SUBSCRIPTION AGREEMENT
FOR
▇▇▇ ▇▇▇▇▇ CORP.
COMMON STOCK ($.05 PER SHARE)
Persons interested in purchasing common stock of ▇▇▇ ▇▇▇▇▇ Corp. must
complete and return this Subscription Agreement along with their check or
money order to: ▇▇▇ ▇▇▇▇▇ CORP. ("the Issuer") ("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 certificates 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 1,100,000
shares of its common stock (par value $.001 per share) at a price of $.05
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 $.05 per Share
Aggregate Subscription Price = $___________________
Check or money order shall be made payable to ▇▇▇ ▇▇▇▇▇ Corp.
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 ______________, 2004.
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):
___________________________________________________________________
As (check one)
__Individual __Tenants in Common __Existing Partnership
__Joint Tenants __Corporation __Trust
__Minor with adult custodian under
the Uniform Gift to Minors Act __IRA
For the person(s) who will be registered shareholder(s):
________________________________ ________________________________
Signature of Subscriber Residence Address
________________________________ ________________________________
Name of Subscriber (Printed) City or Town
________________________________ ________________________________
Signature of Co-Subscriber State Zip Code
________________________________ ________________________________
Name of Co-Subscriber (Printed) Telephone
________________________________ ________________________________
Subscriber Tax I.D. or Co-Subscriber Tax I.D. or
Social Security Number Social Security Number
________________________________
E-mail Address (if available)
ACCEPTED BY: ▇▇▇ ▇▇▇▇▇ Corp., a Nevada Corporation
By: _____________________________Date: ______________________________
Officer
