipt of the
Prospectus and any amendment, the terms of which govern the investment in the
Units.
A. INVESTMENT:
(1) No. of Shares purchased Dollar Amount: $
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(2) [ ] Initial Purchase; or [ ]Additional Purchase
(3) [ ] Check Payment Enclosed: Number: Date / / ; or
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(4) [ ] Wire Transfer: Sending Bank: ----------------------- Wire #: --------------------------
Date / / .
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Bank Address:_______________________ Phone Number__________________
B. REGISTRATION:
(1) Registered Owner: [ ] Mr. [ ] Mrs. [ ] Ms. [ ] Dr. [ ] Other
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Name:
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(2) Co-owner: [ ]Mr. [ ]Mrs. [ ]Ms. [ ]Dr. [ ]Other
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Name:
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(3) Mailing Address:
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(4) Residence Address (if different from above):
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(5) Telephone #: (Home) ( ) - (Office) ( )
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- .
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(6) Email Address:
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(7) Birth Date: / / . (8) Birth Date Co-Owner
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/ / .
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(9) Please indicate Citizenship Status: [ ]U.S. Citizen [ ]Other
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(10) Social Security or (National Identity) Number
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(11) Co-Owner
Corporate or Custodial Taxpayer ID #:
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C. OWNERSHIP: [ ] Individual Ownership [ ] XXX or Xxxxx
[ ] Joint Tenants with Rights of Survivorship
[ ] Trust/Date of Trust Established Pension/Trust ___
/ ___ / ___ (S.E.P.)
[ ] Tenants in Common [ ]Tenants by the Entirety [
]Corporate Ownership
[ ] Partnership [ ]Other _______________________________________________
D. SIGNATURES: By signing below, I/we represent that I/we have relied on the information set forth in the
Prospectus, as and if amended, and on no other statement whatever, whether written or oral.
Signatures - Registered Owner: Co-Owner:
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E. PRINT NAMES OF CUSTODIAN OR TRUSTEE:
Name: Date:
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Authorized Signature: Witness Signature:
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F. RETURN OF PAYMENT SHOULD BE SENT TO (IF DIFFERENT FROM REGISTERED
OWNER): Name: _________________________________ c/o:
__________________________________________
Address: _____________________________________________________________________________
Account #___________________________ Phone: (_____) ______ - _________________________
G. BENEFICIAL OWNER(S): All reports and financial statements will normally be sent to the registered owner
at the address in Section B. If reports and financial statements are to be sent to the Beneficial Owner
of an XXX or Xxxxx, insert name of the Beneficial Owner.
Name of Beneficial Owner Only: _______________________________ Phone: (___)___- ___________
Address: _____________________________________________________________________________
H. BROKER-DEALER/REGISTERED REPRESENTATIVE DATA (broker-dealer use only):
Broker-Dealer NASD Firm Name: ________________________ Telephone Number: (___)_____- _____
Main Office Address: ___________________________________________________________________
Authorized Signature: ______________________________________________ Date: ______________
Print or Type Name of Registered Representative:____________________________________________
Signature: _________________________________________________ Phone: (___)______- ________
Branch Office Address: _________________________________________________________________
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SEND TO: One Financial Securities, Ltd. ACCEPTED:
Attn: Xx. Xxxxxx Xxxxx, President MAC FILMWORKS, INC.
0000 Xxxxxxx, Xxxxx 000
Xxxxxxx, Xxxxx 00000 By:_______________________
Phone (713) ____________ Xxx XxXxxxxxxx, President
Fax (000)000-0000
Date:____/____/____
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