SUBSCRIPTION AMOUNTS. of FT Units to be purchased at Cdn$1.00 each ______________________________________ Total Subscription Funds for FT Units Cdn$__________________________________ Dated this ________ day of ______________________, 2005 _____________________________________________ (Name of Subscriber – please print) By: _________________________________________ (Official Capacity or Title – please print) _____________________________________________ Authorized Signature _________ Please print name of individual whose signature appears above if different than the name of the Subscriber printed above ___________________________________________ Subscriber's Address ___________________________________________ ___________________________________________ (Telephone Number) ___________________________________________ (Facsimile Number) ____________________________________________ (Name – please print) ____________________________________________ ____________________________________________ (if space is inadequate, please attach a schedule containing the necessary information. ___________________________________________ Beneficial Purchaser's Address ___________________________________________ ___________________________________________ Registration Instructions ____________________________________________ (Name ____________________________________________ Account Reference, if applicable ____________________________________________ Address ____________________________________________ Delivery Instructions ___________________________________________ Name ___________________________________________ Account Reference, if applicable ___________________________________________ Contact Name ___________________________________________ Address ___________________________________________ (Telephone Number) ___________________________________________ (Facsimile Number) Execution by the Purchaser above shall constitute an irrevocable offer and agreement by the Purchaser to subscribe for the securities described herein on the terms and conditions herein set out. The Issuer shall be entitled to rely on the delivery of a facsimile copy of this subscription, and acceptance by the Issuer of such facsimile subscription shall be legally effective to create a valid and binding agreement between the Purchaser and the Issuer in accordance with the terms and conditions hereof.
Appears in 1 contract
Sources: Subscription Agreement (Crosshair Exploration & Mining Corp)
SUBSCRIPTION AMOUNTS. No. of FT Units to be purchased at Cdn$1.00 Cdn$0.80 each _______________________________________ Total Subscription Funds for FT Units Cdn$___________________________________ Dated this ________ day of ______________________, 2005 _of_________________________2005 REGISTRATION AND DELIVERY ____________________________________________ (Name of Subscriber – please print) By: _________________________________________ (Official Capacity or Title – please print) ______________________________________________ Authorized Signature ______________________________________________ Please print name of individual whose signature appears above if different than the name of the Subscriber printed above ____________________________________________ Subscriber's Address _____________________________________________ _____________________________________________ (Telephone Number) _____________________________________________ (Facsimile Number) Details of Beneficial Purchaser If Not Same as Subscriber _____________________________________________ (Name – please print) ______________________________________________ ______________________________________________ (if space is inadequate, please attach a schedule containing the necessary information. _____________________________________________ Beneficial Purchaser's Address _____________________________________________ _____________________________________________ Registration Instructions ____________________________________________ (Name _____________________________________________ Account Reference, if applicable _____________________________________________ Address _____________________________________________ Delivery Instructions ____________________________________________ Name ____________________________________________ Account Reference, if applicable ____________________________________________ Contact Name ____________________________________________ Address ____________________________________________ (Telephone Number) _____________________________________________ (Facsimile Number) Execution by the Purchaser above shall constitute an irrevocable offer and agreement by the Purchaser to subscribe for the securities described herein on the terms and conditions herein set out. The Issuer shall be entitled to rely on the delivery of a facsimile copy of this subscription, and acceptance by the Issuer of such facsimile subscription shall be legally effective to create a valid and binding agreement between the Purchaser and the Issuer in accordance with the terms and conditions hereof.
Appears in 1 contract
Sources: Subscription Agreement (Crosshair Exploration & Mining Corp)