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STATE OF UTAH
DEPARTMENT OF COMMERCE
DIVISION OF SECURITIES
FORM 11-7b
Fund Impound Agreement
Name of Issuer: ______________________________________________
Escrow Number: _______________________ Date: _________________
Expiration Date: ______________ Sales/Agent Underwriter: __________________
_______________________________ HEREBY AGREES TO DELIVER, WITHIN THREE BUSINESS DAYS AFTER RECEIPT, and with names and addresses of investors at time deposit is made, funds to be applied to an escrow account in the amount of:
$__________________ To: ____________(Bank Name)_______________
Complete Address (Street Address, City & State, Zip Code)
as escrow agent, the papers, money, or property hereinafter described, to be held and disposed of by said escrow agent in accordance with the duties, instructions, and upon the terms and conditions hereinafter set forth to which the undersigned hereby agree:
1. Above named bank (hereinafter called the "bank") is not a party to, or bound by any agreement which may be evidenced by or arises out of the following instructions.
2. The bank and its officers, agents, and employees, act hereunder as a depository only, and are not responsible or liable in any manner whatever for serving as escrow agent in this matter or for the sufficiency, correctness, genuineness or validity of any instrument deposited with it hereunder, or with respect to the form or execution of the same, or the identity, authority, or rights of any person executing or depositing the same.
3. The bank shall not be required to take or be bound by notice of any default by any person, or to take any action with respect to such default involving any expense or liability, unless notice in writing is given an officer of the bank of such default by the undersigned or any of them, and unless it is indemnified in a manner satisfactory to it against any such expense or liability.
4. The bank shall be protected in acting upon any notice, request, waiver, consent, receipt or other paper or document believed by the bank to be genuine and to be signed by the proper party or parties.
5. The bank shall not be liable for any error of judgement or for any act done or step taken or omitted by it in good faith, or for any mistake of fact or law, or for anything which it may do or refrain from doing in connection herewith, except its own willful misconduct.
6. The bank shall not be answerable for the default or misconduct of any agent, attorney, or employee acting on behalf of the issuer.
7. In the event of any disagreement between the undersigned or any of them, and/or the person or persons named in the foregoing instructions, and/or any other person, resulting in adverse claims and demands being made in connection with or for any papers, money or property involved herein or affected hereby, the bank shall be entitled at its option to refuse to comply with any such claim or demand, so long as such disagreement shall continue, and in so refusing the bank may make no delivery or other disposition of any money, papers or property involved herein or affected hereby and in so doing the bank shall not be or become liable to the undersigned or any of them or to any person named in the foregoing instructions for its failure or refusal to comply with such conflicting or adverse demands; and the bank shall be entitled to continue so to refrain and refuse so to act until:
8. The papers, documents, money or property subject to this escrow (if other than already named) are as follows: Including such items as may be described on attached schedules.
9. The other duties of the bank under the terms of this agreement are as follows:
10. The bank will be named as depository only and has not passed in any way upon the merits or qualifications of the security and makes no recommendation with regard to its purchase. The bank does not authorize the use of its name by any person for the promotion or sale of the security.
11. The issuer agrees that if any amendments are made to the escrow agreements, the issuer will, after receiving approval of the Utah Division of Securities, notify the bank as to the amendment and file such documents as the bank requires.
12. Special requirements:
13. Fees for the usual services of the bank under terms of this agreement are set forth below. All such fees shall be computed on a fiscal or calendar year period adjusted for any fractional part thereof except that a fee for any period shall not be less than the minimum fee indicated.
14. If a minimum of $ _________________________is not deposited with the bank by ____________ the parties to the escrow agreement agree as follows:
15. When 100% or more has been deposited with the escrow agent, and all escrow requirements have been met,
16. Provided all requirements of registration have been met, and the Division notified that escrow requirements have been met, the Division will then issue an order for the release of funds. No funds may be released without this order.
17. After release of escrow, the duties, responsibilities and liability of every kind and character under the escrow agreement shall cease and terminate.
_______________Signed (Issuer)________________________
_______________By (President or Partner)_______________
_______________Signed (Escrow Agent)_________________
_______________By (Officer)_________________________
_______________Signed (Underwriter/Agent)___________
_______________By (Officer)________________________
Approved by: ___________________
Date: __________________________