SUBSCRIPTION FORM FOR OTHER THAN INDIVIDUAL
Exhibit
10.1
SUBSCRIPTION
FORM FOR OTHER THAN INDIVIDUAL
Purchasers
of shares of Silver Star Capital Holdings, Inc., other than individuals, must
complete this form for the proper entity that will hold title to the
shares. Send this completed subscription agreement along with a wire
transfer, check or money order for their total payment, payable only
to:
SILVER STAR CAPITAL HOLDINGS,
INC
0000
Xxxxxx Xxxx Xxxx
Suite
200
Orlando,
Florida 32808-3935
If and
when accepted by us,
this subscription agreement shall constitute a subscription
for shares of our common stock
.. An accepted copy of this agreement will be returned to you as your receipt, and
certificates for your stock will be issued to you shortly
thereafter.
Method of
payment: [ ] Check, [ ] Money Order,
[ ] Wire Transfer
payable
only to: “Silver Star Capital Holdings, Inc.”
Wire
Transfer Instructions:
Bank:
Bank of America
Address:
Orlando, Florida
ABA:
XXXXXXXXX
Account
Name: Silver Star Capital Holdings, Inc.
Account
Number: XXXX XXXX XXXX
Reference:
Silver Star Capital Investors, LLC
I hereby
irrevocably tender this subscription agreement for the purchase of shares at $
________ per share.
With this
subscription agreement, I tender payment in the amount of $ _________________
for the shares subscribed.
In
connection with this investment, I represent and warrant as
follows:
(a) Prior
to tendering payment for the shares, I received your final prospectus dated
____________________.
(b) Our
entity is domiciled in the state of ______________.
|
ENTITY:
|
CORPORATION (authorized
agent of the corporation must sign)
|
|
|
EXISTING
PARTNERSHIP (at least one partner must
sign)
|
||
|
TRUST (all
trustees must sign)
|
|
Name
of Entity
|
|
|
Authorized
Agent (print name above)
|
|
|
Title
of Authorized Agent
|
|
|
Authorized
Agent (print name above)
|
|
|
Street
(business address ) or address of Registered Agent
|
|
|
City,
State, Zip Code
|
|
|
Business
Telephone or Home Telephone of Registered Agent
|
|
|
Fax
|
E-mail
|
The
undersigned acknowledges that the foregoing information is true, accurate, and
complete.
|
Date:
|
|||
For a
Trust, all Trustees must sign. Add a line for each.
|
ACCEPTED BY : Silver
Star Capital Holdings, Inc
|
|||
|
Date
|
|||
