FORM OF SUBSCRIPTION. TO: Enterra Systems Inc. 00 - 0000 Xxxxxxxxx Xxxxxx, Xxxxxxxxx, Xxxxxxx Xxxxxxxx Xxxxxx X0X 0X0 The undersigned Holder of the within Warrants hereby subscribes for___________ common shares (the “Shares”) of Enterra Systems Inc. (the “Company) pursuant to the within Warrants at US$1.15 per Share on the terms specified in the said Warrants. This subscription is accompanied by a certified cheque or bank draft payable to or to the order of the Company for the whole amount of the purchase price of the Shares. The undersigned Holder hereby certifies that the undersigned is not a U.S. person and is not subscribing for the Shares on Behalf of a U.S. person. The undersigned hereby directs that the Shares be registered as follows: NAME(S) IN FULL ADDRESS(ES) NUMBER OF SHARES C.M.M.G. Finance, Inc. 000-000 Xxxx Xxxxxxxx Xxxxxx Xxxxxxxxx XX TOTAL: (Please print full name in which share certificates are to be issued, stating whether Mr., Mrs. or Miss is applicable). DATED this 29 day of November, 2005. In the presence of: C.M.M.G. Finance, Inc. Signature of Witness Authorized Signature Please print below your name and address in full. Name (Mr./Mrs./Miss) Xx. Xxxxxxxx Xxxxxx Address 000-000 Xxxx Xxxxxxxx Xxxxxx Xxxxxxxxx XX
Appears in 1 contract
FORM OF SUBSCRIPTION. TO: Enterra Systems Colorado Goldfields Inc. 00 - 0000 Xxxxxxxxx 00000 X. Xxxxxxx Xxxxxx, XxxxxxxxxXxxxx 000 Xxxxxxxx, Xxxxxxx Xxxxxxxx Xxxxxx X0X 0X0 Xxxxxxxx, XXX 00000 The undersigned Holder of the within Warrants hereby subscribes forfor ____________ common shares (the “"Shares”") of Enterra Systems Colorado Goldfields Inc. (the “"Company") pursuant to the within Warrants at US$1.15 1.00 per Share on the terms specified in the said Warrants. This subscription is accompanied by a certified cheque or bank draft payable to or to the order of the Company for the whole amount of the purchase price of the Shares. The undersigned Holder hereby certifies that represents that, at the time of the exercise of these Warrants, all of the representations and warranties contained in Section 6 of the Subscription Agreement between the Company and the undersigned is not a U.S. person pursuant to which these Warrants were issued are true and is not subscribing for the Shares on Behalf of a U.S. personaccurate. The undersigned hereby directs that the Shares be registered as follows: NAME(S) IN FULL ADDRESS(ES) NUMBER OF SHARES C.M.M.G. Finance, Inc. 000-000 Xxxx Xxxxxxxx Xxxxxx Xxxxxxxxx XX TOTAL: (Please print full name in which share certificates are to be issued, stating whether Mr., Mrs. or Miss is applicable). DATED this 29 ________ day of November__________________ , 2005______. In the presence of: C.M.M.G. Finance, Inc. __________________________________________ __________________________________________ Signature of Witness Authorized Signature of Warrant Holder Please print below your name and address in full. Name (Mr./Mrs./Miss) Xx. Xxxxxxxx Xxxxxx _________________________________________________________ Address 000-000 Xxxx Xxxxxxxx Xxxxxx Xxxxxxxxx XX_________________________________________________________ _________________________________________________________
Appears in 1 contract
Samples: Private Placement Subscription Agreement (Colorado Goldfields Inc.)
