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Disclosure Document (Small Corporate Offering Registration) Form. This is a Wyoming form and can be use in Blue Sky Secretary Of State.
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Tags: Disclosure Document (Small Corporate Offering Registration), U-7, Wyoming Secretary Of State, Blue Sky
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......... ..
:
Index No.
:
Plaintiff(s)
-against-
Calendar No.
:
JUDICIAL SUBPOENA
FORM U-7
:
DISCLOSURE DOCUMENT
:
(Exact name of Company as set forth in Articles of Incorporation
:
or Charter )
Defendant(s)
:
......................................................
Type of securities offered: ______________________________________________________________
Maximum number of securities offered: __________________________________________________
Minimum numberTHE STATE OF NEW YORK
THE PEOPLE OF of securities offered: __________________________________________________
TO
Price per security: $
Total proceeds:
If maximum sold: $ __________
If minimum sold: $ ________
GREETINGS:
(For use of proceeds and offering expenses, see Question Nos. 9 and 10)
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
Is County of
a commissioned selling agent located at securities in this offering? [ ] Yes [ ] No
selling the
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
If or adjourned date, to is commission evidence as a witness in this action on the part of the
yes, what percent testify and give of price to public?
%.
Is there other compensation to selling agent(s)? [ ] Yes [ ] No
Is there a finders fee to comply with this subpoena is punishable]as a contempt of court and will make you liable to
Your failure or similar payment to any person? [ Yes
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
[ ]result(See Question to comply.
No of your failure No. 22)
Is there anWitness, of proceeds until minimum is obtained? [ ] Yes
escrow Honorable
Court in
County,
[ ] No (See Question No. 26)
day of
, one of the Justices of the
, 20
Is this offering limited to members of a special group, such as employees ofand type name below) indi(Attorney must sign above the Company or
viduals?
[ ] Yes [ ] No (See Question No. 25)
Is transfer of the securities restricted? [ ] Yes [ ] No (See Questionfor 25)
Attorney(s) no.
INVESTMENT IN SMALL BUSINESSES INVOLVES A HIGH DEGREE OF RISK, AND INVESTORS SHOULD NOT INVEST ANY FUNDS IN THIS OFFERING UNLESS THEY CAN AFFORD
TO LOSE THEIR INVESTMENT IN ITS ENTIRETY. SEEOffice and P.O.NO. 2 FOR THE RISK FACQUESTION Address
TORS THAT MANAGEMENT BELIEVES PRESENT THE MOST SUBSTANTIAL RISKS TO AN
INVESTOR IN THIS OFFERING.
Telephone No.:
IN MAKING AN INVESTMENT DECISION INVESTORSFacsimile No.: ON THEIR OWN EXAMIMUST RELY
NATION OF THE COMPANY AND THE TERMS OF THE OFFERING INCLUDING THE MERITS
E-Mail Address:
Mobile Tel. No.:
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AND RISKS INVOLVED. THESE SECURITIES HAVE NOT BEEN RECOMMENDED BY ANY
FEDERAL OR STATE SECURITIES COMMISSION OR REGULATORY AUTHORITY. FURTHER:
JUDICIAL SUBPOENA
Plaintiff(s)
MORE, THE FOREGOING AUTHORITIES HAVE NOT CONFIRMED THE ACCURACY OR DE-againstTERMINED THE ADEQUACY OF THIS DOCUMENT. ANY REPRESENTATION TO THE CON:
TRARY IS A CRIMINAL OFFENSE.
:
This Company:
:
[ ] Has never conducted operation.
[ ] Is in the development stage.
Defendant(s)
:
. . . . . . . . . . . . . . . . . . [. ] . .Is .currently. conducting. operations.. . .
. . ....... ......... .........
[ ] Has shown a profit in the last fiscal year.
[ ] Other (Specify):
(Check at least one, as appropriate)
THE PEOPLE OF THE STATE OF NEW YORK
TO
This offering has been registered for offer and sale in the following states:
State
State File No.
Effective date
GREETINGS:
___________
_________________
_______________
___________ COMMAND YOU, that all business and_______________aside, you and each of you attend before
_________________
WE
excuses being laid
___________
_________________
_______________
,
the Honorable
at the
Court
___________
_________________
_______________
located at
County of
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
TABLE OF CONTENTS
Page
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
The Company............................................................................................................................................. 3
Witness, Honorable
, one of the Justices of the
Risk Factors . ..........................................................................................................................................
Court in
County,
day of
, 20
3
Business and Properties ...........................................................................................................................
