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Exhibit No. 10(i)(c)(i)
CAUTION: THIS FORM IS ONLY FOR USE BY RESIDENTS OF CA, CT, DE, IN, IA, KS, KY,
ME, MD, MA, MI, MN, MS, MO, NV, NH, OK, OR, PA, SC, WV AND WI. 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
SOPHISTICATED 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.
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SOPHISTICATED 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 annual gross
income of $65,000 or more and a minimum net worth of $65,000 (excluding
the value of automobiles, homes and home furnishings) OR (ii) a minimum
net worth of $150,000 (excluding the value of automobiles, homes and
home furnishings).(1)
Representations (MUST initial all categories):
____ (A) I 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 custodian ___ Tenants-in-Common
___ Existing Partnership under the Uniform Gift ___ Joint Tenants
___ Corporation 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 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:___________________
Signature:_________________________________ Date:____________________________
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(1) The state securities agencies of CA, CT, DE, IN, IA, KS, KY, ME, MD, MA, MI,
MN, MS, MO, NV, NH, OK, OR, PA, SC, WV, WI. have restricted the sale of these
securities to only residents of these states who meet the sophistication
requirements of the North American Securities Administrators Association. If you
do not meet the income / net worth requirements in section (c) above, you may
not purchase Shares at this time.
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ACCEPTED BY: FANZ ENTERPRISES, INC.
By:________________________________ Title:____________________ Date:____________
Method of Payment: ________________________ Item No.: ____________________
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