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Subscription Agreement (United States)

This is a subscription agreement. The form provided here is simply a sample of what the actual form looks like.

SUBSCRIPTION AGREEMENT

I, __________________________(1)_________, do hereby subscribe to purchase

__________(2)__________ shares of Stock of

__________(3)___________, a ___________(4)___________ corporation (the "Company"), Par Value of which is

$__________(5)________,

and for which I agree to pay $__________(6)________ per share, for a total purchase price of

$________(7)_________.

I agree that my failure to pay any installments as may be required in a promissory note accompanying this subscription agreement is a default of my obligation hereunder, and if those installments are not timely paid, (i) the Company may immediately terminate this Agreement; (ii) my right, title and interest in all the stock purchased hereby shall be null and void; (iii) the Company may cancel all shares of stock then held by me; (iv) I shall forfeit any monies which have been paid to the Company hereunder; and (v) I shall be deemed to have waived any and all claims or cause(s) of action which I may have against the Company.

DATED: ________(8)___________

______________(9)______________

Sworn to and subscribed before me this

_(10)_ day of________(11)_______, ______(12)_________.

(SEAL)

_____________(13)______________
Notary Public

My Commission Expires:

_________(14)____________

ACCEPTED by and for the Corporation:

_____________(15)______________
President

DATED: _________(16)___________

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