5
(Attorney must sign above and type name below)
Offering Price Factors ............................................................................................................................. 12
Use of Proceeds ...................................................................................................................................... 14
Attorney(s) for
Capitalization .......................................................................................................................................... 16
Description of Securities ......................................................................................................................... 17
Office and P.O. Address
Plan of Distribution ................................................................................................................................ 19
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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:
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Dividends, Distributions and Redemptions ............................................................................................ 21
:
JUDICIAL SUBPOENA
Officers and Key Personnel of the Company Plaintiff(s)
......................................................................................... 21
-against-
:
Directors of the Company ........................................................................................................................ 25
:
Principal Stockholders ............................................................................................................................. 28
:
Management Relationships, Transactions and Remuneration ................................................................. 30
Defendant(s)
:
......................................................
Litigation ................................................................................................................................................ 32
FederalPEOPLE OF THE STATE OF NEW YORK
THE Tax Aspects ................................................................................................................................ 33
TO
Miscellaneous Factors ............................................................................................................................ 33
Financial Statements ............................................................................................................................... 34
GREETINGS:
Management Discussion and Analysis of Certain Relevant Factors ........................................................ 34
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
Signatures ............................................................................................................................................... 36
the Honorable
at the
Court
located at
County of
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness inOF THE REPRESENTATIONS BY THE
THIS DISCLOSURE DOCUMENT CONTAINS ALL this action on the part of the
COMPANY CONCERNING THIS OFFERING, AND NO PERSON SHALL MAKE DIFFERENT OR
BROADER STATEMENTS THAN THOSE CONTAINED HEREIN. INVESTORS ARE CAUTIONED NOT TO RELY UPONwith this subpoena is punishable as a contempt ofSET FORTH IN THIS liable to
Your failure to comply ANY INFORMATION NOT EXPRESSLY court and will make you
DISCLOSURE DOCUMENT. subpoena was issued for a maximum penalty of $50 and all damages sustained as a
the party on whose behalf this
result of your failure to comply.
Witness, Honorable
Court in
County,
, one of the Justices of the
day of
, 20
(Attorney must sign above and type name below)
Attorney(s) for
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
,
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:
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This Disclosure Document, together with Financial Statements and other Attachments,
consists of a total of _____ pages.
:
JUDICIAL SUBPOENA
Plaintiff(s)
THE COMPANY :
-against-
1.
Exact corporate name:
:
:
______________________________________________________________________________________
Defendant(s)
:
......................................................
____________________________________________________________________________________
State and date of incorporation:
THE PEOPLE OF THE STATE OF NEW YORK
____________________________________________________________________________________
TO
____________________________________________________________________________________
Street address of principal office:
GREETINGS:
____________________________________________________________________________________
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
the Honorable
at the
Court
____________________________________________________________________________________
located at
County of
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date,Telephone Number:
Company to testify and give evidence as a witness in this action on the part of the
( )
________________________________________________________________________
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
Fiscal Year: ____________
____________
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
(month)
(day)
Person(s) toHonorable Company with respect to offering:
Witness, contact at
Court in
County,
day of
, one of the Justices of the
, 20
____________________________________________________________________________________
____________________________________________________________________________________
(Attorney must sign above and type name below)
Telephone Number (if different from above):
( )
Attorney(s) for
________________________________________________________________________
RISK FACTORS
Office and P.O. Address
2. List in the order of importance the factors which the Company considers to be the most
substantial risks to an investor in this offering in view of all facts and circumstances or which
otherwise make the offering one of high risk or speculative (i.e., those factors which constitute the
Telephone No.:
greatest threat that the investment will be lost in whole orFacsimile or not provide an adequate
in part, No.:
return).
E-Mail Address:
Mobile Tel. No.:
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,
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:
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(1)
____________________________________________________________________________________
:
JUDICIAL SUBPOENA
Plaintiff(s)
-against____________________________________________________________________________________
:
:
____________________________________________________________________________________
:
(2)
____________________________________________________________________________________
Defendant(s)
:
......................................................
____________________________________________________________________________________
____________________________________________________________________________________
THE PEOPLE OF THE STATE OF NEW YORK
TO (3)
____________________________________________________________________________________
____________________________________________________________________________________
GREETINGS:
____________________________________________________________________________________
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
(4)
located at
County of
____________________________________________________________________________________
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
____________________________________________________________________________________
____________________________________________________________________________________ to
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result (5)your failure to comply.
of
____________________________________________________________________________________
Witness, Honorable
, one of the Justices of the
____________________________________________________________________________________
Court in
County,
day of
, 20
____________________________________________________________________________________
(Attorney must sign above and type name below)
(6)
____________________________________________________________________________________
Attorney(s) for
____________________________________________________________________________________
____________________________________________________________________________________
Office and P.O. Address
(7)
____________________________________________________________________________________
Telephone No.:
____________________________________________________________________________________
Facsimile No.:
E-Mail Address:
____________________________________________________________________________________
Mobile Tel. No.:
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(8)
____________________________________________________________________________________
:
JUDICIAL SUBPOENA
Plaintiff(s)
-against____________________________________________________________________________________
:
:
____________________________________________________________________________________
:
(9)
____________________________________________________________________________________
Defendant(s)
:
......................................................
