Authority: IC 23-19-6-5
Affected: IC 23-19-3-4
Sec. 2.
NAME OF ISSUER
Address
Total Shares Offered
(Same in Indiana if different from above)
Price to Public | Underwriting or Selling Commission | Net Proceeds to Issuer After Expenses Estimated at $ _______ | |
Per Share or Unit: | $ | $ | $ |
Aggregate: | $ | $ | $ |
THESE ARE SPECULATIVE SECURITIES
THE INDIANA SECURITIES DIVISION HAS NOT IN ANY WAY PASSED UPON THE MERITS OR QUALIFICATIONS OF OR RECOMMENDED OR GIVEN APPROVAL TO, THE SECURITIES HEREBY OFFERED, OR PASSED UPON THE ACCURACY OR ADEQUACY OF THIS PROSPECTUS. ANY REPRESENTATION TO THE CONTRARY IS A CRIMINAL OFFENSE.
NAME OF UNDERWRITER | NAME OF RESIDENT AGENT |
Address | Address |
The date of this prospectus is: |
IN CONNECTION WITH THIS OFFERING THE UNDERWRITER MAY OVERALLOT OR EFFECT TRANSACTIONS THAT STABILIZE OR MAINTAIN THE MARKET PRICE OF (identify each class of securities in which this type of transaction may be effected) AT A LEVEL ABOVE THAT WHICH MIGHT OTHERWISE PREVAIL IN THE OPEN MARKET. THE STABILIZING, IF COMMENCED, MAY BE DISCONTINUED AT ANY TIME.
TABLE OF CONTENTS
Page | |
Introduction ................................................................................... The Company ................................................................................. The Purpose of the Offering and Use of Proceeds ....................................................... Management's Discussion and Analysis of Financial Condition ............................................ Description of the Business ....................................................................... Dividends .................................................................................... Capitalization ................................................................................. Dilution ...................................................................................... Marketability and Price Range of Offered Securities .................................................... Management and Principal Stockholders ............................................................. Control ...................................................................................... Remuneration and Transactions with Management ..................................................... Options and Warrants ........................................................................... Escrow of Proceeds ............................................................................. Pending or Anticipated Litigation .................................................................. Material Contracts .............................................................................. Underwriter, Broker-Dealer or Plan of Distribution ..................................................... Selling Stockholders ............................................................................ Legal Opinions ................................................................................ Experts ...................................................................................... Opinion of Independent Accountants ................................................................ Financial Statements ............................................................................ |
tax treatment, a statement as to the effect of this treatment.
The discussion shall provide information as specified in clause (B)(i) through (B)(iii) and also shall provide any other information that the issuer believes to be necessary to an understanding of its financial condition. Discussions of liquidity and capital resources may be combined whenever the two (2) topics are interrelated. Where in the issuer's judgment a discussion of segment information or of other subdivisions of the issuer's business would be appropriate to an understanding of the business, the discussion shall focus on each relevant, reportable segment or other subdivision of the business and on the registrant as a whole.
that will result in or that are reasonably likely to result in the registrant's liquidity increasing or decreasing in any material way. If a material deficiency is identified, indicate the course of action that the registrant has taken or proposes to take to remedy the deficiency. Also identify and separately describe internal and external sources of liquidity, and briefly discuss any material unused sources of liquid assets.
Title of Class | Outstanding As of _____, 20___ | After the Offering |
Short-term debt: | $ | |
Long-term debt: Notes to banks | $ | |
Notes to others | $ | |
_____% Convertible Debentures due | $ | |
Total long-term debt: | $ | |
Capital Stock Preferred stock par $_____ | ______ shares | _____ shares |
______ shares authorized ______ % cumulative dividend preference Common stock par $_____ | _____ shares | _____ shares |
_____ shares authorized |
should be carefully enumerated in addition to any other material facts regarding the rights of holders.
and supply a brief description of the business background of each person. Do not include nonbusiness positions unless particularly relevant to the business of the issuer. Include the names of all corporations (including those no longer in existence) that each person has served as director or officer and a very brief statement of the business of each corporation. Include any conviction of a misdemeanor or felony involving fraud in any form and any civil or criminal litigation involving any federal or state securities law to which any person is or has been a party.
Name | No. of Shares Owned As Of _____, 20___ | Cash Price As Of _____, 20___ | % of Shares If Offering Sold | % of Cash Paid In If Offering Sold | % of Shares If All Options or Warrants Exercised |
Total for group Total for public Grand Total | |||||
Name | Total Subscription | Unpaid Balance | |||
Total |
"The following persons had not yet fully paid for _____ shares for which they had subscribed as of _____, 20 _____, and that are shown as owned by those persons in the above table.".
Name | Total Subscription | Unpaid Balance |
Total |
of that person shall be deemed owned by the person for purposes of inclusion in the table required by clause (B). An explanatory footnote to the table shall be included if any shares are so treated.
paid by the issuer or any parent, affiliate, or subsidiary of the issuer to any person identified in subdivision (11), or any person to whom payments totaling twenty-five thousand dollars ($25,000) or more were made during the twelve (12) months prior to the filing of the application, and the estimated total of the payments in the next twelve (12) months.
Name of Holder | Shares Subject to Option or Warrant | Option or Warrant Price | Date of Issue | Date of Expiration |
that may materially affect the issuer's business or ability to commence business.
that are of sufficient importance to the issuer that their termination would materially affect the issuer's business.
If discounts, commissions, or fees are to be variable, state the basis for determination and the maximum and minimum amounts. Briefly state the terms of the underwriting arrangements or plan of distribution, including whether the underwriting is on a best efforts or firm commitment basis and whether exclusive or nonexclusive.
effected or proposed to be effected within the past three (3) years; and
or, if a debt security, that it will be a binding obligation of the issuer.
710 IAC 4-4-2