SIGNATURE PAGE OF PRIVATE PLACEMENT SUBSCRIPTION AGREEMENT
FOR
XXXXXXX XXXXXXXXX
INDIVIDUAL INVESTOR SIGNATURE PAGE
IN WITNESS WHEREOF, the parties have executed this Subscription
Agreement as of the day and year first written above.
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NUMBER OF SHARES 60,000 x $0.125 = $ 7,500
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X /s/ Xxxxxxx Xxxxxxxxx
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Signature Signature (if purchasing jointly)
Xxxxxxx Xxxxxxxxx
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Name Typed or Printed Name Typed or Printed
000 Xxxxxxxx Xxxx
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Xxxxxxx Xxxxxxx
Xxxxx Xxxxx, Xxxxxxxxxx X00 0XX XX
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City, State and Zip Code City, State and Zip Code
Telephone - Business Telephone - Business
Telephone - Residence Telephone - Residence
Facsimile - Business Facsimile - Business
Facsimile - Residence Facsimile - Residence
Tax ID# or Social Security Tax ID# or Social Security
Name in which Shares should be issued: Xxxxxxx Xxxxxxxxx
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Dated:
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This Subscription Agreement is agreed to and accepted as of October 28, 2000
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XXXXXXXXXX.XXX, INC.
/s/ Xxxx Xxxxxx
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Name: Xxxx Xxxxxx
Title: Secretary and Chief Operating Officer
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