____________________________________________________________________________________
____________________________________________________________________________________
THE PEOPLE OF THE STATE OF NEW YORK
TO
(10)
____________________________________________________________________________________
____________________________________________________________________________________
GREETINGS:
____________________________________________________________________________________
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
(11)
located at
County of
____________________________________________________________________________________
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
____________________________________________________________________________________
____________________________________________________________________________________ to
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
(12)
____________________________________________________________________________________
Witness, Honorable
, one of the Justices of the
____________________________________________________________________________________
Court in
County,
day of
, 20
____________________________________________________________________________________
(Attorney must sign above and type name below)
(13)
____________________________________________________________________________________
Attorney(s) for
____________________________________________________________________________________
____________________________________________________________________________________
Office and P.O. Address
(14)
____________________________________________________________________________________
Telephone No.:
____________________________________________________________________________________
Facsimile No.:
E-Mail Address:
____________________________________________________________________________________
Mobile Tel. No.:
American LegalNet, Inc.
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(15)
____________________________________________________________________________________
:
JUDICIAL SUBPOENA
Plaintiff(s)
-against____________________________________________________________________________________
:
:
____________________________________________________________________________________
:
(16)
____________________________________________________________________________________
Defendant(s)
:
......................................................
____________________________________________________________________________________
____________________________________________________________________________________
THE PEOPLE OF THE STATE OF NEW YORK
TO
Note: In addition to the above risks, businesses are often subject to risks not foreseen or fully appreciated by management. In reviewing this Disclosure Document potential investors should keep in
mind other possible risks that could be important.
GREETINGS:
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
located at
County of
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
Witness, Honorable
Court in
County,
, one of the Justices of the
day of
, 20
(Attorney must sign above and type name below)
Attorney(s) for
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
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BUSINESS AND PROPERTIES
:
JUDICIAL SUBPOENA
With respect to the business of the Plaintiff(s) and its properties:
Company
3.
-against-
:
(a) Describe in detail what business the Company does and proposes to do, including what
:
products or goods are or will be produced or services that are or will be rendered.
:
____________________________________________________________________________________
Defendant(s)
:
......................................................
____________________________________________________________________________________
____________________________________________________________________________________
THE PEOPLE OF THE STATE OF NEW YORK
____________________________________________________________________________________
TO
(b) Describe how these products or services are to be produced or rendered and how and
when the Company intends to carry out its activities. If the Company plans to offer a new
product(s), state the present stage of development, including whether or not a working
GREETINGS:
prototype(s) is in existence. Indicate if completion of development of the product would require a
material amount of the resources of all business and excuses being laid aside, you andIf theof you attendis
WE COMMAND YOU, that the Company, and the estimated amount. each Company before
orthe expected to be dependent upon one or a limited number of suppliers for essential raw mateis Honorable
,
at the
Court
rials, energy or other items, describe. at
located Describe any major existing supply contracts.
County of
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
____________________________________________________________________________________
____________________________________________________________________________________
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
____________________________________________________________________________________ as a
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained
result of your failure to comply.
____________________________________________________________________________________
Witness, Honorable
, one of the Justices of the
Court (c) Describe the industry in which the Company is selling or expects to sell its products or
in
County,
day of
, 20
services and, where applicable, any recognized trends within that industry. Describe that part of
the industry and the geographic area in which the business competes or will compete.
(Attorney must sign above and type name below)
Indicate whether competition is or is expected to be by price, service, or other basis. Indicate (by attached table if appropriate) the current or anticipated prices or price ranges for the
Companys products or services, or the formula for determining prices, and how these prices
Attorney(s) for
compare with those of competitors products or services, including a description of any variations
in product or service features. Name the principal competitors that the Company has or expects
to have in its area ofcompetition.Indicate the relative size and financial and market strengths of
the Companys Competitors in the area of competition in Office and P.O. Addressis or will be operatwhich the Company
ing. State why the Company believes that it can effectively compete with these and other companies in its area of competition.
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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____________________________________________________________________________________
:
JUDICIAL SUBPOENA
Plaintiff(s)
____________________________________________________________________________________
-against-
:
____________________________________________________________________________________
:
____________________________________________________________________________________
:
Note: Because this Disclosure Document focuses primarily on details concerning the Company
Defendant(s)
:
.... ... ... ....... . ..... .. ........ ....... .. ..
rather .than. the .industry .in .which .the. Company. operates. or .will operate, potential investors may wish
to conduct their own separate investigation of the Companys industry to obtain broader insight in
assessing the Companys prospects.
