Energy & Water
Integrated Energy Corp
Quantum Fuel® (w-t-e)
Green Acres Energy (solar)
Agriculture & Silviculture
Integrated Agriculture Corp
Infrastructure & Resources
Yilgarn Infrastructure Ltd
Quartz Tech International
i-Ecorp Exec Brief
i-Ecorp Full Brief
Contact, CV & Corporate Profile
Indicates required field
A. I/we apply for
Minimum 100,000,000 shares @ 1
0c per share,
You may be allocated all of the above Shares or a lesser number.
B. I/we lodge full Application Money $
Upon Application $10,000,000.00
C. Individual/Joint applications - refer to naming standards for correct forms of registrable title(s)
Title or Company Name
Joint Applicant 2 or Account Designation
Joint Applicant 3 or Account Designation
D. Enter your postal address - Include State and Zipcode
SOPHISTICATED INVESTOR CERTIFICATE
Please complete the Sophisticated Investor Certificate, using the WORD document here (click to open). After completing - print, sign, scan and save to your computer. Then using the "Upload File" below, attach. Once you click the "Submit" button it will be sent with your Application Form.
Max file size: 20MB
E. Enter your contact details
A Direct Debit transfer can be made to:
Integrated Energy Corporation
BSB: 012-006 | A/C: 2132-58136
details - Make your
or bank draft payable to:
Integrated Energy Corporation - Project 2020
F. Drawer 1
Amount of cheque $
Amount of cheque $
By submitting this Application Form, I/we declare that this application is completed and lodged according to the Executive Brief (EB) and the declarations/statements on page 17 of the EB and I/we declare that all details and statements made by me/us (including the declaration on page 17 of the EB are complete and accurate. I/we agree to be bound by the Constitution of the Company.
See page 17 of the EB for completion guidelines.
This Application Form is important. If you are in doubt as to how to deal with it, please contact your stockbroker or professional adviser without delay. You should read the entire Executive Brief (EB) and Important Notice (IN) carefully before completing this form. To meet the requirements of the Corporations Act, this Application Form must not be distributed unless included in, or accompanied by, the EB and IN.
767 Corporation Group of Companies. All rights reserved.
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