Document:

Exhibit 4.3

 

WINMARK CORPORATION

4200 Dahlberg Drive, Suite
100

Minneapolis, Minnesota
55422-4837

 

PURCHASE CONFIRMATION

 

	
  [Investor name and address]

  	
   

  	
  STATEMENT DATE:                     ,
  200      

  

 

TRANSACTION INFORMATION

 

SECURITY DESCRIPTION: Winmark Corporation Renewable Unsecured
Subordinated Note

TRANSACTION:  PURCHASE

TYPE OF OWNERSHIP: 

SSN: 

 

	
  NOTE ID

  	
   

  	
  TERM

  	
   

  	
  PURCHASE DATE

  	
   

  	
  MATURITY DATE

  	
   

  	
  PAYMENT SCHEDULE

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  

 

	
  PRINCIPAL AMOUNT

  	
   

  	
  INTEREST RATE

  	
   

  	
  INVESTOR FEES

  	
   

  	
  NET AMOUNT

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  

 

NOTE: These securities are issued in book-entry form only; no physical
certificates will be provided.

 

	
  INTEREST PAYMENT INFORMATION

  	
   

  	
   

  
	
  ACCOUNT NAME:

  	
   

  	
  BANK:

  
	
  ACCOUNT #:

  	
   

  	
  ROUTING NUMBER:

  
	
  INTEREST PAYMENT METHOD: ACH (Direct Deposit)

  	
   

  	
   

  

 

Your interest payments will be automatically deposited directly into
the account listed above. Please verify the account information. If it is
incorrect, please call Sumner Harrington Investor Services at 800-234-5777.

 

All interest payments will be made in accordance with the Interest
payment schedule shown in the previous section. If your note pays interest
monthly and the monthly interest payment date you selected is within five
business days of the Purchase Date, your first interest payment will be made
the following month and will include all of the interest earned since the Note
Issue Date. If an interest payment date falls on a Saturday, Sunday, or legal
holiday, the payment will be made on the next business day.

 

SECURITIES OFFERED THROUGH SUMNER HARRINGTON LTD.

Sumner Harrington Ltd. was the selling agent for the Issuer in this
transaction and is sending you this confirmation statement on the Issuer’s
behalf. The Issuer will pay Sumner Harrington Ltd. fees and commissions of up
to 3% of the Net Amount as its selling agent plus other fees for providing
marketing and other services, but this will not affect your interest or
principal.

 

PLEASE CALL SUMNER HARRINGTON LTD. INVESTOR SERVICES AT 800-234-5777 IF
YOU HAVE ANY QUESTIONS.

 

	
  Sumner Harrington Ltd.

  	
   

  	
  (800) 234-5777

  
	
  11100 Wayzata Blvd., Suite 170

  	
   

  	
  investorservices@sumnerharrington.com

  
	
  Minneapolis, MN 55305

  	
   

  	
  www.sumnerharrington.comExhibit 4.4

 

WINMARK CORPORATION

 

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 WINMARK CORPORATION (“Winmark”). 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

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Three Month

  	
   

  	
  $

  	
   

  	
  [ ]

  	
   

  	
  [ ]

  	
   

  	
  N/A

  	
   

  	
  N/A

  	
   

  	
  [ ]

  	
   

  
	
  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 OtherIRA, 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 Winmark 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  Winmark 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 Winmark and understand the
risks related to the notes and to Winmark; (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 Winmark; (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 Winmark or its selling agent.

 

 

	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

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

  	
   

  	
  Date

  	
   

  	
  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 Winmark 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 Winmark Corporation, its
affiliates, or its agents (collectively referred to hereinafter as “Winmark”)
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 Winmark to the listed account. In the event of an erroneous credit
entry, I also authorize Winmark 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 Winmark and my financial institution have received written notice
from me of its termination in such time and in such manner as to afford Winmark
and my financial institution reasonable opportunity to act on it. In the event
the listed account is closed, I will promptly notify Winmark 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

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