THE PEOPLE OF THE STATE OF NEW YORK
(d) Describe specifically the marketing strategies the Company is employing or will emTO
ploy in penetrating its market or in developing a new market. Set forth in response to Question 4
below the timing and size of the results of this effort which will be necessary in order for the
Company to be profitable. Indicate how and by whom its products or services are or will be
marketed (such as by advertising, personal contact by sales representatives, etc.), how its marketGREETINGS:
ing structure operates or will operate and the basis of its marketing approach, including any
market studies. Name any customers that account for, orbeing laid aside, you and each of will attend before
WE COMMAND YOU, that all business and excuses based upon existing orders you account
for a Honorable
major portion (20% or more) of the Companys sales. Describe any major existing sales
,
the
at the
Court
contracts.
located at
County of
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
____________________________________________________________________________________
____________________________________________________________________________________
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
____________________________________________________________________________________ as a
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained
result of your failure to comply.
____________________________________________________________________________________
Witness, Honorable
, one of the Justices of the
Court (e) State the backlog of written firm orders, for products and/or services as of a recent date
in
County,
day of
20
(within the last 90 days) and compare it with the backlog of a year ago from that date.
As of: _____/_____/_____ $______________ sign above and type name below)
(Attorney must
(a recent date)
As of: _____/_____/_____ $______________ for
Attorney(s)
(a year earlier)
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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Explain the reason for significant variations between the two figures, if any. Indicate what
types and amounts of orders are included in the backlog figures. State the size of typical orders.
:
JUDICIAL SUBPOENA
Plaintiff(s)
If the Companys sales are seasonal or cyclical, explain.
-against-
:
____________________________________________________________________________________
:
____________________________________________________________________________________
:
____________________________________________________________________________________
Defendant(s)
:
......................................................
____________________________________________________________________________________
(f) State the number of the Companys
THE PEOPLE OF THE STATE OF NEW YORK present employees and the number of employees it
anticipates it will have within the next 12 months. Also, indicate the number by type of employee
TO
(i.e., clerical, operations, administrative, etc.) the Company will use, whether or not any of them
are subject to collective bargaining agreements, and the expiration date(s) of any collective bargaining agreement(s). If the Companys employees are on strike, or have been in the past three
years, or are threatening to strike, describe the dispute. Indicate any supplemental benefits or
GREETINGS:
incentive arrangements the Company has or will have with its employees.
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
____________________________________________________________________________________
the Honorable
at the
Court
located at
County of
____________________________________________________________________________________
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
____________________________________________________________________________________
____________________________________________________________________________________ to
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result (g)your failure generally the principal properties (such as real estate, plant and equipment,
of Describe to comply.
patents, etc.) that the Company owns, including the amount of payments, expiration dates and the
terms of any renewal options. Indicate what properties the Companyone of the Justices of the the
Witness, Honorable
, intends to acquire in
immediate future, theCounty, suchday of
cost of
acquisitions and 20 sources of financing it expects to use in
Court in
, the
obtaining these properties, whether by purchase, lease or otherwise.
____________________________________________________________________________________
(Attorney must sign above and type name below)
____________________________________________________________________________________
Attorney(s) for
____________________________________________________________________________________
____________________________________________________________________________________
Office and P.O. Address
(h) Indicate the extent to which the Companys operations depend or are expected to
depend upon patents, copy rights, trade secrets, know-how or other proprietary information and
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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the steps undertaken to secure and protect this intellectual property, including any use of confidentiality agreements, covenants-not-to- compete and the like. Summarize the principal terms
:
JUDICIAL SUBPOENA
Plaintiff(s)
and expiration dates of any significant license agreements. Indicate the amounts expended by the
-againstCompany for research and development during the last fiscal year, the amount expected to be
:
spent this year and what percentage of revenues research and development expenditures were for
:
the last fiscal year.
:
____________________________________________________________________________________
Defendant(s)
:
......................................................
____________________________________________________________________________________
____________________________________________________________________________________
THE PEOPLE OF THE STATE OF NEW YORK
____________________________________________________________________________________
TO
(i) If the Companys business, products, or properties are subject to material regulation
(including environmental regulation) by federal, state, or local governmental agencies, indicate
the nature and extent of regulation and its effects or potential effects upon the Company.
GREETINGS:
____________________________________________________________________________________
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
the Honorable
at the
Court
____________________________________________________________________________________
located at
County of
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
____________________________________________________________________________________
____________________________________________________________________________________
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
(j) State the names of any subsidiaries of the maximum their of $50 and all damages sustained as a
the party on whose behalf this subpoena was issued for aCompany,penalty business purposes and
result of your failure to comply.
ownership, and indicate which are included in the Financial Statements attached hereto. If not
included, or if included but not consolidated, please explain.
