1
Exhibit No. 10(i)(b)(i)
CAUTION: THIS FORM IS ONLY FOR USE BY RESIDENTS OF AL, NJ AND VA. RESIDENTS OF
AK, DC, HI, ID, MT, NE, NM, ND, RI, SD, TN, UT, VT, WA, AND WY ARE NOT PERMITTED
TO PURCHASE SHARES IN THIS OFFERING. RESIDENTS OF ALL OTHER STATES MUST USE A
DIFFERENT FORM.
INSTRUCTIONS TO
ACCREDITED INVESTOR SUBSCRIPTION AGREEMENT
FOR
FANZ ENTERPRISES, INC.
Persons interested in purchasing shares of Common Stock, $.01 par
value per share, ("Shares") of FanZ Enterprises, Inc. (the "Company") must :
1. FULLY complete and sign the attached Subscription Agreement (the
"Agreement");
PLEASE COMPETE THE ENTIRE FORM. INCOMPLETE FORMS WILL BE
RETURNED TO YOU.
2. Include a check made payable to "FIRSTAR BANK, N.A., ESCROW
ACCOUNT FOR FANZ ENTERPRISES, INC." (Please note the minimum
amount of $250.00.)
3. Send the completed and signed AGREEMENT AND CHECK to:
FanZ Enterprises, Inc.
5419 Cayman Drive
Carmel, IN 46033
If and when accepted by the Company, the Agreement shall constitute a
subscription for Shares of the Company. THE MINIMUM INVESTMENT IS $250.00 (25
SHARES).
The Company reserves the right to reject in its entirety any
subscription that is tendered or to allocate to any prospective purchaser a
smaller number of Shares than the prospective purchaser has subscribed to
purchase. In such event, the Company will return to you the Agreement, your
payment (or a pro rata portion of your payment, if subscription is rejected only
in part), with interest if your check or funds are deposited in the escrow
account.
A copy of the accepted Agreement will be returned to you as your
receipt, and a stock certificate will be issued to you shortly thereafter.
PLEASE COMPLETE AND RETURN THE ATTACHED PAGES WITH YOUR
CHECK
NOTE: Before completing the attached subscription agreement, you should
carefully and completely read the Company's Prospectus. In making your
investment decision, you should rely only on the information in the
Company's Prospectus and not on any other information.
2
ACCREDITED INVESTOR SUBSCRIPTION AGREEMENT
FOR
FANZ ENTERPRISES, INC.
I/we hereby irrevocably tender this Agreement for the purchase of
_________ Shares (25 SHARES MINIMUM) at $10.00 per Share. With this Agreement,
I/we tender payment in the amount of $_______ ($10.00 per Share; $250.00 MINIMUM
INVESTMENT) for the Shares subscribed.
In connection with this investment in the Company, I/we represent and
warrant as follows:
a. Prior to tendering payment for the Shares, I/we received the Company's
Prospectus dated ___________, 2001.
b. I am/we are bona fide resident(s) of
__________________________________,_________________________.
(State) (Country)
c. I/we HAVE / DO NOT HAVE (please circle one) either (i) an individual
income of $200,000 or more in each of the two most recent years or
joint income with my spouse in excess of $300,000 in each of those
years and reasonably expect to reach the same income level in the
current year OR (ii) an individual net worth or joint net worth with my
spouse at the time of subscription of $1,000,000.(1)
Representations (MUST initial all categories):
____ (A) I am an "Accredited Investor" as defined in Rule 501 of Regulation D
and meet AT LEAST one of the economic standards set forth in
Paragraph (c) above.
____ (B) I am purchasing the shares for my own account.
____ (C) I have received a copy of the Company's Prospectus.
____ (D) I understand that the shares being purchased are not liquid.
Form/Type of Ownership for Shares Being Purchased ( MUST check one):
___ Individual ___ Minor with adult ___ Tenants-in-Common
___ Existing Partnership custodian under the ___ Joint Tenants
___ Corporation Uniform Gift To Minors Act ___ Trust
For the person(s) who will be registered shareholder(s) (MUST FULLY COMPLETE):
Name of shareholder as you would like it to appear on stock
certificate:_______________________________
Name(s): __________________________________ Telephone:_______________________
Street Address:____________________________ Social Security or
Taxpayer ID No.:_________________
City:______________ State: ______ Zip:_____ Date of Birth:___________________
- --------
(1) The state securities agencies of Alabama, New Jersey and Virginia have
restricted the sale of these securities only residents of these states who meet
the requirements of an accredited investor as defined in Rule 501 of Regulation
D promulgated by the U.S. Securities and Exchange Commission. If you do not meet
the income / net worth requirements in section (c) above, you may NOT purchase
Shares at this time.
3
Signature: ___________________________________ Date:_______________________
- --------------------------------------------------------------------------------
ACCEPTED BY: FANZ ENTERPRISES, INC.
By:____________________________ Title:________________________ Date:___________
Method of Payment: _____________________ Item No.: ___________________
- --------------------------------------------------------------------------------