exv4w10






EXHIBIT 4.10




ADVANCED ENVIRONMENTAL RECYCLING TECHNOLOGIES, INC.




RENEWABLE UNSECURED SUBORDINATED NOTE SUBSCRIPTION AGREEMENT



To purchase a renewable unsecured subordinated note(s), please complete this form and write a check
made payable to ADVANCED ENVIRONMENTAL RECYCLING TECHNOLOGIES, INC. (“AERT”). Send this form along
with your check and any other documents requested below to the selling agent for the notes, SUMNER
HARRINGTON LTD., 11100 WAYZATA BOULEVARD, SUITE 170, MINNEAPOLIS, MN 55305. If you have any
questions, call the selling agent for the notes, SUMNER HARRINGTON LTD., at 800-234-5777.




NOTE PURCHASE AMOUNT (minimum principal amount of $1,000 per note)




INTEREST PAYMENT SCHEDULE (please select one for each note)




 






	 	 	 	 	 	 	 	 	 	 	 	 	 
	Note Term	 	Principal Amount	 	Monthly*	 	Quarterly	 	Semi-Annually	 	Annually	 	Maturity
	Six Month

	 	$                    
	 	[ ]
	 	[ ]
	 	[ ]
	 	N/A
	 	[ ]
	One Year

	 	$                    
	 	[ ]
	 	[ ]
	 	[ ]
	 	[ ]
	 	[ ]
	Two Year

	 	$                    
	 	[ ]
	 	[ ]
	 	[ ]
	 	[ ]
	 	[ ]
	Three Year

	 	$                    
	 	[ ]
	 	[ ]
	 	[ ]
	 	[ ]
	 	[ ]
	Four Year

	 	$                    
	 	[ ]
	 	[ ]
	 	[ ]
	 	[ ]
	 	[ ]
	Five Year

	 	$                    
	 	[ ]
	 	[ ]
	 	[ ]
	 	[ ]
	 	[ ]
	Ten Year

	 	$                    
	 	[ ]
	 	[ ]
	 	[ ]
	 	[ ]
	 	[ ]
	TOTAL	 	$                    	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 






 




*Monthly payment date (e.g. 1st, 15th, etc.)
                                             




FORM OF OWNERSHIP (please select one)




	 	 	 
	o    Individual Investor (with optional beneficiary)


	 	o    Custodian for a Minor

	 
	o    Joint Tenants with Right of Survivorship


	 	o    Other IRA, SEP, 401(k), 403(b), Keogh,
trust, corporation, partnership, etc.
(Please include with this form a trust resolution
or the appropriate corporation or
partnership documents authorizing you to make
this investment.)







NOTE PURCHASER (please circle one)



Full Name of Individual Investor/First Joint Tenant/Minor/Entity/Administrator/Trustee




	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 
	First Name

	 	Middle name
	 	Last name
	 	Social Security Number/Tax ID Number
	 	Date of Birth (if applicable)





Full Name of Beneficiary/Second Joint Tenant/Custodian/Transfer on Death (please circle one if
applicable)




	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 
	 
	First Name

	 	Middle name
	 	Last name
	 	Social Security Number/Tax ID Number
	 	Date of Birth (not required for custodians)






	 	 	 	 	 
	 
	 	 	 	 
	Name(s) and Relationship of other Family AERT Note Investors
	 	 	 	 
	 
	 	 	 





PRIMARY ADDRESS (Original correspondence will be sent to this address.)




 





Individual Investor, IRA Administrator, Trustee, Custodian, Partnership, etc.





 

Address


	 	 	 	 	 
	 
	 	 	 	 
	 
	City

	 	State
	 	Zip






	 	 	 
	 
	 	 
	 
	Daytime Phone (Include Area Code)

	 	E-mail Address




















 




SECONDARY ADDRESS (Optional—copies of correspondence will be sent to this address.)




	 	 	 	 	 
	 
	 	 	 	 
	 
	Beneficiary, IRA Owner, Joint Tenant, Partner, etc.
	 
	 	 	 	 
	 
	 	 	 	 
	 
	Address
	 	 	 	 
	 
	 	 	 	 
	 
	 	 	 	 
	 
	City

	 	State
	 	Zip
	 
	 	 	 	 
	 
	 	 	 	 
	 
	Daytime Phone (Include Area Code)

	 	E-mail Address	 	 





DIRECT DEPOSIT AERT will electronically deposit your principal and interest payments directly into
the account listed in the Direct Deposit section on the reverse side of this form. Please complete
and sign the reverse side of this form for automatic deposit to either your checking or savings
account.



PASSWORD When you call Sumner Harrington to discuss your investment, you may be asked to verify
your identification by answering the following question.




	 	 	 
	What is your mother’s maiden name?

	 	 
	 

	 	 






CERTIFICATION Under penalties of perjury, I hereby declare and certify that: (i) I am a bona fide
resident of the state listed in the primary mailing address; (ii) I have received and read the
prospectus provided by AERT and understand the risks related to the notes and to AERT; (iii) Sumner
Harrington Ltd. has neither recommended this investment to me nor given me investment, legal or tax
advice regarding the notes and the creditworthiness of AERT; (iv) I have independently determined
that this investment is suitable for me without relying on such advice from Sumner Harrington Ltd.;
(v) the notes are illiquid due to significant transfer restrictions and the lack of a secondary
market; (vi) I risk the loss of my entire principal amount and all accrued but unpaid interest when
purchasing the notes and have the financial ability to withstand these losses; (vii) I am
purchasing the notes to fulfill my investment objective of earning current taxable interest income;
(viii) the social security number or tax identification number listed above is correct; and (ix) I
am not subject to backup withholding, either because the Internal Revenue Service has not notified
me that I am subject to backup withholding as a result of a failure to report all interest or
dividends or I have been notified that I am no longer subject to backup withholding. I understand
that my purchase offer is subject to the terms contained in the prospectus, may be rejected in
whole or in part and will not become effective until accepted by AERT or its selling agent.



	 	 	 
	 
	 	 
	
 

Signature of Individual Investor/First Joint                                Date Tenant/Custodian/Authorized Person
	 	 

Signature of Second Joint Tenant (if applicable)                         Date






(Please complete reverse side)




Office Use Only            ACTP
                               ACTP
                               DATE
                    

















 





DIRECT DEPOSIT




Direct Deposit Information (please check one)





			
	o	 	I currently receive direct deposit payments from
an existing AERT note. Please deposit all
principal and interest payments for this new note






			
	o	 	Please deposit my payments into the account listed
below. (If this option is chosen, the account
owner must attached to the bottom of this form
either a VOIDED check, if this is a checking
account, or a deposit slip, if this is a savings
account.





 





Account Owner Name(s)




	 	 	 	 	 
	 

	 	o   Checking     o   Savings     o   Other	 	 
	 

Account Number

	 	 	 	 
	 
	 	 	 	 
	 

	 	 
	 	 
	Bank Routing Number (9 digits)

	 	Bank Name
	 	Branch Location





Some financial institutions (e.g. brokerage firms, custodians, mutual savings banks, credit unions,
money market funds, etc.) also require “for further credit” information to correctly identify
direct deposit accounts. If your financial institution requires this additional information,
please list it below. If you are unsure if this additional information is required, please call
your financial institution.




	 	 	 
	For further credit:
	 	 
	 

	 	 





Direct Deposit Authorization



As the investor of record and authorized signatory of the account listed above, I hereby authorize
Advanced Environmental Recycling Technologies, Inc., its affiliates, or its agents (collectively
referred to hereinafter as “AERT”) to deposit interest and principal payments owed to me, by
initiating credit entries in the account to my financial institution listed on this Form. Further,
I authorize my financial institution to accept and to credit any credit entries initiated by AERT
to the listed account. In the event of an erroneous credit entry, I also authorize AERT to debit
the account for an amount not to exceed the original amount of the erroneous credit.



This authorization is to remain in full force and effect until AERT and my financial institution
have received written notice from me of its termination in such time and in such manner as to
afford AERT and my financial institution reasonable opportunity to act on it. In the event the
listed account is closed, I will promptly notify AERT of an alternate account into which payments
can be made.




	 	 	 
	 
	 

	 	 
	Authorized Signature

	 	Date





Mail to:

SUMNER HARRINGTON LTD.

11100 Wayzata Boulevard

Suite 170

Minneapolis, Minnesota 55305




ATTACH VOIDED CHECK or DEPOSIT SLIP HERE