EX-10.I.E.I 7 l85628gex10-i_ei.txt EXHIBIT 10(I)(E)(I) 1 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. 2 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 (MUST INITIAL ALL CATEGORIES):
____ (A) I am/we are bona fide resident(s) of , . ------------------------- ------------------------- (State) (Country)
____ (B) I am/we are purchasing the shares for my/our own account. ____ (C) I/we have received a copy of the Company's Prospectus, dated _____________, 2001. ____ (D) I/we understand that the shares being purchased are not liquid. ____ (E) I/we have 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). PLEASE NOTE: The securities agencies of the following states require that residents of these states must meet the investor suitability standards listed below prior to being permitted to invest in the Company's Stock. -------------------------------------------------------------------------------- ALABAMA, NEW JERSEY & VIRGINIA Residents must have either (i) an individual income of $200,000 or more in each of the two most recent years or joint income with their spouse in excess of $300,000 in each of those years and reasonably expect to reach the same income level in the current year OR (ii) an individual net worth or joint net worth with their spouse at the time of subscription of $1,000,000. (All computations of net worth must exclude the value of the investor's principal residence, its furnishings and personal automobile(s). All other assets should be valued at their fair market value.) -------------------------------------------------------------------------------- OHIO In order to subscribe for more than the minimum number of 25 Shares, residents must have either (i) an individual or joint annual income with their spouse in excess of $65,000 and an individual or joint net worth with their spouse of $65,000 (including the value of homes, home furnishings and automobiles) OR (ii) an individual or joint net worth with their spouse of $500,000 (including the value of homes, home furnishings and automobiles). -------------------------------------------------------------------------------- ARIZONA, ARKANSAS, CALIFORNIA, Residents must have either (i) an annual CONNECTICUT, DELAWARE, INDIANA, gross income of $65,000 or more and a IOWA, KANSAS, KENTUCKY, MAINE, minimum net worth of $65,000 OR (ii) a MARYLAND, MASSACHUSETTS, MICHIGAN, minimum net worth of $150,000. (All MINNESOTA, MISSISSIPPI, MISSOURI, computations of net worth must exclude the NEVADA, NEW HAMPSHIRE, NORTH value of the investor's principal residence, CAROLINA, OKLAHOMA, OREGON, its furnishings and personal automobile(s). PENNSYLVANIA, SOUTH CAROLINA, All other assets should be valued at their TEXAS, WEST VIRGINIA & WISCONSIN fair market value.) -------------------------------------------------------------------------------- PLEASE CONTINUE ON THE NEXT PAGE 3 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:
Name(s): Telephone: -------------------------------------------------------------- ------------------------------------- Street Address: Social Security or -------------------------------------------------------- Taxpayer ID No.: ------------------------------ City: State: Zip: Date of Birth: ------------------------ ----------------- ----------- --------------------------------- Signature: Date: ----------------------------------------------------------- ------------------------------------------
------------------------------------------------------------------------------------------------------------------------------ ACCEPTED BY: FANZ ENTERPRISES, INC. By: Title: Date: ---------------------------------------- ---------------------------- ----------------------- Method of Payment: Item No.: ---------------------------------- -------------------------------- -------------------------------------------------------------------------------------------------------------------------------