Number of Units subscribed for. Two (2) Units against payment in cash in the amount of $ 50,000 , representing $25,000 per Unit, each representing 0.625% of Gross Margin. If the Units hereby subscribed for are to be owned by more than one person in any manner, the Purchaser understands and agrees that all of the co-owners of such Units must sign this Subscription Agreement. Jxx X. Xxxxxx Please print above the exact name(s) in which the Units are to be held.
Number of Units subscribed for. 2. Payment tendered (number of units subscribed for multiplied by $.50): ______________
Number of Units subscribed for. $ __________________________(at $1.20 per Unit)
Number of Units subscribed for. 2. Payment tendered (number of Units subscribed for multiplied by $0.01): _______________ (the “Aggregate Purchase Price”). Payment of the Aggregate Purchase Price can be made in cash or by check, bank draft or postal express money order payable to PhytoMedical Technologies, Inc. or by wire transfer of funds as follows: FORWARD THIS SUBSCRIPTION AGREEMENT TO PHYTOMEDICAL TECHNOLOGIES, INC. AT: 000 Xxxxxxxx Xxxxx, 0xx Xxxxx Xxxxxxxxx, Xxx Xxxxxx, 00000 Attention: President and Chief Executive Officer In connection with the offer and sale of the Units, the Company reserves the right, in its sole discretion, to reject any subscription in whole or in part for any reason whatsoever notwithstanding the tender of payment at any time prior to its acceptance of any subscriptions. This Subscription Agreement does not constitute an offer to sell or a solicitation of any offer to buy any Shares by anyone in any jurisdiction in which such offer or solicitation is not qualified to do so or to anyone to whom it is unlawful to make such offer or solicitation. The shares have not been registered in the State of Florida. The sale of the shares pursuant to this Subscription Agreement in the State of Florida shall be voidable by the Purchaser within three days after the receipt of consideration from such purchaser by the the Company. Questions concerning the construction, validity and enforceability of this Subscription Agreement shall be governed by the laws of the State of New York. Florida residents hereby represent that they have such knowledge and experience in financial and business matters as to be capable of evaluating the merits and risks of the investment in PhytoMedical Technologies, Inc. and they are able to bear the economic risk to such investment. SIGNATURE PAGE TO THE PHYTOMEDICAL TECHNOLOGIES, INC. SUBSCRIPTION AGREEMENT _____________________________ _____________________________ Signature Date ____________________________ _____________________________ Print Name of Purchaser Soc. Sec. or Tax ID No. ___________________________________________________________________________ Address for Delivery of Shares ___________________________________________________________________________ Telephone Number Facsimile Number ____________________________________________________________________________ Email Address
Number of Units subscribed for. 2,000,000 ------------------------------------------------ Total Dollar Amount: $500,000 ------------------------------------------------ Signature of Subscriber: /s/ Gregory I. Porges ------------------------------------------------ Gregory I. Porges Managing Memxxx Xxxx xx Xxxxcriber: Spectra Capital Management, LLC ------------------------------------------------ Address of Subscriber: 595 Madison Avenue, 37th Floor Xxx Xxxx, XX 00000 ------------------------------------------------ Subscriber's SS# or Tax Identification #: 20-1000866 ---------------------------------------------- Email contact address: gporges@sfgnyc.com ---------------------------------------------- Primary Contact Number: (212) 857 - 9300 Fax Number: (212) 857 - 9301 --- --- ---- --- --- ----- ACCEPTED BY: IVANY MINING, INC. Signature xx Xxthorized Signatory: /s/ Victor Cantore ------------------------------------ Name of Authorized Signatory: Victor Cantore ------------------------------------ Position of Authorized Signatory: Chief Financial Officer ------------------------------------ Date of Acceptance: December 8, 2007 ------------------------------------ ACCREDITED INVESTOR DEFINITION The Subscriber will be an "Accredited Investor" as such term is defined in Rule 501 of Regulation D promulgated under the United States Securities Act of 1933, as amended (the "Act") if the Subscriber is any of the following:
Number of Units subscribed for. (All Subscribers should please print information below exactly as they wish it to appear in the records of the Company.) Certificate in the Name of : _________________ Amount of Certificates: ________ Social Security Number of Individual or Other Corporate Taxpayer ID. Number ________________________________________ Address: _____________________________________________________________ Number and Street _____________________________________________________________ City State Zip Code Telephone Number Please check the box to indicate the form of ownership (if applicable): ________ TENANTS-IN-COMMON ________ JOINT TENANTS WITH RIGHT OF (All parties must sign) SURVIVORSHIP (All parties must sign above) ________ TENANTS BY THE ENTIRETIES (Both parties must sign above) All Parties Must Sign: ACCEPTANCE OF SUBSCRIPTION AXXXXXXXXX.XXX, INC. The foregoing subscription is hereby accepted this ________day of ________, 2001, for ________Units of Common Stock of the Company, AUTO CXXXXX.XXX, INC. BY: ____________________ Authorized Signature
