Exhibit 4.3.1
MAINSTREET BANKSHARES, INC.
SHARES SUBSCRIPTION AGREEMENT
To: MainStreet BankShares, Inc.
Suite 12
000 Xxxx Xxxxxx Xxxxxx
Xxxxxxxxxxxx, Xxxxxxxx 00000
Attn: Xxxx XxXxxxxx, President
Gentlemen:
You have informed me that MainStreet BankShares, Inc., a Virginia
corporation (the "Company"), is offering 891,807 shares of the Company's Common
Stock ("Shares") to the public at a price of $10.50 per Share payable as
provided herein and as described in and offered pursuant to the Prospectus
furnished to the undersigned herewith (the "Prospectus").
1. Subscription. Subject to the terms and conditions hereof, the
undersigned hereby tenders this subscription, together with payment indicated
below in United States currency by check, bank draft or money order payable to
"MainStreet BankShares, Inc. - Escrow Account", representing the payment of
$10.50 per Share for the number of Shares indicated below. The total
subscription price must be paid at the time the Subscription Agreement is
executed.
2. Acceptance of Subscription. It is understood and agreed that the
Company shall have the right to accept or reject this subscription in whole or
in part, for any reason whatsoever. The Company may reduce the number of Shares
for which the undersigned has subscribed, indicating acceptance of less than all
of the Shares subscribed on its written form of acceptance.
3. Acknowledgments. The undersigned hereby acknowledges receipt of a copy
of the Prospectus, and represents that this subscription is made solely on the
basis of the information contained in the Prospectus and is not made in reliance
on any inducement, representation or statement not contained in the Prospectus.
The undersigned understands that no person (including any officer or director)
has authority to give any information or make any representation not contained
in the Prospectus, and if given or made, such information and representations
should not be relied upon as having been made by the Company or its officers or
directors. This Subscription Agreement and the Prospectus contain the entire
agreement and understanding among the undersigned, the officers and directors
and the Company with respect to the offering and sale of Shares to the
undersigned. This Subscription Agreement creates a legally binding obligation,
and the undersigned agrees to be bound by the terms of this Agreement.
4. Revocation. The undersigned agrees that once this Subscription
Agreement is tendered to the Company it may not be withdrawn by the undersigned
and that this Agreement shall survive the death or disability of the
undersigned.
5. Governing Law. This Agreement is governed by Virginia law (other than
its principles of conflict of laws).
By executing this Agreement, the subscriber is not waiving any rights he or
she may have under federal securities laws, including the Securities Act of 1933
and the Securities Exchange Act of 1934.
Please indicate in the space provided below ("Registration Instructions")
the exact name or names and address in which the stock certificate representing
Shares subscribed for hereunder should be registered.
____________________________________________
No. of Shares Subscribed at $10.50 per Share
____________________________________________
Total (Funds Tendered)
____________________________________________
(Signature of Subscriber)
____________________________________________
Name (Please Print)
____________________________________________
(Signature of Subscriber)
____________________________________________
Name (Please Print)
Date: _____________________________________
Residence Address:
____________________________________________
____________________________________________
City, State and Zip Code
____________________________________________
Social Security Number or other
Taxpayer Identification Number
REGISTRATION INSTRUCTIONS
Name: ___________________________________________
Mailing Address: __________________________________________________________
___________________________________________________________
Social Security Number of Taxpayer Identification Number:________________
If certificates will be registered in more than one name, please print the full
name of each person or entity and indicate the type of legal ownership by using
the following abbreviations. If you fail to identify the type of legal
ownership, certificates for subscriptions made in the name of two or more
persons will be issued in the names of such persons as joint tenants with right
of survivorship, and not as tenants in common.
TEN COM - As Tenants in Common
TEN ENT - As Tenants by the Entireties
JT TEN - As Joint Tenants with Right of Survivorship and not as Tenants in
Common
UNIF GIFT MIN ACT - Under Uniform Gifts to Minor Act,
Custodian: __________________________________
Minor: __________________________________
