I, _______________, do hereby subscribe to purchase ___ shares of Stock of _______________, a ___ corporation (the "Company"), Par Value of which is $____, and for which I agree to pay $___ 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.
Sworn to and subscribed before me this _ day of_________, 20__.
My Commission Expires:
ACCEPTED by and for the Corporation: