SUBSCRIPTION AGREEMENT
FOR
CHARRETTE DE CAFE, CORP.
Please mail this Subscription Agreement, with your check, to the address shown
below.
I/We acknowledge receipt of the Prospectus dated _______________, 2003 of
CHARRETTE DE CAFE, CORP. (the "Company") and I/we have reviewed the Prospectus
of the Company as filed with the Securities and Exchange Commission. After a
review, I/We hereby subscribe for Shares of the Company's Common Stock ($0.001
par value) as follows:
________ number of Shares at $ 0.10 per Share.
$_______ Check payable to CHARRETTE DE CAFE, CORP.
I/We represent and warrant that I fall within the following category:
[ ] (1) A bank as defined in Section 3(a)(2) of the 1933 Act or a
savings and loan association or other institution as defined
in Section (3)(a)(5)(A) of the 1933 Act whether acting in its
individual or fiduciary capacity; a broker dealer registered
pursuant to Section 15 of the Securities Exchange Act of 1934;
an insurance company as defined in Section 2(13) of the Act;
an investment company registered under the Investment Company
Act of 1940 or a business development company as defined in
Section 2(a)(48) of the Investment Company Act; a small
business investment company licensed by the U.S. Small
Business Administration under Section 301(c) or (d) of the
Small Business Investment Act of 1958; a plan established and
maintained by a state, its political subdivisions, or any
agency or instrumentality of a state or its political
subdivisions for the benefit of its employees, if such plan
has total assets in excess of $5,000,000; and an employee
benefit plan with the meaning of the Employee Retirement
Income Security Act of 1974, if the investment decision is
made by a plan fiduciary, as defined in Section 3(21) of such
Act, which is either a bank, savings and loan association,
including company, or registered investment adviser, or if the
employee benefit plan has total assets in excess of
$5,000,000, or, if a self-directed plan, with investment
decisions made solely by persons that are accredited
investors;
[ ] (2) A private business development company as defined in Section
202(a)(22) of the Investment Advisers Act of 1940;
[ ] (3) An organization described in Section 501(c)(3) of the
Internal Revenue Code, or a corporation, Massachusetts or
similar business trust, or partnership, not formed for the
specific purpose of acquiring the securities offered, with
total assets in excess of $5,000,000;
[ ] (4) A director or executive officer of the Company;
[ ] (5) A natural person whose individual net worth, or joint net
worth with that person's spouse, exceeds $1,000,000 at the
time of purchase;
[ ] (6) A natural person who had an individual income (not
including that of his or her spouse) in excess of $200,000 in
2001 and 2002 or joint income with his or her spouse in excess
of $300,000 in each of those years, and who reasonably expects
the same income level in 2003;
[ ] (7) A trust, with total assets in excess of $5,000,000, not
formed for the specific purpose of acquiring securities
offered, whose purchase is directed by a person who, either
alone or together with his or her purchaser representative(s),
has such knowledge and experience in financial and business
matters that such person is capable of evaluating the merits
and risks of the prospective investment;
[ ] (8) An entity in which all of the equity owners are accredited
investors; or
[ ] (9) Other [please supply facts to support that the investment is a
suitable investment].
Shares are to be registered to (mark one):
____ Individual
____ Tenants-in-Common
____ Joint Tenants with Right of Survivorship
____ As Tenants in the Entireties
____ As Custodian/Minor Under the Uniform Gifts to Minors Act
____ Corporation
____ Trust
Please provide complete name(s) and address(es) of all parties:
_______________________ Name
_______________________ Address
_______________________ City, State, Zip
_______________________ Telephone with Area Code
_______________________ Social Security Number/EIN
_______________________ Name
_______________________ Address
_______________________ City, State, Zip
_______________________ Telephone with Area Code
_______________________ Social Security Number/EIN
____________________________________________
Signature of primary investor
Remit this form with your check to:
CHARRETTE DE CAFE, CORP.
0000 Xxxx Xxxxx Xxxxxx Xxxx, Xxxxx 000-000
Xxxxxxx, Xxxxxxxxxx 00000
Attn: Xxxxxx X. Xxxxx
An accepted copy of this form will be returned to you within five days of
receipt. If the Company should decline to accept the subscription, it will be
returned with your check within five days of receipt. By executing this
Subscription Agreement, you acknowledge that you have had the opportunity to
read the Prospectus.
Accepted by Xxxxxx X. Xxxxx
___________________________
Date: ________________,2003