Common use of Subscription Information Clause in Contracts

Subscription Information. If an Individual: If a Corporation --------------------------------- --------------------------------- Full Name Full Corporation Name --------------------------------- --------------------------------- Residential Address Head Office Address --------------------------------- --------------------------------- City Province/State Postal Code City Province/State Postal Code --------------------------------- --------------------------------- Telephone Telecopier Attention --------------------------------- --------------------------------- Social Security No. or Tax Telephone Telecopier Identification No. (US Persons) --------------------------------- --------------------------------- Social Security No. or Revenue Telephone Telecopier Canada Corporation No. (Canadian Residents)

Subscription Information. If an Individual: If a Corporation Corporation: --------------------------------- --------------------------------- -------------------------------------- Full Name Full Corporation Name --------------------------------- --------------------------------- -------------------------------------- Residential Address Head Office Address --------------------------------- --------------------------------- -------------------------------------- City Province/State Postal Code City Province/State Postal Code --------------------------------- --------------------------------- -------------------------------------- Telephone Telecopier Attention --------------------------------- --------------------------------- -------------------------------------- Social Security No. or Tax Telephone Telecopier Identification No. (US Persons) --------------------------------- --------------------------------- Social Security -------------------------------------- Tax Identification No. or Revenue Telephone Telecopier Canada Corporation No. (Canadian Residents)If a Corporation, please provide the names of its directors below: ------------------------------------------------------------------- ------------------------------------------------------------------- ------------------------------------------------------------------- -------------------------------------------------------------------

Subscription Information. If an Individual: If a Corporation Corporation: --------------------------------- --------------------------------- Full Name Full Corporation Name --------------------------------- --------------------------------- Residential Address Head Office Address --------------------------------- --------------------------------- City Province/State Postal Code City Province/State Postal Code --------------------------------- --------------------------------- Telephone Telecopier Attention --------------------------------- --------------------------------- Social Security No. or Tax Telephone Telecopier Identification No. (US Persons) --------------------------------- --------------------------------- Social Security No. or Revenue Canada Telephone Telecopier Canada Corporation No. (Canadian Residents)

Subscription Information. If an Individual: If a Corporation --------------------------------- ------------------------------------- --------------------------------- Full Name Full Corporation Name --------------------------------- ------------------------------------- --------------------------------- Residential Address Head Office Address --------------------------------- ------------------------------------- --------------------------------- City Province/State Postal Code City Province/State Postal Code --------------------------------- ------------------------------------- --------------------------------- Telephone Telecopier Attention --------------------------------- ------------------------------------- --------------------------------- Social Security No. or Tax Telephone Telecopier Tax Identification No. (US Persons) --------------------------------- ------------------------------------- --------------------------------- Social Security No. or Revenue Canada Telephone Telecopier Canada Corporation No. (Canadian Residents)