Witness, Honorable
, one of the Justices of the
____________________________________________________________________________________
Court in
County,
day of
, 20
____________________________________________________________________________________
(Attorney must sign above and type name below)
____________________________________________________________________________________
____________________________________________________________________________________
Attorney(s) for
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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(k) Summarize the material events in the development of the Company (including any
material mergers or acquisitions) during the past five years, or for whatever lesser period the
:
JUDICIAL acquisitions, spinPlaintiff(s)
Company has been in existence. Discuss any pending or anticipated mergers, SUBPOENA
offs or recapitalization. If-againstthe Company has recently undergone a stock split, stock dividend or
:
recapitalization in anticipation of this offering, describe (and adjust historical per share figures
:
elsewhere in this Disclosure Document accordingly.):
:
____________________________________________________________________________________
Defendant(s)
:
......................................................
____________________________________________________________________________________
____________________________________________________________________________________
THE PEOPLE OF THE STATE OF NEW YORK
____________________________________________________________________________________
TO
4. (a) If the Company was not profitable during its last fiscal year, list below in chronological
order the events which in managements opinion must or should occur or the milestones which in
GREETINGS:
managements opinion the Company must or should reach in order for the Company to become
profitable,WE COMMAND YOU, that all businessof occurrence or laid expected method byyou attend before
and indicate the expected manner and excuses being the aside, you and each of which the
Company will achieve the milestones.
,
the Honorable
at the
Court
located at
County of
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the of
Date, or number
months after receipt
Expected manner of
of proceeds, when
occurrence or method
should be court and will
Your failure to comply with this subpoena is punishable as a contempt ofaccomplishedmake you liable to
Event or Milestone of achievement
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
(1)
_____________
____________________
_____________
Witness, Honorable ____________________
Court _____________
in
County,____________________20
day of
,
(2)
_____________
____________________
_____________
____________________
_____________
____________________
(3)
_____________
____________________
_____________
____________________
_____________
____________________
(4)
_____________
____________________
_____________
____________________
______________
____________________
(5)
_____________
____________________
_____________
____________________
____________________
____________________
, one of the Justices of the
____________________
____________________
____________________
____________________ name below)
(Attorney must sign above and type
____________________
____________________
____________________
Attorney(s) for
____________________
____________________
____________________
____________________
Office and P.O. Address
____________________
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Index No.
:
Calendar
b) State the probable consequences to the Company of delays in No.
achieving
each of the events or milestones within the above time schedule, and particularly the effect of any
:
JUDICIAL SUBPOENA
Plaintiff(s)
delays upon the Companys liquidity in view of the Companys then anticipated level of operating
-againstcosts. (See Question Nos. 11 and 12)
:
:
____________________________________________________________________________________
:
____________________________________________________________________________________
Defendant(s)
:
......................................................
____________________________________________________________________________________
____________________________________________________________________________________
THE PEOPLE OF THE STATE OF NEW YORK
TO
Note: After reviewing the nature and timing of each event or milestone, potential investors should
reflect upon whether achievement of each within the estimated time frame is realistic and should
assess the consequences of delays or failure of achievement in making an investment decision.
GREETINGS:
OFFERING and excuses being laid
WE COMMAND YOU, that all business PRICE FACTORS aside, you and each of you attend before
,
the Honorable
at the
Court
If the
located at
County of securities offered are common stock, or are exercisable for or convertible into commonroom the following factors may be relevant to the price ato'clock in thesecurities are being recessed
which the
in stock,
, on the
day of
, 20
, at
noon, and at any
or adjourned date, to testify and give evidence as a witness in this action on the part of the
offered.
5. What were net, after-tax earnings for the last fiscal year?
(If losses, show in parenthesis.)
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
Total whose behalf this subpoena was issued for a maximum penalty of
the party on$___________________ ($___________________ per share) $50 and all damages sustained as a
result of your failure to comply.
6. If the Company had profits, show offering price as a multiple of earnings. Adjust to reflect
for any stock splitsHonorable
Witness, or recapitalization, and use conversion or exerciseone of the lieu of of the
, price in Justices offering
price, ifin
Court applicable. County,
day of
, 20
Offering Price Per Share = _____(price/earnings multiple)
Net After-Tax Earnings Last Year Per Share
(Attorney must sign above and type name below)
7. (a) What is the net tangible book value of the Company? (If deficit, show in parenthesis.)
For this purpose, net tangible book value means total assets (exclusive of copyrights, patents,
Attorney(s) for
goodwill, research and development costs and similar intangible items) minus total liabilities.
$ ______________________ ($ __________________ per share)
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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......... ..
:
Index No.
:
Calendar No.
If the net tangible book value per share is substantially less than this offering (or exercise
or conversion) price per share, explain the reasons for the variation.
:
JUDICIAL SUBPOENA
Plaintiff(s)
-against____________________________________________________________________________________
:
:
____________________________________________________________________________________
:
____________________________________________________________________________________
Defendant(s)
:
......................................................
____________________________________________________________________________________
(b) State the dates on which the Company sold or otherwise issued securities during the
last 12 PEOPLE OF THE STATE such securities sold, the number of persons to whom they were sold,
THE months, the amount of OF NEW YORK
any relationship of such persons to the Company at the time of sale, the price at which they were
TO
sold and, if not sold for cash, a concise description of the consideration. (Exclude bank debt.)
