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Exhibit No. 10(i)(a)(i)
CAUTION: THIS FORM IS ONLY FOR USE BY RESIDENTS OF CO, GA, IL, LA, AND NY.
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
GENERAL 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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GENERAL 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 (MUST INITIAL ALL CATEGORIES):
____ (A) I am/we are purchasing the shares for my/our own account.
____ (B) I/we have received a copy of the Company's Prospectus, dated
_______________, 2001.
____ (C) I/we understand that the shares being purchased are not liquid.
____ (D) I am/we are bona fide resident(s) of ,
--------------------------------
(State)
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(Country)
Form/Type of Ownership for Shares Being Purchased ( MUST check one):
___ Individual
___ Existing Partnership
___ Corporation
___ Minor with adult custodian
under the Uniform Gift
To Minors Act
___ Tenants-in-Common
___ Joint Tenants
___ 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:
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Name(s): Telephone:
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Street Address: Social Security or
--------------------------- Taxpayer ID No.:
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City: State: ____ Zip: Date of Birth:
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Signature: Date:
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ACCEPTED BY: FANZ ENTERPRISES, INC.
By: Title: Date:
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Method of Payment: Item No.
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