FORM OF SUBSCRIPTION. TO: Enterra Systems Nexaira Wireless Inc. 00 - 0000 Xxxxxxxxx Xxxxxx, 1404 – 000 Xxxx Xxxxxxxx Xxxxxx Xxxxxxxxx, Xxxxxxx Xxxxxxxx Xxxxxx X0X 0X0 The undersigned Holder of the within Warrants hereby subscribes forfor _____________ common shares (the “Shares”) of Enterra Systems Nexaira Wireless Inc. (the “Company”) pursuant to the within Warrants at US$1.15 1.00 per Share on the terms specified in the said Warrants. This subscription is accompanied by a certified cheque or bank draft payable to or to the order of the Company for the whole amount of the purchase price of the Shares. The undersigned Holder hereby certifies that represents that, at the time of the exercise of these Warrants, all of the representations and warranties contained in Section 6 of the Subscription Agreement between the Company and the undersigned is not a U.S. person pursuant to which these Warrants were issued are true and is not subscribing for the Shares on Behalf of a U.S. personaccurate. The undersigned hereby directs that the Shares be registered as follows: NAME(S) IN FULL ADDRESS(ES) NUMBER OF SHARES C.M.M.G. Finance, Inc. 000-000 Xxxx Xxxxxxxx Xxxxxx Xxxxxxxxx XX TOTAL: (Please print full name in which share certificates are to be issued, stating whether Mr., Mrs. or Miss is applicable). DATED this 29 _________ day of November___________________, 2005________. In the presence of: C.M.M.G. Finance, Inc. Signature of Witness Authorized Signature of Warrant Holder Please print below your name and address in full. Name (Mr./Mrs./Miss) Xx. Xxxxxxxx Xxxxxx Address 000-000 Xxxx Xxxxxxxx Xxxxxx Xxxxxxxxx XX.
Appears in 1 contract
Samples: Form of Subscription Agreement (Nexaira Wireless Inc.)
FORM OF SUBSCRIPTION. TO: Enterra Systems Nexaira Wireless Inc. 00 - 0000 Xxxxxxxxx Xxxxxx, 1404 – 000 Xxxx Xxxxxxxx Xxxxxx Xxxxxxxxx, Xxxxxxx Xxxxxxxx Xxxxxx X0X 0X0 The undersigned Holder of the within Warrants hereby subscribes forfor ____________ common shares (the “Shares”) of Enterra Systems Nexaira Wireless Inc. (the “Company”) pursuant to the within Warrants at US$1.15 1.50 per Share on the terms specified in the said Warrants. This subscription is accompanied by a certified cheque or bank draft payable to or to the order of the Company for the whole amount of the purchase price of the Shares. The undersigned Holder hereby certifies that represents that, at the time of the exercise of these Warrants, all of the representations and warranties contained in Section 6 of the Subscription Agreement between the Company and the undersigned is not a U.S. person pursuant to which these Warrants were issued are true and is not subscribing for the Shares on Behalf of a U.S. personaccurate. The undersigned hereby directs that the Shares be registered as follows: NAME(S) IN FULL ADDRESS(ES) NUMBER OF SHARES C.M.M.G. Finance, Inc. 000-000 Xxxx Xxxxxxxx Xxxxxx Xxxxxxxxx XX TOTAL: (Please print full name in which share certificates are to be issued, stating whether Mr., Mrs. or Miss is applicable). DATED this 29 ________ day of November__________________, 2005______. In the presence of: C.M.M.G. Finance, Inc. Signature of Witness Authorized Signature of Warrant Holder Please print below your name and address in full. Name (Mr./Mrs./Miss) Xx. Xxxxxxxx Xxxxxx Address 000-000 Xxxx Xxxxxxxx Xxxxxx Xxxxxxxxx XXAddress
Appears in 1 contract
Samples: Form of Subscription Agreement (Nexaira Wireless Inc.)
FORM OF SUBSCRIPTION. TO: Enterra Systems Global Health Ventures Inc. 00 - 0000 Xxxxxxxxx Xxxxxx, Xxxx 00xx Xxxxxx Xxxxxxxxx, Xxxxxxx Xxxxxxxx Xxxxxx X0X 0X0 The undersigned Holder of the within Warrants hereby subscribes forfor ____________ common shares (the “Shares”) of Enterra Systems Global Health Ventures Inc. (the “Company”) pursuant to the within Warrants at US$1.15 _____ per Share on the terms specified in the said Warrants. This subscription is accompanied by a certified cheque or bank draft payable to or to the order of the Company for the whole amount of the purchase price of the Shares. The undersigned Holder hereby certifies that represents that, at the time of the exercise of these Warrants, all of the representations and warranties contained in Section 6 of the Subscription Agreement between the Company and the undersigned is not a U.S. person pursuant to which these Warrants were issued are true and is not subscribing for the Shares on Behalf of a U.S. personaccurate. The undersigned hereby directs that the Shares be registered as follows: NAME(S) IN FULL ADDRESS(ES) NUMBER OF SHARES C.M.M.G. Finance, Inc. 000-000 Xxxx Xxxxxxxx Xxxxxx Xxxxxxxxx XX TOTAL: (Please print full name in which share certificates are to be issued, stating whether Mr., Mrs. or Miss is applicable). DATED this 29 ________ day of November__________________ , 2005______. In the presence of: C.M.M.G. Finance, Inc. Signature of Witness Authorized Signature of Warrant Holder Please print below your name and address in full. Name (Mr./Mrs./Miss) Xx. Xxxxxxxx Xxxxxx Address 000-000 Xxxx Xxxxxxxx Xxxxxx Xxxxxxxxx XXAddress
Appears in 1 contract
Samples: Private Placement Subscription Agreement (Global Health Ventures Inc.)