Number of Units subscribed for. Units Total Subscription Price payable for Units:(U.S. $1.00 x number of Units): U.S. $ BOX B: Purchaser Information Name of Purchaser: Street Address: Street Address (2): City and State: ZIP Code: Contact Name: Phone No.: Email Address: DRS Delivery Email (if different from email address above): The Corporation hereby accepts the foregoing subscription by the Purchaser. Xxxxxx Farms Inc. Date: (Authorized Signature) ANNEX A TO: Xxxxxx Farms Inc. (the “Corporation”) In connection with the purchase of the Units, the Purchaser hereby represents, warrants and certifies to the Corporation that the Purchaser satisfies one or more of the categories indicated below (please initial the appropriate line(s) below): Category 1. A bank, as defined in Section 3(a)(2) of the United States Securities Act of 1933, as amended (the “Securities Act”), whether acting in its individual or fiduciary capacity; or Category 2. A savings and loan association or other institution as defined in Section 3(a)(5)(A) of the Securities Act, whether acting in its individual or fiduciary capacity; or Category 3. A broker or dealer registered pursuant to Section 15 of the United States Securities Exchange Act of 1934, as amended; or Category 4. Any investment adviser registered pursuant to Section 203 of the United States Investment Advisers Act of 1940, as amended or registered pursuant to the laws of a state; or Category 5. Any investment adviser relying on the exemption from registering with the Securities and Exchange Commission under Section 203(l) or (m) of the United States Investment Advisers Act of 1940, as amended; or Category 6. An insurance company as defined in Section 2(a)(13) of the Securities Act; or Category 7. An investment company registered under the United States Investment Company Act of 1940, as amended; or Category 8. A business development company as defined in Section 2(a)(48) of the United States Investment Company Act of 1940, as amended; or Category 9. A small business investment company licensed by the U.S. Small Business Administration under Section 301 (c) or (d) of the United States Small Business Investment Act of 1958, as amended; or Category 10. Any Rural Business Investment Company as defined in section 384A of the Consolidated Farm and Rural Development Act; or Category 11. A plan established and maintained by a state, its political subdivisions or any agency or instrumentality of a state or its political subdivisions, for the benefit of its employees if...
Number of Units subscribed for. Total Purchase Price of Units Subscribed For: $__________ Make Checks payable to "Xxxx Xxxx Development Fund, LLC” and mail payment with a completed and executed Subscription Agreement to: Xxxx Xxxx Development Fund, LLC 00000 X. Xxxxx Xxxxx Xxxxxx Blvd., Suite 200 Scottsdale, Arizona 85260 Attention: Xxxx Xxxx Manner in which title is to be held: _______ Community property (one signature). _______ Individual ownership. _______ Joint tenancy (both sign). _______ Tenancy-in-common (all sign). _______ Corporation _______ Partnership _______ XXX, Xxxxx, Pension or Profit Sharing Plan _______ Trust _______ Other (Please indicate) _________________________ Xxxx Xxxx Development Fund, LLC (For Individuals) TO BE COMPLETED AND SIGNED BY ALL INDIVIDUAL INVESTORS This page constitutes the Signature Page for all of the following documents: (a) Subscription Agreement; (b) Offeree Questionnaire; and (c) LLC Agreement. Execution of this Signature Page constitutes execution of such documents.
Number of Units subscribed for. Total Purchase Price of Units Subscribed For: $__________ Make Checks payable to "Xxxx Xxxx Development Fund, LLC” and mail payment with a completed and executed Subscription Agreement to: Xxxx Xxxx Development Fund, LLC 00000 X. Xxxxx Xxxxx Xxxxxx Blvd., Suite 200 Scottsdale, Arizona 85260 Attention: Xxxx Xxxx Xxxx Xxxx Development Fund, LLC (For Corporations, Partnerships, Trusts or Other Entities) TO BE COMPLETED AND SIGNED BY ALL INVESTORS WHO ARE PARTNERSHIPS, CORPORATIONS, LIMITED LIABILITY COMPANIES OR TRUSTS This page constitutes the Signature Page for the following documents: (a) Subscription Agreement; (b) LLC Agreement; and (c) Offeree Questionnaire. Execution of this Signature Page constitutes execution of such documents.
Number of Units subscribed for. Number of Units Oversubscribed for: ___________________ Total Number of Units Subscribed for: ___________________ Total Subscription Price (at $6.00 per Unit): ____________________ Please PRINT or TYPE exact name(s) in which undersigned desires shares to be registered {signatures continued on next page} Under the penalty of perjury, I certify that: (A) the Social Security Number or Taxpayer Identification Number given below is correct; and (B) I am not subject to backup withholding. INSTRUCTION: YOU MUST CROSS OUT (B) 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. Date Signature(s)* Print Address: ____________________________________ ____________________________________ ____________________________________ Please indicate form of ownership you desire for the shares ( [_] individual, [_] joint tenants with right of survivorship, [_] tenants in common, [_] trust, [_] corporation, [_] partnership, [_] custodian, etc.) ____________________________________ Area Code and Telephone No. ______________________________________ Social Security or Federal Taxpayer Identification No. TO BE COMPLETED BY THE COMPANY: Accepted as of __________ ___, 2003, as to ___________________ Units. HORIZON BANCORPORATION, INC. By: _____________________________ Signature __________________________________ Print Name
