EX-1.1 4 d27710_ex1-1.txt SUBSCRIPTION AGREEMENT [EXHIBIT 1.1] WILD HEART RANCH INC. SUBSCRIPTION AGREEMENT Gentlemen: The Investor named below, by payment of the purchase price for such Common Shares, by the delivery of a check payable to "Wild Heart Ranch Inc.", hereby subscribes for the purchase of the number of Common Shares indicated below of Wild Heart Ranch Inc., at a purchase price of $1.00 per Share as set forth in the Prospectus. By such payment, the named Investor further acknowledges receipt of the Prospectus and the Subscription Agreement, the terms of which govern the investment in the Common Shares being subscribed for hereby. A. INVESTMENT: (1) Number of Shares ___________________________ (2) Total Contribution ($1.00/Share) $__________________ Date of Investor's check ___________ B. REGISTRATION: (3) Registered owner: __________________________ Co-Owner: __________________________________ (4) Mailing address: ___________________________ City, State & Zip: _________________________ (5) Residence Address (if different from above): ____________________ City, State & Zip: _________________________ (6) Birth Date: ______/______/______ (7) Employee or Affiliate: Yes ______ No ______ (8) Social Security #: ______/______/______ U.S. Citizen [ ] Other [ ] Co-Owner Social Security #: ______/______/______ U.S. Citizen [ ] Other [ ] Corporate or Custodial: Taxpayer ID #: ______/______/______ U.S. Citizen [ ] Other [ ] (9) Telephone (H) ( ) ______________________ C. OWNERSHIP: [ ] Individual Ownership [ ] IRA or Keogh [ ] Joint Tenants with Rights of Survivorship [ ] Tenants in Common [ ] Tenants by the Entirety [ ] Trust/Date Trust Established_______________ [ ] Pension/Trust (S.E.P.) [ ] Corporate Ownership [ ] Partnership [ ] Other_______________________________ D. SIGNATURES: Registered Owner: _____________________________ Co-Owner: _____________________________ Print Name of Custodian or Trustee: _____________________________ Authorized Signature: _____________________________ Date: _____________________ Signature: ___________________________________ MAIL TO: Ms. Dawn L. Van Zant Wild Heart Ranch, Inc. 145 Tyee Drive, Number 1573 Point Roberts, Washington 98281 Telephone: (800) 665-0411 Facsimile: (604) 948-0814 -------------------------------------------------------------------------------- FOR OFFICE USE ONLY: Date Received: _________________ Date Accepted/Rejected:__________________ Subscriber's Check Amount: $___________________ Check No.: ______________ Date of Check: ________________ Date of Deposit: ________________________________