FORM OF SUBSCRIPTION. TO: Enterra Systems Inc. 00 - Kore Nutrition Incorporated 0000 Xxxxxxxxx XxxxxxXxxxxx Xxxxxxx, Xxxxx X-000 Xxxxxxxxx, Xxxxxxx Xxxxxxxx Xxxxxx X0X 0X0 00000 Attention: President Fax No. (000) 000-0000 c/o Xxxxxx X. Xxxx The undersigned Holder of the within Warrants hereby subscribes forfor ____________ common shares (the “Shares”) of Enterra Systems Inc. Kore Nutrition Incorporated (the “Company”) pursuant to the within Warrants at US$1.15 0.15 per Share on the terms specified in the said Warrants. This subscription is accompanied by a certified cheque or bank draft payable to or to the order of the Company for the whole amount of the purchase price of the Shares. The undersigned Holder hereby certifies that represents that, at the time of the exercise of these Warrants, all of the representations and warranties contained in subsections 6.1 and 10.3 of the Subscription Agreement between the Company and the undersigned is not a U.S. person pursuant to which these Warrants were issued are true and is not subscribing for the Shares on Behalf of a U.S. personaccurate. The undersigned hereby directs that the Shares be registered as follows: NAME(S) IN FULL ADDRESS(ES) NUMBER OF SHARES C.M.M.G. Finance, Inc. 000-000 Xxxx Xxxxxxxx Xxxxxx Xxxxxxxxx XX TOTAL: (Please print full name in which share certificates are to be issued, stating whether Mr., Mrs. or Miss is applicable). DATED this 29 ________ day of November__________________ , 2005______. In the presence of: C.M.M.G. Finance, Inc. Signature of Witness Authorized Signature of Warrant Holder Please print below your name and address in full. Name (Mr./Mrs./Miss) Xx. Xxxxxxxx Xxxxxx Address 000-000 Xxxx Xxxxxxxx Xxxxxx Xxxxxxxxx XXAddress
Appears in 1 contract
Samples: Private Placement Subscription Agreement (Kore Nutrition, Inc.)
FORM OF SUBSCRIPTION. TO: Enterra Systems Inc. 00 - 0000 Xxxxxxxxx XxxxxxUrex Energy Corp. 00000 X. XxXxxxxx Xxxx. Xxxxxxxx 000-000 Xxxx, Xxxxxxxxx, Xxxxxxx Xxxxxxxx Xxxxxx X0X 0X0 00000 XXX The undersigned Holder of the within Warrants hereby subscribes forfor ____________ common shares (the “"Shares”") of Enterra Systems Inc. Urex Energy Corp. (the “"Company") pursuant to the within Warrants at US$1.15 1.00 per Share on the terms specified in the said Warrants. This subscription is accompanied by a certified cheque or bank draft payable to or to the order of the Company for the whole amount of the purchase price of the Shares. The undersigned Holder hereby certifies that represents that, at the time of the exercise of these Warrants, all of the representations and warranties contained in Section 6 of the Subscription Agreement between the Company and the undersigned is not a U.S. person pursuant to which these Warrants were issued are true and is not subscribing for the Shares on Behalf of a U.S. personaccurate. The undersigned hereby directs that the Shares be registered as follows: NAME(S) IN FULL ADDRESS(ES) NUMBER OF SHARES C.M.M.G. Finance, Inc. 000-000 Xxxx Xxxxxxxx Xxxxxx Xxxxxxxxx XX TOTAL: (Please print full name in which share certificates are to be issued, stating whether Mr., Mrs. or Miss is applicable). DATED this 29 ________ day of November__________________ , 2005______. In the presence of: C.M.M.G. Finance, Inc. __________________________________________ ________________________________________ Signature of Witness Authorized Signature of Warrant Holder Please print below your name and address in full. Name (Mr./Mrs./Miss) Xx. Xxxxxxxx Xxxxxx __________________________________________________________ Address 000-000 Xxxx Xxxxxxxx Xxxxxx Xxxxxxxxx XX__________________________________________________________ __________________________________________________________
Appears in 1 contract
Samples: Private Placement Subscription Agreement (Urex Energy Corp.)
