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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.
Accepted by and for the Corporation:
This Section for Notary:
State of _________
County of ________ [COUNTY]
On [DATE] before me, [NAME OF NOTARY], notary, personally appeared [NAME OF PERSON(S) INVOLVED], personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
Witness my hand and official seal.
My commission expires: _____