FINAL SUBSCRIPTION AGREEMENT
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EXHIBIT 99.2
Mountain Bancshares, Inc.
P. O. Xxx 000
Xxxxxxxxxxx, Xxxxxxx 00000
Ladies and Gentlemen:
I hereby subscribe to purchase the number of shares of Mountain Bancshares, Inc.'s common stock indicated below.
I have received a copy of Mountain Bancshares, Inc.'s final prospectus, dated ___________________, 2002. I understand that my purchase of Mountain Bancshares, Inc.'s common stock involves significant risk, as described under "Risk Factors" in the final prospectus. I also understand that no federal or state agency has made any finding or determination regarding the fairness of Mountain Bancshares, Inc.'s offering of common stock, the accuracy or adequacy of the final prospectus, or any recommendation or endorsement concerning an investment in the common stock.
I enclose my check in the amount of $10.00 multiplied by the number of shares I wish to buy. My check is made payable to "The Bankers Bank - Escrow Account for Mountain Bancshares, Inc."
WHEN MOUNTAIN BANCSHARES, INC. RECEIVES THIS AGREEMENT AND MY CHECK, THIS SUBSCRIPTION WILL BE FINAL AND BINDING AND WILL BE IRREVOCCABLE UNTIL THE OFFERING IS CLOSED.
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Number of Shares (minimum 250 shares): ________ Total Subscription Price (at $10.00 per shares): $_______ |
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____________________________________ Please PRINT or TYPE exact name(s) in which the shares should be registered |
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SUBSTITUTE W-9
Under the penalties of perjury, I certify that: (1) the Social Security number or Taxpayer Identification Number given below is correct; and (2) I am not subject to backup withholding. INSTRUCTION: YOU MUST CROSS OUT #2 ABOVE IF YOU HAVE BEEN NOTIFIED BY THE INTERNAL REVENUE SERVICE THAT YOU ARE SUBJECT TO BACKUP WITHHOLDING BECAUSE OF UNDERREPORTING INTEREST OR DIVIDENDS ON YOUR TAX RETURN.
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Date |
Signature(s) |
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Area Code and Telephone No. |
Please indicate the form of ownership desired for the shares (individual), joint tenants with right of survivorship, tenant in common, trust, corporation, partnership custodian, etc.) |
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Social Security or Federal Taxpayer Identification No. |
Street Address |
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City/State/Zip Code |
TO BE COMPLETED BY MOUNTAIN BANCSHARES, INC.
Accepted as of __________________________, 2002, as to ___________ shares.
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MOUNTAIN BANCSHARES, INC. |
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By:___________________________________ |
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Signature |
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______________________________________ |
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Print Name |
When signing as attorney, trustee, administrator or guardian, please give your full title as such. If a corporation, please sign in full corporate name by president or other authorized officer. In case of joint tenants, each joint owner must sign.
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