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Exhibit No. 10(i)(e)(i)
CAUTION: THIS FORM IS ONLY FOR USE BY RESIDENTS OF OH. 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
OHIO 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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OHIO 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 or
joint annual income with my spouse in excess of $65,000 and an individual
or joint net worth with my spouse of $65,000 (including the value of homes,
home furnishings and automobiles) OR (ii) an individual or joint net worth
with my spouse of $500,000 (including the value of homes, home furnishings
and automobiles)).(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 ___ 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:___________________
Signature: ___________________________________ Date:_______________________
___________________
(1) The Ohio Division of Securities restricted the sale of these securities to
residents of Ohio. If you do not meet the income / net worth requirements in
section (c) above, you may only purchase the minimum number of twenty-five
Shares for a total investment of $250. If you meet the income / net worth
requirements in section (c) above, you may purchase any amount of Shares, but
any investment must not be less than the twenty-five Share minimum.
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ACCEPTED BY: FANZ ENTERPRISES, INC.
By:____________________________ Title:________________________ Date:___________
Method of Payment: _____________________ Item No.: ___________________
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