Form A
Form of Application For Shares
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| To: The Board of Directors Queen of the South Football Club Ltd. I/we wish to purchase ____________ Ordinary Shares of 5p each at 1500p per Share (Available in blocks of ten shares only) Remittance for __________________ is enclosed. Dated :
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| Signature :
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| Name :
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| Address :
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| Note:- This form should be returned to the Company Secretary, Queen of the South Football Club Ltd., Palmerston Park, Dumfries, DG2 9BA. Together with the relevant amount.
| Cheques made payable to Queen of the South Football Club Ltd. The amount payable is 1500 pence for each share purchased and these are available in blocks of ten only. For example 20 shares = 300GBP |