SUBSCRIPTION AND SUBSCRIBER INFORMATION. Please print all information (other than signatures), as applicable, in the space provided below Number of Units: (Name of Subscriber) Unit Price: X $3.85 Account Reference (if applicable): Aggregate Subscription Price: By: (the “Subscription Price”) Authorized Signature If the Subscriber is signing as agent for a principal (beneficial purchaser) and is not purchasing as trustee or agent for accounts fully managed by it, complete the following: (Official Capacity or Title – if the Subscriber is not an individual) (Name of individual whose signature appears above if different than the name of the Subscriber printed above.) (Name of Principal) (Subscriber’s Address, including State) (Principal’s Address) (Telephone Number) (Email Address)
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Samples: Subscription Agreement (Geopetro Resources Co), Registration Rights Agreement (Geopetro Resources Co)
SUBSCRIPTION AND SUBSCRIBER INFORMATION. Please print all information (other than signatures), as applicable, in the space provided below Number of Units: (Name of Subscriber) Unit Price: X $3.85 0.48 Account Reference (if applicable): = Aggregate Subscription Price: By: (the “Subscription Price”) Authorized Signature If the Subscriber is signing as agent for a principal (beneficial purchaser) and is not purchasing as trustee or agent for accounts fully managed by it, complete the following: (Official Capacity or Title – — if the Subscriber is not an individual) (Name of individual whose signature appears above if different than the name of the Subscriber printed above.) (Name of Principal) (Subscriber’s Address, including State) (Principal’s Address) (Telephone Number) (Email Address)
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SUBSCRIPTION AND SUBSCRIBER INFORMATION. Please print all ALL information (other than signatures), as applicable, in the space provided below Number of Units: (Name of Subscriber) Unit Price): Number of Flow-Through Shares: X x $3.85 0.30 Account Reference (if applicable): = Aggregate Subscription Price: By: (the “"Subscription Price”") Authorized Signature (Official Capacity or Title – if the Subscriber is not an individual) If the Subscriber is signing as agent for a principal (beneficial purchaser) and is not purchasing as trustee or agent for accounts fully managed by it, complete the following: (Official Capacity or Title – if the Subscriber is not an individual) (Name of individual whose signature appears above if different than the name of the Subscriber subscriber printed above.) (Name of Principal) (Subscriber’s Address, including StateMunicipality and Province) (Principal’s Address) S.I.N. or Taxation Account of Subscriber (Telephone Number) (Email Address)
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SUBSCRIPTION AND SUBSCRIBER INFORMATION. Please print all information (other than signatures), as applicable, in the space provided below Number of Units: (Name of Subscriber) Unit Price: X $3.85 0.45 Account Reference (if applicable): = Aggregate Subscription Price: By: (the “Subscription Price”) Authorized Signature If the Subscriber is signing as agent for a principal (Official Capacity or Title — if the Subscriber is not an individual) (beneficial purchaser) and is not purchasing as trustee or agent for accounts fully managed by it, complete the following: (Official Capacity or Title – if the Subscriber is not an individual) (Name of individual whose signature appears above if different than the name of the Subscriber printed above.) (Name of Principal) (Subscriber’s Address, including State) (Principal’s Address) (Telephone Number) (Email Address)
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