APPLICATION AGREEMENT
A.C.I is a closely held corporation consisting
of an association of professionals who are well versed in
investments as well as the adult entertainment industry.
This dedicated group of businessmen have brought a new set
of standards to an already exploding global industry.
The primary objective of ACI is profits, promoting successful
projects, seizing and capitalizing on financial opportunities.
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ADULT CONCEPTS, INC.
1245 S. Powerline Rd Suite 148 Pompano Beach Fl.33069
PARTNERS SUBSCRIPTION APPLICATION AND AGREEMENT
Dear Sir;
1. I hereby make application for _______ Units @$5,000.00
per Unit, in an A.C.I. Limited Liability Partnership ("LLP").
2. I am herewith tendering payment for the subscribed Units
by delivering a check payable to ADULT CONCEPTS, INC., ("A.C.I.")
or transmitting by wire transfer to the A.C.I. Account the
sum of $________________.
In the event my subscription is not accepted, all funds delivered
by me will be returned promptly (subject to check clearance)
without deduction and without interest. This subscription
is not binding on the parties unless accepted by A.C.I. My
subscription for Units is not binding on A.C.I. until the
funds paid by check clear and are credited to the A.C.I. account.
3. A representative of A.C.I. has given me, and my advisors,
prior to the date hereof, the opportunity to ask questions
and receive answers form its principals and their representatives,
concerning the terms and conditions of the proposed LLP, as
well as access to any information or documents I requested.
All materials and information required by either me, my counsel,
my advisors, or others representing me, including any information
required to verify any information furnished, have been made
available and examined.
4. I understand the Units have not been registered under the
Securities Act of 1933, as amended (the "Act"),
nor pursuant to the provisions of other securities laws, or
other laws or any other applicable jurisdictions. I am fully
aware that the interest subscribed to by me is to be sold
to me in reliance upon my representation, warranties, and
assignment of the Units.
5. I am acquiring the Units for my own account and not for
the account of others and for investment purposes and not
with a view to transfer, assign, resell, or distribute them,
in whole or in part.
6. I will not rescind or cancel this Agreement, except as
otherwise provided by law.
7. The foregoing representations and warranties are true and
correct as of the date hereof and as of the date of my purchase
of the Units subscribed for herein. I hereby agree to indemnify,
defend and hold harmless A.C.I. and its affiliated persons
from any and all damages, losses, cost, and expenses that
they, or any of them, may incur by reason of my failure, or
alleged failure to fulfill any of the terms and conditions
of this subscription or by reason of my breach of any of my
representation and warranties contained herein. All notices
given or made hereunder (other than notices of partnership
meetings) shall be in writing delivered or mailed by registered
or certified mail, return receipt requested, postage prepaid,
to me at my address as set forth below and to A.C.I. at it
address set forth above. The Subscription Application and
Agreement, the LLP, and its exhibits constitute the entire
agreement between the parties with respect to the subject
matter hereof and may be amended only by a writing executed
by all parties.
8. The amount of money damages suffered by me on account of
any material misstatement or omission of any material fact,
or otherwise, in connection with this investment with be extremely
difficult to calculate. I hereby acknowledge and agree that
in light of this difficulty, the money damages I may recover
as a result of any such event shall be limited to the amount
of my initial investment in the LLP, which amount is reasonable
in light of the difficulty in determining the amount of money
damages. This amount shall not act as a penalty and recovery
of this amount shall be my sole and exclusive remedy.
9. If I am a United States citizen, under penalties of perjury,
I certify that my social security number or taxpayer identification
number that has been disclosed to A.C.I. is correct (or I
am awaiting the issuance of a social security number or taxpayer
identification number), and I am not subject to backup withholding
because (a) I am exempt from backup withholding, or (b) I
have not been notified by the Internal Revenue Service (IRS)
that I am subject to backup withholding as a result of a failure
to report all interest and dividends, or (c) the IRS has notified
me that I am on longer subject to backup withholding.
IN WITNESS WHEREOF, I have executed this Subscription Agreement
and Application
this _____ day of __________, 20_____.
_____________________________________ ________________________________________
Name Joint Tenant or Tenant-in Common
______________________________________ ____________________________________
Signature Signature (Joint Tenant)
__________________________________ ___________________________________
State of Residence and Domicile State of Residence and Domicile
APPROVED AND ACCEPTED this _____ day of _____________, 20_____.
__________________________________
Authorized Representative of A.C.I.
SUBSCRIPTION INSTRUCTION
A.C.I. PARTNERS
MAKE CHECKS PAYABLE TO: ADULT CONCEPTS, INC.
SEND CHECK/DOCUMENTS TO: ADULT CONCEPTS, INC.
1245 S. Powerline Rd. Suite 148
Pompano Beach Fl.33069
ALL PAYMENTS MUST BE SENT DIRECTLY OT ADULT CONCEPTS, INC.
OR WIRED TO ITS ACCOUNT) AT THE ADDRESS SET FORTH ABOVE AND
NOT TO ANY OTHER PARTY. ADULT CONCEPTS, INC., AND ANY AFFILIATED
PERSONS OR ENTITIES BEAR NO RESPONSIBILITY FOR ANY PAYMENT
SENT TO ANY OTHER PARTY.
Please complete this Questionnaire as fully as possible,
sign and date.
PLEASE PRINT OR TYPE YOUR ANSWERS. IF THE ANSWER TO ANY QUESTION
IS "NONE" OR "NOT APPLICABLE",
PLEASE SO STATE._______________________________________________.
Will this investment be held by our IRA or SEP/IRA? YES NO
Name _____________________________________ Date of Birth ___________________
Marital Status_______________________________ Citizenship
_____________________
Home Telephone Number (____) _______________ Social Security
#_________________
Permanent Home Address__________________________________________________________
Employer _______________________________________________________________________
Business Address_________________________________________________________________
Business Telephone # (___) __________ Cellular # (___) ____________
Fax # (___) ___________
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