Amount of Subscription. The undersigned hereby subscribes to purchase an aggregate of 7,333,529 Units for a total of $2,500,000. “PURCHASER” Check enclosed in the amount of $____________ or Wire Transfer Sent in the Amount of $2,500,000.00 Subscribed For: $2,500,000 in Units Social Security or Taxpayer I.D. Number [required if applicable]:___________________ Business Address (including zip code): Attention: Xxx Prychitka, CFO & VP Shared Services________ 0000 Xxxxxxxxx Xxxx, Mississauga, ON L4Y 1S4 Business Phone: 000 000 0000 Residence Address (including zip code) Residence Phone: (____) All communications to be sent to: x Business or Residence Address Please indicate on the following page the form in which you will hold title to your interest in the securities. PLEASE CONSIDER CAREFULLY. ONCE YOUR SUBSCRIPTION IS ACCEPTED, A CHANGE IN THE FORM OF TITLE CONSTITUTES A TRANSFER OF THE INTEREST IN THE SECURITIES AND MAY THEREFORE BE RESTRICTED BY THE TERMS OF THIS SUBSCRIPTION, THE SECURITIES AND MAY RESULT IN ADDITIONAL COSTS TO YOU. Subscribers should seek the advice of their attorneys in deciding in which of the forms they should take ownership of the interest in the securities, because different forms of ownership can have varying gift tax, estate tax, income tax, and other consequences, depending on the state of the investor's domicile and his or her particular personal circumstances. Subscription Agreement Jammin Java Corp. Please select one of the following forms of ownership: ________ INDIVIDUAL OWNERSHIP (one signature required) ________ JOINT TENANTS WITH RIGHT OF SURVIVORSHIP AND NOT AS TENANTS IN COMMON (both or all parties must sign) ________ COMMUNITY PROPERTY (one signature required if interest held in one name, i.e., managing spouse; two signatures required if interest held in both names) ________ TENANTS IN COMMON (both or all parties must sign) ________ GENERAL PARTNERSHIP (fill out all documents in the name of the PARTNERSHIP, by a PARTNER authorized to sign, and include a copy of the Partnership Agreement) ________ LIMITED PARTNERSHIP (fill out all documents in the name of the LIMITED PARTNERSHIP, by a GENERAL PARTNER authorized to sign, and include a copy of the Limited Partnership Agreement and any other document showing that the investment is authorized) ________ LIMITED LIABILITY COMPANY (fill out all documents in the name of the LIMITED LIABILITY COMPANY, by a member authorized to sign, and include a copy of the LIMITED LIABILITY COMPANY’s Operating Agree...
Amount of Subscription. Number of Shares: ___________________
Amount of Subscription. The undersigned hereby subscribes to purchase an aggregate of ___________ Units for a total of $______________.
Amount of Subscription a. Shares of Stock (including fractions thereof) $0.50 minimum investment, 1 share.
Amount of Subscription. (a) Number of Units (including fractions thereof) of the Company): __________
Amount of Subscription. The undersigned hereby subscribes (or subscribes for the Investor, as the case may be) for the total amount as set forth below: Total Amount of Subscription: $__________________ Make checks or wire transfers payable to: "BIOMUNE SYSTEMS, INC." THE UNDERSIGNED HEREBY CERTIFIES that the foregoing information is true, correct and accurate to the best of the undersigned's knowledge. DATED this _____ day of September, 1996. IF INDIVIDUAL(S): ________________________________ ________________________________ Name (Please Print) Signature ________________________________ ________________________________ Name (Please Print) Signature IF CORPORATION, PARTNERSHIP, LIMITED LIABILITY COMPANY OR TRUST (ATTACH RESOLUTION AUTHORIZING ACQUISITION OF SHARES, IF NECESSARY): ________________________________ ________________________________ Name (Please Print) Signature Title: _________________________ ________________________________ ________________________________ Name (Please Print) Signature Title: _________________________ CERTIFICATE OF ACCEPTANCE Subscription: Accepted: __________ Rejected __________ BIOMUNE SYSTEMS, INC., a Nevada corporation ________________________________ ____________________________, 1996 David G. Derrick Date Chief Executive Ofxxxxx APPENDIX "A"
Amount of Subscription. The undersigned hereby subscribes to purchase 185,185 Shares in connection with this Subscription for a total of $250,000. This Agreement is executed (on the applicable following page) this 17th day of July, 2013. Subscription Agreement Xxxxx Energy, Inc.
Amount of Subscription. $ The Company hereby accepts the foregoing Subscription Agreement subject to the terms and conditions thereof. Accepted this ____ day of May, 2000. ENTRADE INC. By: ------------------------------ Name: Its:
Amount of Subscription. The Subscriber is an "investment company" within the meaning of the Investment Company Act or an entity that would be an "investment company" but for the exception provided for in Section 3(c)(1) or 3(c)(7) thereof. ¨ The Subscriber elects to opt out of participation in the 26North BDC, Inc.'s dividend reinvestment plan. ¨ Print or Type Name of Subscriber Signed by: (Title, if applicable) Typed or printed address of Subscriber (as described in Section 10(l)): Please list Type of Entity (e.g., individual, corporation, estate, trust, partnership, exempt organization, nominee, custodian) and check the applicable box(es) below, if any: __________________________________________________ If the Subscriber is a "FOIA Subscriber" as such term is defined in Section 10(q) of this Subscription Agreement: ¨ If the Subscriber is a "Benefit Plan Investor" for purposes of this Agreement: ¨ If the Subscriber is a "401(k)/IRA Investor" as such term is defined in Section 10(p) of this Agreement: ¨ If the Subscriber is an "Other Plan Investor" for purposes of this Agreement : ¨ Subscriber's Social Security or Federal Tax Identification No.: Unless otherwise indicated, the undersigned consents to receive annual updates and changes to the Company's "privacy notice" described in Section 10(t) above via e-mail or web site. Is the party signing this document acting as a nominee or custodian for another person or entity? Yes ¨ No ¨ Country of residence for U.S. federal income tax purposes Consent to electronic delivery of Form 1099? Yes ¨ No ¨ * If yes, please read and sign Exhibit F. State of residence for U.S. federal income tax purposes Check the following box if, to the knowledge of the Subscriber, the Subscriber is controlled by, controls or is under common control with any other shareholder of the Company. ¨ 26North BDC, Inc. Investor Signature Page ACCEPTANCE FORM The foregoing Subscription Agreement is hereby accepted by the undersigned as of the acceptance date listed below: 26NORTH BDC, INC. By: Name: Title: A Duly Authorized Officer Date of Acceptance: _________________ Amount of Capital Commitment accepted by the Company (if less than the amount set forth on the Subscriber's signature page above as permitted by Section 1): $________________________ If the Company executes this Agreement and the preceding line is left blank, the Company has accepted the Subscriber's subscription for Shares with a Capital Commitment in the amount set forth on the Subscriber's signature p...
Amount of Subscription. Twenty Five Thousand Five Hundred Dollars in common stock of Solanbridge Group, Inc. EVENTUS CAPITAL INC. $25,500 By: /s/ Dxxxx Xxxxx Amount of Subscription Signature 850,000 Dxxxx Xxxxx Number of Shares Purchased Name (Please Print) _________________________________ Street Address _________________________________ City State Zip Code _________________________________ Telephone Number
