from SB-1
1 page
Subscription Form To: Columbia River Resources Inc. the Undersigned Hereby Acknowledges Receipt of the Prospectus, Dated , 2000, of Columbia River Resources Inc. (The "Company") and Subscribes for the Following Number of Shares of the Company Upon the Terms and Conditions Set Forth Therein: Number of Shares: All Subscriptions Are Subject to Acceptance by the Company, to Price Per Share: $ Availability, and to Certain Other Conditions, and Any Subscription May Payment Enclosed: $ Be Declined in Whole or in Part by Return of the Subscription Monies Without Interest. (Make Checks Payable to "Columbia River Resources Inc.") Accepted by Company: Date: , 2000 Authorized Officer - For Shares - (Signature(s) of Subcriber(s) - Social Security or Tax I.D. Check One if More Than One Owner: The Certificates for Such Stock Are [ ] Joint Tenants Wrs to Be Issued as Follows: [ ] Tenants in Common - [ ] Custodian Under Ugma Name(s) Other: - - Address - - <page>
