SUBSCRIPTION AGREEMENT BALIUS CORP.
EXHIBIT 10.2
XXXXXX CORP.
The undersigned (the “Subscriber”) hereby irrevocably subscribes for that number of shares of common stock (the “Shares”) of Xxxxxx Corp., a Nevada corporation (the “Company”), set forth below, upon and subject to the terms and conditions set forth in the Company’s Prospectus dated ________________ 2013, in the United States Securities and Exchange Commission Registration Statement on Form S-1, to which this Subscription Agreement is attached.
Total number of shares subscribed for at US $0.01 per share: _______________ shares.
Amount paid with this Subscription Agreement at a price of US $0.01 per Share: US $________.
This Subscription Agreement constitutes the entire agreement among the parties hereto with respect to the subject matter hereof and may be amended only by a writing executed by all parties.
IN WITNESS WHEREOF, the undersigned has executed this Subscription Agreement this ______ day of _________________, 2013.
Name of Entity (for purchasers which are entities only): ________________________________
Signature: __________________________________________
Print Name: ________________________________________________________________________
Print Title (for purchasers which are entities only): _________________________________________
Address: ___________________________________________
__________________________________________
Telephone No.: _____________________________________
E-mail Address: ____________________________________
Subscriber’s US Social Security Number or
identification number of home jurisdiction: ___________________________
Signature of Co-owners, if applicable: ___________________________________
Name as it should appear on the Certificate: ______________________________________________________
If Joint Ownership, check one (all parties must sign above):
[ ] Joint Tenants with Right of Survivorship
[ ] Tenants in Common
[ ] Community Property
If Fiduciary or Business Entity check one:
[ ] Trust Authorized Person _________________________ Capacity_____________________
[ ] Estate Authorized Person _________________________ Capacity_____________________
[ ] Corporation Authorized Person _________________________ Capacity_____________________
[ ] Limited Liability Company
Authorized Person _________________________ Capacity_____________________
[ ] Partnership Authorized Person _________________________ Capacity_____________________
[ ] Other ____________________ (Describe)
Authorized Person _________________________ Capacity_____________________
PAYMENT BY CHECK OR MONEY ORDER INSTRUCTIONS
If Subscriber wishes to pay the purchase price of his or her Shares by check, all checks or money orders shall be made payable to: Xxxxxx Corp., 00 Xxx Xxxx Xxxx, Xxxxxxxxx, Xx. Xxxxx, Xxxxxxx, Telephone x000000000000.
WIRE TRANSFER INSTRUCTIONS
If Subscriber wishes to wire transfer the purchase price of his or her Shares, he or she shall wire transfer immediately available funds in the amount of the purchase price subscribed for hereunder, as follows:
Bank: _______________________
Account Name: _______________________
Account No.: _______________________
ABA Routing No.: _______________________
SWIFT code: _______________________
Bank Address: _______________________
ACCEPTANCE OF SUBSCRIPTION
The foregoing Subscription is hereby accepted for and on behalf of Xxxxxx Corp. this
______day of ______________, 2013.
XXXXXX CORP.
By: _______________________________________
Name: Xxxxxxx Xxxxxx
Title: President
