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EXHIBIT 99.b |
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SUBSCRIPTION AGREEMENT - Mag-Well, Inc. |
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1. INVESTMENT: |
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Signatures: Executed this ______ day of _____________________, 1999 at |
___________________, |
__________________. |
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City |
State |
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X__________________________________________ |
X__________________________________________ |
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Signature (investor or authorized signature) |
Signature (investor or authorized signature) |
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2. INVESTOR INFORMATION: |
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______________________________________________________________________________________________________________ |
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Name (type or print) |
Social Sec. No. |
Address |
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______________________________________________________________________________________________________________ |
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Name (type or print) |
Social Sec. No. |
Address |
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Mailing Address (if different from above): |
__________________________ |
_______________ |
_______ |
_____ |
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Street |
City |
State |
Zip |
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Business Phone: ( ) _______________ Home Phone: ( ) _______________ |
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3. TYPE OF OWNERSHIP: (You must check one box) |
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1. [ ] Individual |
6. [ ] Joint Tenants with rights of Survivorship |
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2. [ ] Tenants in Common |
7. [ ] Custodian for ________________________________________________ |
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3. [ ] Community Property |
8. [ ] Uniform Gifts to Minors Act of the State of ______________________ |
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4. [ ] Partnership |
9. [ ] Corporation |
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5. [ ] Trust |
10. [ ] Other (explain)______________________________________________ |
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4. RECEIPT OF DISCLOSURE DOCUMENT: |
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By executing this subscription agreement, the undersigned acknowledges receipt of a current Disclosure Document, as supplemented to the date of this Subscription Agreement, in which the terms and conditions of the offering of Common Stock and the risks associated therewith are described. |
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5. TERMINATION OF THE OFFERING: |
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The undersigned understands that the Company may terminate the offering at any time and for any reason. If the offering is so terminated, and the Company, and/or the Escrow Agent, is holding subscriptions that have not been accepted by an authorized representative of the Company, together with the un-accepted subscription agreements, then in that event the subscriptions so held shall be returned with any interest earned thereon. |
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6. REPRESENTATION AND WARRANTS: |
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By executing this subscription agreement, the undersigned represents and warrants to the Company that: |
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7. ACCEPTANCE OF SUBSCRIPTION: |
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The undersigned hereby confirms Subscriber's understanding that the Company has the full right to accept or reject this subscription, providing that the Company must accept or reject the subscription within thirty (30) days after it is received by the Company. In case of rejection of a subscription, contributions of such persons will promptly be returned to such persons without interest thereon. |
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Please make a copy of your completed Subscription Agreement for yourself after signing. X______________________________________________ Subscriber's Signature |
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Dated this ______ day of ____________________, 1999. |
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MAKE CHECK PAYABLE TO: |
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Chase Bank of Texas |
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c/o Escrow Agent: Mag-Well, Inc. |
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SEND SUBSCRIPTION AGREEMENT AND CHECK TO: |
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Chase Bank of Texas |
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c/o Escrow Agent - Mag-Well, Inc. |
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600 Travis Street, Suite #1150 |
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Houston, TX 77002 |
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Accepted for the Company this day of __ , 1999. By: Title: |
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