[CORPORATION'S NAME]

The undersigned hereby subscribes for [NUMBER] common shares in a corporation to be organized under the laws of the State of [STATE], to be known as [NAME], and agrees to pay for said shares in cash in the amount of [AMOUNT] upon acceptance by the directors of said corporation of this subscription and call for payment thereof. Certificates for said common shares shall be issued to the undersigned, in a manner designated by the corporation, as fully paid and non-assessable.

Date:

__________________________________

SIGNATURE OF SUBSCRIBER

__________________________________

PRINTED NAME OF SUBSCRIBER

__________________________________

STREET ADDRESS

__________________________________

CITY STATE ZIP

__________________________________

SIGNATURE OF SPOUSE

(if purchasing jointly)

__________________________________

PRINTED NAME OF SPOUSE

(if applicable)

ACCEPTED BY:

[CORPORATION'S NAME]

Date:

By: ___________________________

[OFFICER'S NAME & TITLE]