____________________________________________________________________________________
GREETINGS:
____________________________________________________________________________________
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
____________________________________________________________________________________
the Honorable
at the
Court
located at
County of
____________________________________________________________________________________
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
____________________________________________________________________________________
____________________________________________________________________________________ to
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
____________________________________________________________________________________
____________________________________________________________________________________
Witness, Honorable
, one of the Justices of the
Court in
County,
day of
, 20
____________________________________________________________________________________
____________________________________________________________________________________
(Attorney must sign above and type name below)
____________________________________________________________________________________
Attorney(s) for
____________________________________________________________________________________
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
,
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Index No.
:
Calendar No.
8.
(a) What percentage of the outstanding shares of the Company will the investors in this
offering have? (Assume exercise of outstanding options, warrants or rights and conversion of
:
JUDICIAL SUBPOENA
Plaintiff(s)
convertible securities, if the respective exercise or conversion prices are at or less than the offer-againsting price. Also assume exercise of any options, warrants or: rights and conversions of any convertible securities offered in this offering.)
:
If the maximum is sold:
______%
If the minimum is sold:______%
:
(b) What post-offering value is management implicitly attributing to the entire Company
Defendant(s)
:
. establishing .the. price .per. .security .set .forth.on .the. cover .page (or exercise or conversion price
........... .. ..... .. ....... .. .... .. .. .....
by
if common stock is not offered)? (Total outstanding shares after offering times offering price, or
exercise or conversion price if common stock is not offered.)
THE PEOPLE OF THE STATE OF NEW YORK
If maximum is sold:$ ______*
If minimum is sold: $ _____________*
TO
(For above purposes, assume outstanding options are exercised in determining shares if the
exercise prices are at or less than the offering price. All convertible securities, including outstanding
convertible securities, shall be assumed converted and any options, warrants or rights in this offering
GREETINGS:
shall be assumed exercised.)
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
*These values assume that the Companys capital structure would be changed to reflect any
,
the Honorable
at the
Court
conversions of outstanding convertible securities and any use of outstanding securities as paylocated at
County of
ment in the exercise ofthe
in room
, on outstanding options, warrants or rights included in the calculation. any recessed
day of
, 20
, at
o'clock in the
noon, and at The
or and amount to testify and give other securities thus this action on the part of
typeadjourned date,of convertible or evidence as a witness in eliminated would be: the
___________________________. These values also assume an increase in cash in the Company by
the amount of any cash payments that would be made upon cash exercise of options, warrants or
rights included failure to comply with this subpoena isof such cash would be: of court and will make you liable to
Your in the calculations. The amount punishable as a contempt $ _________.
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
Note: After reviewing the above, potential investors should consider whether or not the offering price
(or exercise or conversion price, if applicable) for the securities is appropriate at the present stage of
the Companys development.
Witness, Honorable
, one of the Justices of the
Court in
County,
day of
, 20
(Attorney must sign above and type name below)
Attorney(s) for
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
:
USE OF PROCEEDS
9.
Index No.
Calendar No.
:
JUDICIAL SUBPOENA
Plaintiff(s)
(a) The following table sets forth the use of the proceeds from this offering.
-against-
:
If Minimum
Sold
Amount
:
%
:
If Maximum
Sold
Amount
%
Defendant(s)
:
......................................................
Total Proceeds
$ ______
Less: Offering Expenses
______
Commissions & Finders Fees OF NEW YORK
______
THE PEOPLE OF THE STATE
Legal & Accounting
______
TO
Copying & Advertising
______
Other (Specify):
______
100%
___
___
___
___
___
$_________
________
________
________
________
________
100%
____
____
____
____
____
Net Proceeds from Offering
___
________
____
GREETINGS:
$______
Use of Net WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
Proceeds
,
at the
Court
$________
____ ________
%___
located at
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify
____________________ and give evidence as a witness in this action on the part of the
________
____ ________
___
the Honorable
____________________
County of
Total Use of Net Proceeds
$ _______
100% ________
100%
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
Note: After reviewing the portion of the offering allocated to the payment of offering expenses, and
to the immediate payment to management and promoters of any fees, reimbursements, past salaries
or similar payments, a potential investor should consider whether the remaining portion of the investWitness, Honorable
, one of the Justices of his
ment, which would be County, available for future development of the Companys business and
that part
Court in
day of
, 20
operations, would be adequate.
(Attorney must sign above and type name below)
10. (a) If material amounts of funds from sources other than this offering are to be used in
conjunction with the proceeds from this offering, state the amounts and sources of such other
funds, and whether funds are firm or contingent. If contingent, explain.
Attorney(s) for
____________________________________________________________________________________
____________________________________________________________________________________
Office and P.O. Address
____________________________________________________________________________________
Telephone No.:
____________________________________________________________________________________
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
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COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
:
Index No.
