Amount of Investment. Purchaser understands that the Tendered Crypto will not be held by the Company, but instead will converted into U.S. dollars by a reputable third party chosen by the Company, with the net proceeds (denominated in U.S. dollars, and after subtracting fees paid to the third party) paid to the Company. The purchase price of the LLC Interest (and, for purposes of the LLC Agreement, Purchaser’s “Capital Contribution”) will be equal to the amount of such net proceeds paid to the Company, denominated in U.S. dollars, and not the nominal value of the Tendered Crypto.
Amount of Investment. Please indicate the amount of your proposed investment: __________________________________________________
Amount of Investment. Number of Units (minimum 3 Units per Investor):______________ Corresponding dollar amount ($10,000 multiplied by number of Units): $_______________ Date of Formation or incorporation: ____________ State of Formation: _____________________ Describe the business of the Entity: _________________________________________________________________________________ _____________________________________________________________________________________________________________ List the names and positions of the executive officers, managing members, partners or trustees authorized to act with respect to investments by the Entity generally and specify who has the authority to act with respect to this investment. Name Position Authority for this investment (yes or no)
Amount of Investment. Purchaser, having received and read in its entirety the Company’s Confidential Private Placement Memorandum dated February 1, 2012, and all supplements and amendments thereof if any (the “PPM”), hereby offers to purchase the number of Units set forth on page 3 for a total purchase price of such number of Units times the Offering Price (the “Subscription Amount”). (For more information regarding the Units, please refer to the PPM.)
Amount of Investment. Number of Units (minimum of 3 Units per Investor) :______________ Corresponding dollar amount ($10,000 multiplied by number of Units): $_______________ Accredited Investor Status For Individuals. (INVESTORS THAT ARE CORPORATIONS, LIMITED LIABILITY COMPANIES, PARTNERSHIPS, REVOCABLE TRUSTS, IRREVOCABLE TRUSTS, EMPLOYEE BENEFIT PLAN TRUSTS AND INDIVIDUAL RETIREMENT ACCOUNTS SHOULD IGNORE THE FOLLOWING QUESTIONS AND PROCEED TO THE ENTITY SIGNATURE PAGE).
Amount of Investment. The amount of the investment is $4,000,000 (four million dollars).
Amount of Investment. The agreements and representation herein are made by each person signing this agreement, if more than one. (Signature) (Print full name) ------------------------------------------------------------------------------------------------------------------------------------------------------------------------- STAFF USE ONLY W9 Receipt acknowledged for $ Check #, Cash or CC: License Payment Received by: Entered Into Square Deposited Ownership Accepted Update ACCO Master List Update Mailchimp SIGNATURE DATE
Amount of Investment. Number of Shares: ______________ Corresponding dollar amount ($0.45 multiplied by number of Shares): $_______________ Accredited Investor Status For Individuals. (INVESTORS THAT ARE CORPORATIONS, LIMITED LIABILITY COMPANIES, PARTNERSHIPS, REVOCABLE TRUSTS, IRREVOCABLE TRUSTS, EMPLOYEE BENEFIT PLAN TRUSTS AND INDIVIDUAL RETIREMENT ACCOUNTS SHOULD IGNORE THE FOLLOWING QUESTIONS AND PROCEED TO THE ENTITY SIGNATURE PAGE).
Amount of Investment. Number of Shares: Corresponding dollar amount ($0.45 multiplied by number of Shares): $ Date of Formation or incorporation: State of Formation: Describe the business of the Entity: List the names and positions of the executive officers, managing members, partners or trustees authorized to act with respect to investments by the Entity generally and specify who has the authority to act with respect to this investment. Name Position Authority for this investment (yes or no)
Amount of Investment. $--------------------- INDIVIDUAL INVESTOR: ---------------------- Name: PARTNERSHIP, CORPORATION, TRUST, CUSTODIAL ACCOUNT, OTHER INVESTOR --------------------------- (Print Name of Entity) By: __________________ Name: Title:
