Backers Network Inc. Class C Common Shares @ $0.15/share
Private Issuer Exemption - - directors, officers, employees or control persons of the issuer - family members (spouse, parent, grandparent, sister, brother or child) of the directors, senior officers or control persons - close personal friends or close business associates of the directors, senior officers or control persons - current security holders - family members of the selling security holder - accredited investors
Address Line 1
Address Line 2
State / Province / Region
Antigua and Barbuda
Bolivia (Plurinational State of)
Bonaire, Saint Eustatius and Saba
Bosnia and Herzegovina
British Indian Ocean Territory
Central African Republic
Cocos (Keeling) Islands
Congo (Democratic Republic of the)
Eswatini (Kingdom of)
Falkland Islands (Malvinas)
French Southern Territories
Heard Island and McDonald Islands
Iran (Islamic Republic of)
Ireland (Republic of)
Isle of Man
Korea (Democratic People's Republic of)
Korea (Republic of)
Lao People's Democratic Republic
Micronesia (Federated States of)
Moldova (Republic of)
North Macedonia (Republic of)
Northern Mariana Islands
Palestine (State of)
Papua New Guinea
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Sao Tome and Principe
Sint Maarten (Dutch part)
South Georgia and the South Sandwich Islands
Svalbard and Jan Mayen
Syrian Arab Republic
Taiwan, Republic of China
Tanzania (United Republic of)
Trinidad and Tobago
Turks and Caicos Islands
United Arab Emirates
United Kingdom of Great Britain and Northern Ireland
United States Minor Outlying Islands
United States of America
Vatican City State
Venezuela (Bolivarian Republic of)
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Investing as a corporation
I would like to make the investment in the name of a corporation
Amount to Invest (CAD)?
Minimum Investment $3000 CAD
Electronic signature: By checking the ‘I confirm & Sign’ box, I acknowledge that I am signing this form electronically and agree that this is the legal equivalent of my handwritten signature. I will not at any time in the future claim that my electronic signature is not legally binding. The date of my electronic signature is the same as my acknowledgement.
Name (copy) (copy)
I confirm & Sign
I confirm & Sign
1. The purchaser must complete all the information required in the forms and clicking the “I confirm & Sign” button where indicated to evidence the purchaser’s electronic signature.
2. The purchaser acknowledges and agrees that: a. The purchaser is purchasing the purchased shares as principal; b. The decision to subscribe for shares agreed to be purchased hereunder has been made solely based upon the information available and has not been based upon any oral or written representation as to fact or otherwise made by or on behalf of the Issuer; c. the Issuer is entitled to rely on the representations and warranties of the purchaser contained in this Agreement, as applicable, and the purchaser will hold harmless the Issuer from any loss or damage it or it may suffer as a result of the purchaser’s failure to correctly complete this Agreement. d. no prospectus has been or is intended to be filed by the Issuer with any securities commission having jurisdiction over the Issuer, the purchaser or this subscription, including any Canadian provincial securities commissions (collectively, the “Commission”) in connection with the issuance of the purchased shares, the issuance is intended to be exempted from the prospectus and registration requirements of the applicable legislation and as a consequence: i. the purchaser is restricted from using most of the civil remedies available under the applicable legislation; ii. the purchaser may not receive information that would otherwise be required to be provided to the purchaser under applicable legislation; and iii. the Issuer is relieved from certain obligations that would otherwise apply under applicable legislation; e. There are restrictions on the purchaser’s ability to resell the purchased shares and it is the responsibility of the purchaser to find out what those restrictions are and to comply with them before selling the purchased shares; f. The purchaser has been advised that the issuer is not a reporting issuer as that term is defined in applicable securities legislation nor will it become a reporting issuer in any jurisdiction in Canada or elsewhere following completion of the Offering and, as a result: i. the Issuer will not be subject to the continuous disclosure requirements of such securities legislation, including the requirements relating to the production and filing of audited financial statements and other financial information, and ii. any applicable hold periods under applicable securities legislation may never expire, and the Purchased Shares may be subject to restrictions on resale for an indefinite period of time;
3. no person has made to the Purchaser any written or oral representations: a. that any person will resell or repurchase the Purchased Shares; b. that any person will refund the purchase price of the Purchased Shares; or c. as to the future price or value of any of the Purchased Shares;
4. The purchaser has the legal capacity and competence to enter into and execute this Agreement and to take all actions required pursuant hereto and, if the purchaser is a corporate entity, it is duly incorporated and validly subsisting under the laws of its jurisdiction of incorporation and all necessary approvals by its directors, shareholders and others have been obtained to authorize execution and performance of this Agreement on behalf of the purchaser; and
5. The purchaser has made an independent examination and investigation of an investment in the Purchased Shares and the Issuer and agrees that the Issuer will not be responsible in any way whatsoever for the purchaser’s decision to invest in the Issuer or to purchase the Purchased Shares. COLLECTION OF PERSONAL INFORMATION
6. The purchaser acknowledges and consents to the fact that the Issuer is collecting the purchaser’s personal information for the purpose of fulfilling this Agreement and completing the Offering. The purchaser's personal information may be disclosed by the Issuer to (a) stock exchanges or securities regulatory authorities, (b) the Issuer's registrar and transfer agent, (c) Canadian tax authorities, (d) authorities pursuant to the Proceeds of Crime (Money Laundering) and Terrorist Financing Act (Canada) and (e) any of the other parties involved in the Offering, including legal counsel, and may be included in record books in connection with the Offering. By executing this Agreement, the purchaser is deemed to be consenting to the foregoing collection, use and disclosure of the purchaser's personal information for the foregoing purposes and to the retention of such personal information for as long as permitted or required by law or business practice.
6. By executing this Agreement, the purchaser consents to the collection, use and disclosure of such personal information as described above. The purchaser also consents to the filing of a report of trade and copies or originals of any of the documents provided to the Issuer (including this Agreement) by or on behalf of the purchaser with any securities regulatory or taxation authorities. Furthermore, the purchaser is hereby notified that: a. the Issuer may deliver to any Commission certain personal information pertaining to the purchaser, including such purchaser’s full name, residential address and telephone number, the number of Purchased Shares or other securities of the Issuer owned by the purchaser, the number of Purchased Shares purchased by the purchaser and the total purchase price paid for such Purchased Shares, the prospectus exemption relied on by the Issuer and the date of distribution of the Purchased Shares, b. such information is being collected indirectly by the Commission under the authority granted to them in securities legislation, c. such information is being collected for the purposes of the administration and enforcement of the securities laws, and d. the purchaser may contact the following public official in Ontario with respect to questions about the Ontario Securities Commission’s indirect collection of such information at the following address and telephone number: Ontario Securities Commission 20th Floor, 20 Queen Street West Toronto, Ontario M5H 3S8 Telephone: 416-593-8314 or 1-877-785-1555 (toll free across Canada) Email: firstname.lastname@example.org
7. All funds are set out in Canadian dollars.
8. The purchaser acknowledges and agrees that all costs and expenses incurred by the purchaser relating to the purchase of the Purchased Shares shall be borne by the purchaser.
9. This Agreement is not transferable or assignable.
10. This Agreement, including without limitation the representations, warranties and covenants contained herein, shall survive and continue in full force and effect and be binding upon the parties hereto notwithstanding the completion of the purchase of the Purchased Shares by the purchaser.
11. Except as expressly provided in this Agreement and in the agreements, instruments and other documents contemplated or provided for herein, this Agreement contains the entire agreement between the parties with respect to the purchase and sale of the Purchased Shares and there are no other terms, conditions, representations or warranties, whether expressed, implied, oral or written, by statute or law, by the Issuer or by anyone else.
12. The invalidity or unenforceability of any particular provision of this Agreement shall not affect or limit the validity or enforceability of the remaining provisions of this Agreement.
13. This Agreement is to be read with all changes in gender or number as required by the context.
14. This Agreement is exclusively governed by the laws of the Province of Ontario and the federal laws of Canada applicable thereto. The purchaser irrevocably attorns to the exclusive jurisdiction of the courts of the Province of Ontario.
Electronic Funds Transfer
Bank Account Number
Void Cheque (Optional)
Click or drag files to this area to upload.
You can upload up to 2 files.
Send E-Transfer to: email@example.com
After placing your order, please send an Email money transfer to us (thru Interac or any other Email Transfer means).
Driver License Upload (Front)
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