Exhibit 99
SUBSCRIPTION AGREEMENT
FOR
COASTAL MEDIA INC.
COMMON STOCK ($.025 PER SHARE)
Persons interested in purchasing common stock of COASTAL MEDIA INC. must
complete and return this Subscription Agreement along with their check or money
order payable to: COASTAL MEDIA INC. ("the Issuer" and "the Company").
Subject only to acceptance hereof by the Issuer, in its discretion, the
undersigned hereby subscribes for the number of common shares and at the
aggregate subscription price set forth below.
An accepted copy of this Agreement will be returned to the Subscriber as a
receipt, and the physical stock certificate will be delivered to each Investor
within thirty (30) days of the Close of this Offering.
SECURITIES OFFERED - The Company is offering a total of 1,600,000 shares of
its common stock (par value $.001 per share) at a price of $.025 per share.
There is no minimum subscription amount.
SUBSCRIPTION - In connection with this subscription the undersigned hereby
subscribes to the number of common shares shown in the following table.
NUMBER OF COMMON SHARES = ___________________
Multiply by Price of Shares x $.025 per Share
Aggregate Subscription Price = $___________________
Check or money order shall be made payable to COASTAL MEDIA INC.
In connection with this investment in the Company, I represent and warrant as
follows:
a) Prior to tendering payment for the shares, I received a copy of and read
your prospectus dated ___________, 2006.
b) I am a bona fide resident of the state of ________________________________
or ______ a non-US resident.
c) The Issuer and the other purchasers are relying on the truth and accuracy
of the declarations, representations and warranties herein made by the
undersigned. Accordingly, the foregoing representations and warranties and
undertakings are made by the undersigned with the intent that they may be
relied upon in determining his/her suitability as a purchaser. Investor
agrees that such representations and warranties shall survive the
acceptance of Investor as a purchaser.
Please register the Shares, which I am purchasing in the following name(s):
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As (check one)
__Individual __Tenants in Common __Existing Partnership
__Joint Tenants __Corporation __Trust
__IRA __Minor with adult custodian under
the Uniform Gift to Minors Act
For the person(s) who will be registered shareholder(s):
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Signature of Subscriber Signature of Co-Subscriber
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Name of Subscriber (Printed) Name of Co-Subscriber (Printed)
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Address Address of Co-Subscriber
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Address Address of Co-Subscriber
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Telephone Telephone of Co-Subscriber
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Subscriber Tax I.D. or Co-Subscriber Tax I.D. or
Social Security Number Social Security Number
ACCEPTED BY: COASTAL MEDIA INC., a Nevada Corporation
By: Date:
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Officer