Calendar No.
(b) If any material part of the proceeds is to be used:to discharge indebtedness, describe
JUDICIAL be discharged
the terms of such indebtedness, includingPlaintiff(s)rates. If the indebtedness toSUBPOENA was
interest
-againstincurred within the current or previous fiscal year, describe: the use of the proceeds of such indebtedness.
:
:
____________________________________________________________________________________
Defendant(s)
:
......................................................
____________________________________________________________________________________
____________________________________________________________________________________
THE PEOPLE OF THE STATE OF NEW YORK
____________________________________________________________________________________
TO
(c) If any material amount of the proceeds is to be used to acquire assets, other than in the
ordinary course of business, briefly describe and state the cost of the assets and other material
GREETINGS:
terms of the acquisitions. If the assets are to be acquired from officers, directors, employees or
principal stockholders of the Company or their associates, give the names of the persons from before
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend
whom the assets are to be acquired and set forth the cost to the Court
Company, the method followed in
,
the Honorable
at the
determining the cost, and any profit to such persons.
located at
County of
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
____________________________________________________________________________________
____________________________________________________________________________________
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
____________________________________________________________________________________ as a
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained
result of your failure to comply.
____________________________________________________________________________________
Witness, Honorable
, one of the Justices of the
Court (d) If any amount of the proceeds is to be used to reimburse any officer, director, employee
in
County,
day of
, 20
or stockholder for services already rendered, assets previously transferred, or monies loaned or
advanced, or otherwise, explain:
(Attorney must sign above and type name below)
____________________________________________________________________________________
Attorney(s) for
____________________________________________________________________________________
____________________________________________________________________________________
Office and P.O. Address
____________________________________________________________________________________
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
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......... ..
:
Index No.
:
Calendar No.
11. Indicate whether the Company is having or anticipates having within he next 12 months any
cash flow or liquidity problems and whether or not it is in :
default or in breach of any note, loan,
JUDICIAL to make payments.
Plaintiff(s) requiring the Company SUBPOENA
lease or other indebtedness or financing arrangement
-againstIndicate if a significant amount of the Companys trade payable have not been paid within the
:
stated trade term. State whether the Company is subject to any unsatisfied judgments, liens or
:
settlement obligations and the amounts thereof. Indicate the Companys plans to resolve any such
problems.
:
____________________________________________________________________________________
Defendant(s)
:
......................................................
____________________________________________________________________________________
____________________________________________________________________________________
THE PEOPLE OF THE STATE OF NEW YORK
TO
____________________________________________________________________________________
12. Indicate whether proceeds from this offering will satisfy the Companys cash requirements
GREETINGS:
for the next 12 months, and whether it will be necessary to raise additional funds. State the
source of additional funds, if known. business and excuses being laid aside, you and each of you attend before
WE COMMAND YOU, that all
,
the Honorable
at the
Court
located at
County of
____________________________________________________________________________________
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
____________________________________________________________________________________
____________________________________________________________________________________ to
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
____________________________________________________________________________________
Witness, Honorable
Court in
County,
, one of the Justices of the
day of
, 20
(Attorney must sign above and type name below)
Attorney(s) for
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
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COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
:
CAPITALIZATION
Index No.
Calendar No.
:
JUDICIAL SUBPOENA
Plaintiff(s)
13. Indicate the capitalization of the Company as of the most recent balance sheet date (adjusted
-againstto reflect any subsequent stock splits, stock dividends, recapitalization or refinancing) and as
:
adjusted to reflect the sale of the minimum and maximum amount of securities in this offering
:
and the use of the net proceeds therefrom:
:
Amount Outstanding
Defendant(s)
:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . As. of:. . . . .
.. ..
___/___/___(date)
As Adjusted
Minimum
Maximum
Debt: PEOPLE OF THE STATE OF NEW YORK
THE
TO
Short-term debt (average
interest rate ____%)
$_______
$_____
$_____
Long-term debt (average
GREETINGS:
interest rate ____%)
$_______
$_____
$____
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
Total debt
$_______
$_____
$______
,
the Honorable
at the
Court
located at
County of
Stockholders equity (deficit): day of
in room
, on the
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
Preferred stock - par or
stated value (by class of
preferred in order of comply with this subpoena is punishable as a contempt of court and will make you liable to
Your failure to
preferences)whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
the party on
result of your failure to comply.
___________________________
$_______
$______
$______
___________________________
$_______
$______
$______
___________________________
$_______
$______ of the Justices of the
$_____
Witness, Honorable
, one
Court in
County,
Common Stockpar or stated
value
Additional paid in capital
Retained earnings (deficit)
Total stockholders equity
(deficit)
Total Capitalization
day of
, 20
$_______
$_______
$_______
$_______
$______
$_______
$____
(Attorney must sign above and type name below)
$_______
$_____
Attorney(s) for
$_______
$_______
$______
$______
$______
$_____
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
:
Number of preferred shares
authorized to be outstanding:
Number of
Class of Preferred
__________________
__________________
__________________
Index No.
