Fill and Sign the Sec Filingoverstockcom Inc Form

2.09 Short-Form Subscription Agreement (Rule 504)The undersigned investor ("Investor"), by signing this Agreement, will purchase the number of shares of stock in ____________ ("Issuer") indicated below (the "Shares"), at a purchase price of $______ per share (the "Offering Price"). To purchase the Shares, please do the following:¥ Read and understand this Agreement. ¥ If you agree with and agree to be bound by this Agreement, complete and sign this Agreement below. ¥ Write a check, payable to "____________," in the amount of the number of Shares multiplied by the Offering Price. ¥ Give or send the completed and signed Agreement and the check to Issuer. 1. Commitment to Purchase. Investor understands that, once this Agreement is signed by Investor and Issuer, Investor will be irrevocably obligated to purchase the Shares and to pay Issuer the purchase price indicated below. 2. High-Risk Undertaking. Investor understands that Issuer is a high-risk undertaking and that there is no guarantee that Investor will receive back Investor's investment in the Shares or any return on such investment. 3. Non-Voting Stock; Dilution. Investor understands that (1) the Shares are non- voting stock; (2) Issuer is not agreeing to maintain the percentage ownership provided by Investor's purchase of the Shares; (3) Issuer is currently selling and probably will in the future sell more equity and other securities to raise capital and issue such securities for purposes of providing compensation and reimbursement to Issuer officers and others; and (4) any such issuance of equity securities will reduce Investor's percentage ownership in Issuer accordingly. 4. Ability to Withstand Loss. Investor represents to Issuer that Investor is able to withstand the complete loss of Investor's investment in the Shares without undue financial hardship or significant change in Investor's present or planned lifestyles due to financial hardship. 5. Sufficient Information. Investor represents to Issuer that Investor understands Issuer's business plans, business history, competitive position and capital structure, and that all Investor's questions concerning these matters have been answered to Investor's satisfaction. 6. Ability to Assess Investment. Investor represents to Issuer that Investor, together with any necessary assistance from persons not affiliated with Issuer, has the ability to understand and assess the risk involved in an investment in Issuer. 7. Investment Purpose. Investor represents to Issuer that Investor is purchasing the Shares for investment purposes only, and not with the present intent of re- selling all or any of the Shares. 8. Issuer's Right to Refuse. Investor understands that Issuer, until it signs this Agreement below, has the right to refuse Investor's purchase of the Shares if Issuer reasonably determines that an investment in Issuer would not be suitable for Investor. 9. If Investor is an Entity. If Investor is a corporation, partnership, trust or other entity, Investor represents that its signatory below is duly authorized to act on behalf of and to bind such entity to this Agreement. If Investor is an entity, Investor represents to Issuer that the other representations and understandings of this Agreement apply to and are valid for every equity owner, beneficiary and controlling person of such entity. 10. Any Other Representations Superseded. Any representations or promises made by any person that contradict the provisions of this Agreement have not been authorized by Issuer and cannot be relied upon by Investor.IN WITNESS WHEREOF, the parties have executed this Agreement by their signature or the signature of their duly authorized representatives below. ISSUER: INVESTOR: Signed: ____________________ Number of Shares subscribed Printed name: ______________ for: _____________________ Title: _____________________ Subscription Price (number of Dated: _____________________ shares subscribed for multiplied by the Offering Price): $__________________ Signed:___________________ Title: ____________________ Dated: ___________________