InterCare Dx, Inc REG-A-Plus Offering Subscription Agreement
EXHIBIT 4.1
InterCare Dx, Inc
REG-A-Plus Offering
Subscription Agreement
The undersigned, intending to be legally bound, hereby irrevocably subscribes for and agrees to purchase shares of the common stock of InterCare Dx, Inc., a California (the “Company”), for a purchase price of $5.00. Simultaneous with the execution and delivery of this confirmation to the Company, the undersigned is either delivering a check made payable to “InterCare Dx, Inc.” via tracking mail to 00000 Xxxxx Xxxxxxx Xxxxxx, Xxxxx 000, Xxxxxxxx Xxxxxxxxxx 00000 or sending a wire transfer payment to the Company’s account via our Online Subscription Portal at xxxxx://xxx.xxxxxxxxx.xxx.
The undersigned acknowledges that he has received a copy of the Offering Circular of the Company, filed with the Securities and Exchange Commission (“Offering Circular”) with respect to the offer and sale of the shares of stock being purchased.
The undersigned further acknowledges that although the shares of common stock being purchased from the Company are registered securities under the U.S. Securities Act of 1933, as amended, there may be restrictions on the resale of the shares imposed by the particular state law where the undersigned resides or in a jurisdiction outside of the United States. Accordingly, the undersigned will not offer to sell or sell the Shares in any jurisdiction unless the undersigned obtains all required consents, if any.
The undersigned understands that an investment in the shares is a speculative investment, which involves a high degree of risk and the potential loss of his entire investment. The undersigned is further aware that no federal or state agency has (i) made any finding or determination as to the fairness of this investment, (ii) made any recommendation or endorsement of the shares or the Company, or (iii) guaranteed or insured any investment in the Shares or any investment made by the Company. The undersigned understands that the price of the stock purchased hereby bears no relation to the assets, book value or net worth of the Company and was determined arbitrarily by the Company. The undersigned agrees and acknowledges that it has read all the information contained in the Offering Circular, including without limitation, the Risk Factors contained therein.
| Date: | Amount of Investment: $ | Number of Shares: |
| 1. | Print Full Name of Investor: |
|
| 2. | Permanent Address of Investor: |
|
| 3. | Authorized Signatory: |
|
If Investor is an entity, provide copy of Articles of Incorporation, Certificate of Formation or other evidence of existence, as well as a copy of board resolution or other evidence of authorization to purchase the shares of the Company.
| Authorized signature of the CEO of InterCare Dx, Inc. |
|
