AFFIRMOLOGY
Investor Subscription Packet
AFFIRMOLOGY LLC · Private placement of membership units · Prepared for Norman Adams · v3, July 2026
How to use this packet
This packet has three parts. The investor completes and signs Parts 2 and 3. The Company countersigns Part 3 and delivers the disclosure document (the Confidential Disclosure Document) alongside it.
Order of events: the investor reviews the disclosure document and asks any questions; the investor completes the Accredited Investor Questionnaire (Part 2); both sides sign the Subscription Agreement (Part 3); the investor wires funds; the Company files a Form D within 15 days of the first sale and makes any required state notice filing where the investor resides.
Part 1. Investor cover
Investor name: Norman Adams
Entity name (if investing through an entity): ______________________________________
Mailing address: ______________________________________
Email: ______________________________________
State of residence: ______________________________________
Amount subscribed (USD): ______________________________________
At a $1,500,000 post-money valuation, each $15,000 is approximately 1% of the Company. Membership units, not a note (see the alternative below).
Note alternative. An investor who prefers debt to equity may instead take a promissory note (a fixed interest return, repaid over 18 to 24 months, and no Schedule K-1). Indicate preference here: ☐ Membership units ☐ Promissory note.
Part 2. Accredited Investor Questionnaire
The Company is relying on Regulation D, Rule 506(b). Please tell us, truthfully, which of the following applies. Under Rule 506(b) the Company relies on your representation; you do not need to send documents. If you are NOT accredited, you may still be able to invest as a sophisticated investor (see the last item).
Accredited as an INDIVIDUAL (check any that apply)
☐ My individual income exceeded $200,000 in each of the two most recent years, and I reasonably expect the same this year.
☐ My joint income with my spouse or spousal equivalent exceeded $300,000 in each of the two most recent years, and I reasonably expect the same this year.
☐ My net worth, alone or with my spouse or spousal equivalent, exceeds $1,000,000, excluding the value of my primary residence.
☐ I hold a Series 7, Series 65, or Series 82 license in good standing.
☐ I am a director, executive officer, or manager of AFFIRMOLOGY LLC.
Accredited as an ENTITY (check any that apply)
☐ The entity has total assets over $5,000,000 and was not formed just to make this investment.
☐ All of the entity's equity owners are themselves accredited investors.
☐ The entity owns investments over $5,000,000.
If NOT accredited
☐ I am not accredited, but I have sufficient knowledge and experience in financial and business matters to evaluate the merits and risks of this investment. Briefly describe your relevant experience:
______________________________________
______________________________________
Source of funds representation. I represent that this investment is not being financed by any third party for the purpose of making it, and that I can bear the risk of losing my entire investment.
Investor signature: ______________________________________
Print name: ______________________________________
Date: ______________________________________
Part 3. Subscription Agreement
This Subscription Agreement is between AFFIRMOLOGY LLC, a Wyoming limited liability company (the "Company"), and the undersigned investor (the "Investor").
1. Subscription. The Investor subscribes for membership units of the Company for the amount stated in Part 1, at a $1,500,000 post-money valuation, and agrees to be bound by the Company's Operating Agreement, a copy of which the Investor has received or may request.
2. Acceptance. This subscription is not binding until accepted by the Company. The Company may accept or reject it in whole or in part.
3. Disclosure received. The Investor has received and reviewed the Company's Confidential Disclosure Document, has had the opportunity to ask questions and receive answers, and has obtained all information the Investor considers necessary.
4. Investor representations. The Investor represents that: the information in Part 2 is true; the Investor is acquiring the units for their own account, for investment, and not with a view to resale; the Investor understands the units are restricted securities with no public market and cannot be resold absent registration or an exemption; the Investor can bear the economic risk of a total loss; and the Investor is not relying on the Company for legal, tax, or investment advice.
5. Risk acknowledgment. The Investor acknowledges that the Company is a pre-revenue, early-stage business; that all projections are illustrative and not promises; that the investment is illiquid and speculative; and that the Investor may lose the entire investment.
6. Restrictions and legend. The units are subject to the transfer restrictions and right of first refusal in the Operating Agreement, and any certificate or record will bear a restrictive legend.
7. Tax. If the Investor receives membership units, the Company is taxed as a partnership and will issue the Investor a Schedule K-1; the Investor may owe tax on allocated income. If the Investor elects the promissory-note alternative, the Investor receives interest income reported on a Form 1099-INT and does not become a member.
8. Governing law. Florida, venue Miami-Dade County.
The Investor
Signature: ______________________________________
Print name: ______________________________________
Amount ($): ______________________________________
Date: ______________________________________
AFFIRMOLOGY LLC
By (Jeff Parker, Manager): ______________________________________
Date: ______________________________________
Questions are welcome at every step. Ask before you invest, not after. Review by securities counsel is pending.