SUBSCRIPTION AGREEMENT
Exhibit
99.1
2nd
Floor, 1901 Avenue of the Stars
Xxx
Xxxxxxx, XX 00000
Dear
Sirs:
Concurrent with execution of this
Agreement, the undersigned (the “Purchaser”) is purchasing
_______________________________________________ (__________) shares of Common
Stock of Surna Inc. (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.
Purchaser further confirms that Mr.
Xxxxxxx Xxxxxx and Xx. Xxxxxx Ping-Xxx Xxx solicited him/her/it to purchase the
shares of Common Stock of the Company and no other person participated in such
solicitation other than Xx. Xxxxxx or Xx. Xxx.
MAKE CHECK PAYABLE TO: SURNA INC.
Executed this _____ day of
___________________, 2010.
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_________________________________________________
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_________________________________________________
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Signature
of Purchaser
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_________________________________________________
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_________________________________________________
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Address
of Purchaser
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_________________________________________________
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Printed
Name of Purchaser
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PLEASE
ENSURE FUNDS ARE IN US DOLLARS
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__________________________________________________
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X
$0.10
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________________
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=
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US$________________
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Number
of Shares Purchased
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Total
Subscription Price
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Form
of Payment:
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Cash: ____________
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Check
#: ____________
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Other:
_______________
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By:
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________________________________________
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Title:
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________________________________________
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