EX-99 4 powersaveam9sb2ex99-3.txt REVISED SUBSCRIPTION AGREEMENT SUBSCRIPTION AGREEMENT The undersigned hereby subscribes to purchase common stock ("Common Stock") of Power Save International, Inc., a Nevada corporation (the "Corporation"). In this regard, enclosed is $___ for the purchase of Common Stock. In connection with its purchase, the undersigned warrants and represents the following: The Common Stock is not being issued for services performed by the undersigned; The undersigned understands that the Common Stock being acquired hereunder have been registered under the Securities Act of 1933, as amended, and the applicable securities laws of his state of residence; The undersigned represents and warrants that it has not acted as a Purchaser Representative for any person in connection with this purchase of Common Stock by the undersigned; The undersigned requests that the Common Stock be issued in the name of the undersigned and delivered to the undersigned at the address below. Dated:___________ I will hold title to my shares as follows: (check one) [ ] Community Property [ ] Joint tenancy (both must sign) [ ] Tenancy in common [ ] Individual ownership (all must sign) [ ] Trust or Keogh Plan [ ] As custodian under State [ ] Partnership Gifts to Minors Act [ ] Other (please describe): --------------------------------------------------- --------------------------------------------------- --------------------------------------------------- Intending to be legally bound hereby, the parties hereto have set their hands and seals on this day of _______________________________. X ___________________ X________________________ (Signature of Authorize (Signature of Representative) Subscriber)(Seal) ___________________________________________________ (Title of Authorized Representative (Print Name of Subscriber) (Residence Address) 2 (City) (State) (Zip Code) / / (Social Security Number) Please type or print the following information: ________________________________ _________________________________ Full name(s) of subscriber(s) Social security or employer as it (they) should appear I.D. number(s) of subscriber(s) on schedule of Corporation ________________________________________________________________________ Street Address City State Zip Code Dated: Dated:_________________________. X______________________________ X________________________ Signature Signature
_________________________________________________ Title or capacity of signing party if the subscriber is partnership, corporation, trust or other nonindividual entity. Remittance should be payable to Power Save International, Inc. Completed subscription agreements and checks should be sent to Power Save International, Inc. 5800 NW 64 Avenue Building 26, #109 Tamarac, FL 33319 ACCEPTANCE OF SUBSCRIPTIONS BY CORPORATION Power Save International, Inc. Accepted as of Received and Subscription Accepted Check No. Power Save International, Inc. ____________________________________ , President