SUBSCRIPTION AGREEMENT
EXHIBIT 99.1
Ucluelet Exploration Corp.
0000 X. 00xx Xxxxxx
Xxxxxxxxx, XX
Xxxxxx X0X 0X0
Dear Sirs:
Concurrent with execution of this Agreement, the undersigned (the "Purchaser") is purchasing ________________ shares of Common Stock of Ucluelet Exploration Corp. (the "Company") at a price of $0.10 per Share (the "Subscription Price") Purchaser hereby confirms the subscription for and purchase of said number of Shares and hereby agrees to pay herewith the Subscription Price for such Shares.
Residents of British Columbia must complete Schedule A hereto.
MAKE CHECK PAYABLE TO: Ucluelet Exploration Corp.
Executed this _____ day of ________________, _______, at _____________________ (Street Address), ___________________ (City), _________________ (State) ________ (Zip Code).
___________________________________
Signature of Purchaser
___________________________________
Printed Name of Purchaser
___________________________________
Social Security Number/Tax I.D.
Number of Shares Purchased Total Subscription Price
__________________________ _______________________
Form of Payment: Cash _________________
Check# _________________
Other _________________
ACCEPTED THIS _____ DAY OF ________________, _______.
BY: __________________________________
Title: ___________________________