FORM OF SUBSCRIPTION. TO: Enterra Systems Inc. 00 - 0000 Xxxxxxxxx XxxxxxUrex Energy Corp. 00000 X. XxXxxxxx Xxxx. Xxxxxxxx 000-000 Xxxx, Xxxxxxxxx, Xxxxxxx Xxxxxxxx Xxxxxx X0X 0X0 00000 XXX The undersigned Holder of the within Warrants hereby subscribes forfor ____________ common shares (the “"Shares”") of Enterra Systems Inc. Urex Energy Corp. (the “"Company") pursuant to the within Warrants at US$1.15 0.50 per Share on the terms specified in the said Warrants. This subscription is accompanied by a certified cheque or bank draft payable to or to the order of the Company for the whole amount of the purchase price of the Shares. The undersigned Holder hereby certifies that represents that, at the time of the exercise of these Warrants, all of the representations and warranties contained in Section 6 of the Subscription Agreement between the Company and the undersigned is not a U.S. person pursuant to which these Warrants were issued are true and is not subscribing for the Shares on Behalf of a U.S. personaccurate. The undersigned hereby directs that the Shares be registered as follows: NAME(S) IN FULL ADDRESS(ES) NUMBER OF SHARES C.M.M.G. Finance, Inc. 000-000 Xxxx Xxxxxxxx Xxxxxx Xxxxxxxxx XX TOTAL: (Please print full name in which share certificates are to be issued, stating whether Mr., Mrs. or Miss is applicable). DATED this 29 ________ day of November__________________ , 2005______. In the presence of: C.M.M.G. Finance, Inc. ___________________________________________ __________________________________ Signature of Witness Authorized Signature of Warrant Holder Please print below your name and address in full. Name (Mr./Mrs./Miss) Xx. Xxxxxxxx Xxxxxx _________________________________________________________ Address 000-000 Xxxx Xxxxxxxx Xxxxxx Xxxxxxxxx XX_________________________________________________________ _________________________________________________________
Appears in 1 contract
Samples: Private Placement Subscription Agreement (Urex Energy Corp.)
FORM OF SUBSCRIPTION. TO: Enterra Systems Nexaira Wireless Inc. 00 - 0000 Xxxxxxxxx Xxxxxx, 1404 – 000 Xxxx Xxxxxxxx Xxxxxx Xxxxxxxxx, Xxxxxxx Xxxxxxxx Xxxxxx X0X 0X0 The undersigned Holder of the within Warrants hereby subscribes forfor ____________ common shares (the “Shares”) of Enterra Systems Nexaira Wireless Inc. (the “Company”) pursuant to the within Warrants at US$1.15 1.00 per Share on the terms specified in the said Warrants. This subscription is accompanied by a certified cheque or bank draft payable to or to the order of the Company for the whole amount of the purchase price of the Shares. The undersigned Holder hereby certifies that represents that, at the time of the exercise of these Warrants, all of the representations and warranties contained in Section 6 of the Subscription Agreement between the Company and the undersigned is not a U.S. person pursuant to which these Warrants were issued are true and is not subscribing for the Shares on Behalf of a U.S. personaccurate. The undersigned hereby directs that the Shares be registered as follows: NAME(S) IN FULL ADDRESS(ES) NUMBER OF SHARES C.M.M.G. Finance, Inc. 000-000 Xxxx Xxxxxxxx Xxxxxx Xxxxxxxxx XX TOTAL: (Please print full name in which share certificates are to be issued, stating whether Mr., Mrs. or Miss is applicable). DATED this 29 ________ day of November__________________, 2005______. In the presence of: C.M.M.G. Finance, Inc. Signature of Warrant Holder Signature of Witness Authorized Signature Please print below your name and address in full. Name (Mr./Mrs./Miss) Xx. Xxxxxxxx Xxxxxx Address 000-000 Xxxx Xxxxxxxx Xxxxxx Xxxxxxxxx XXAddress
Appears in 1 contract
Samples: Private Placement Subscription Agreement (Nexaira Wireless Inc.)