To The Board of Directors
In order to induce you to sell shares of the common stock of ______________________, ("the corporation") I herewith make the following representations:
(a) that I am purchasing the shares for my own account, for investment, and not for distribution or resale.
(b) that I not will not resell or otherwise dispose or encumber the shares until and unless that changed circumstances or contingencies, none of which I am aware of at this time that I would need to dispose of the shares.
(c) That I am a bona fide and legal resident of the state of _________. I if determine at some later time to sell or otherwise dispose of the shares that I will only sell or otherwise transfer the shares to another resident of the state of __________, or any other state approved by the corporation.
(d) That prior to any sale, transfer or other disposition I will deliver a written opinion of legal counsel that either:
(i) there is an exisiting exemption from registration under any applicable state or federal laws;
(ii) registration requirements necessary for such a proposed transfer have been met fully, and that the sale may proceed under the securities laws.
Such opinion shall be reasonably acceptable to the corporation.
The corporation may include stock transfer restrictions on the shares.
IT IS A VIOLATION OF FEDERAL AND STATE LAW TO MAKE FALSE REPRESENTATIONS IN ORDER TO INDUCE THE SALE OF SECURITIES.