Subscription

Subscription Sample
Date
Escrow Agent’s Name
Escrow Bank Name
Address
City, State, ZIP Code
Dear Mr. or Ms. (Name):
Having read the registration statement dated (insert date) of (name of national bank/
Federal savings association, city, state), I subscribe for (number) shares of capital stock of
(name of national bank/Federal savings association) at $(amount) per share.
Enclosed with this letter is a check for $(amount) made payable to the (escrow bank name).
This check represents the total amount due for my purchase of capital stock in (name of
national bank/Federal savings association). When received by you, the funds are to be
held in escrow subject to the following instructions:
•

You may invest the funds only in United States Treasury securities (bills, bonds, or
notes), including a mutual fund consisting exclusively of such securities, until the
national bank/Federal savings association receives its charter from the Office of the
Comptroller of the Currency (OCC).

•

The organizers reserve the right to reject, in whole or in part, any offer to subscribe and
to allot a lesser number of shares than are subscribed for. Until the date the national
bank/Federal savings association commences operations, the organizers, if ordered to
do so by the OCC, have the right to return the subscription price in whole or in part
and cancel the subscription agreement.

•

If this subscription offer, or any part of it, is rejected by the organizers, return to the
undersigned the amount:
−

Paid to you as escrow agent or

−

The amount required for the shares allotted, if the organizers rejected a portion
of the originally requested subscription.

If any profits accrue on money because of the investment by you, the amount returned
will include any such profits.
•

If the OCC does not charter the national bank/Federal savings association, you must
return promptly the amount of this payment, plus any profits accrued thereon. The
funds can be returned only after the OCC directs their release. In that event, your
duties and responsibilities hereunder shall terminate.

Name
(insert information)

No. of
Shares

Address

Dollar
Amount

If you need any additional information, contact me at (telephone number or e-mail
address).
Sincerely,
-- Signature -Name and Title
Enclosure: Check

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