Plaintiff(s)
-against- Par Value
Calendar No.
:
JUDICIAL SUBPOENA
:
Shares Authorized
:
_________________
___________________
:
___________________
Defendant(s)
Per Share
__________
___________
___________
:
...... . ........ ..... .......... ............... ..
Number .of. common .shares. authorized:. .______________ .shares. Par or stated value per share, if
any: $ _________
Number of common shares reserved to meet conversion requirements or for the issuance upon
THE PEOPLE OF THE STATE OF NEW YORK
exercise of options, warrants or rights: ____________ shares.
TO
GREETINGS:
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
located at
County of
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
Witness, Honorable
Court in
County,
, one of the Justices of the
day of
, 20
(Attorney must sign above and type name below)
Attorney(s) for
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
American LegalNet, Inc.
www.USCourtForms.com
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COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Index No.
:
Calendar No.
DESCRIPTION OF SECURITIES
Plaintiff(s)
14. The securities being offered hereby are:
-against-
[]
[]
[]
[]
:
JUDICIAL SUBPOENA
:
Common Stock
:
Preferred or Preference Stock
Notes or Debentures
:
Units of two or more types of securities, composed of:
Defendant(s)
:
. . . . . . . . . . . . . . . . . . _________________________________________________
....................................
[] Other:
_______________________________________________
THE PEOPLE OF THE STATE OF NEW YORK
TO
15. These securities have:
Yes
No
[]
[] Cumulative voting rights
GREETINGS:
[]
[] Other special voting rights
[] WE [] Preemptive rights to purchase inand excuses being laid aside, you and each of you attend before
COMMAND YOU, that all business new issues of shares
[]
[] Preference as to dividends or interest
,
the Honorable
at the
Court
[]
[] Preference uponlocated at
liquidation
County of
[]
[] Other the
in room
, on special rights or preferences (specify):
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
_________________________________________________________
Explain:
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
____________________________________________________________________________________ as a
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained
result of your failure to comply.
____________________________________________________________________________________
Witness, Honorable
, one of the Justices of the
____________________________________________________________________________________
Court in
County,
day of
, 20
____________________________________________________________________________________
16. Are the securities convertible? []Yes [] No
If so, state conversion price or formula.
__________________________
Date when conversion becomes effective:
_____/______/______
Date when conversion expires:
_______/_______/_______
(Attorney must sign above and type name below)
Attorney(s) for
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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......... ..
:
17.
(a)
Index No.
:
Calendar
If the securities are notes or other types of debt securities: No.
(1)
What is the interest rate? _____%
:
Plaintiff(s)
If interest rate is variable or multiple rates, JUDICIAL SUBPOENA
-againstdescribe:_________________________________________________
:
:
(2)
What is the maturity date? _______/_______/_______
:
If serial maturity dates, describe: _______________
Defendant(s)
:
. . . . . . . . . . . . . . . . . . _____________________________________________
....................................
(3)
Is there a mandatory sinking fund? [] Yes [] No
THE PEOPLE OF THE STATE OF NEW YORK
Describe: _________________________________________
________________________________________________________
TO
(4)
GREETINGS:
Is there a trust indenture? [] Yes [] No
Name, address and telephone number of Trustee
____________________________________________
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
___________________________________________________
,
the Honorable
at the
Court
located at
County of
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
or adjourned date, to testify and give evidence as a witness in this action on the part of the
(5)
Are the securities callable or subject to redemption?
[] Yes [] No Describe, including redemption prices:
_______________________________________________________
________________________________________________________
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your (6)
failure to comply.
Are the securities collateralized by real or personal
property?
[] Yes []
Witness, Honorable No Describe_________________________________
, one of the Justices of the
Court in
County,
day of
, 20
____________________________________________________
____________________________________________________ name below)
(Attorney must sign above and type
(7)
If these securities are subordinated in right of payment
of interest or principal, explain the terms of such
Attorney(s) for
subordination. ________________________________
_______________________________________________________
How much currently outstanding indebtedness of the Companyand senior to the securities in right
Office is P.O. Address
of payment of interest or principal? $__________. How much indebtedness shares in right of
payment on an equivalent (pari passu) basis? $________________. How much indebtedness is
junior (subordinated) to the securities? $______________.
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
Index No.
(b)
If notes or other types of debt securities are being offered and the Company had earnings
:
Calendar No.
during its last fiscal year, show the ratio of earnings to fixed charges on an actual and pro forma
basis for that fiscal year. Earnings means pretax income from continuing operations plus fixed
:
JUDICIAL SUBPOENA
Plaintiff(s)
charges and capitalized interest. Fixed charges means interest (including capitalized interest),
-against:
