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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
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)___________
Sworn to and subscribed before me this _(10)_ day of________(11)_______, ______
Notary Public
My Commission Expires:
ACCEPTED by and for the Corporation:
DATED: _________(16)___________

The information in this document is designed to provide an outline that you can follow
when formulating business or personal plans. Due to the variances of many local, city, county
and state laws, we recommend that you seek professional legal counseling before entering into
any contract or agreement.