SUBSCRIPTION AGREEMENT Revival Resources, Inc.
EXHIBIT
10.4
000 Xxxxx
Xxxxx Xxxxxx
Xxxxxx
Xxxx Xxxxxx, 00000
A. Instructions.
Each
person considering subscribing for the Shares should review the following
instructions:
Subscription
Agreement: Please complete, execute and deliver to the Company the
enclosed copy of the Subscription Agreement. The Company will review the
materials and, if the subscription is accepted, the Company will execute the
Subscription Agreement and return one copy of the materials to you for your
records.
The
Company shall have the right to accept or reject any subscription, in whole or
in part.
An
acknowledgment of the acceptance of your subscription will be returned to you
promptly after acceptance.
Payment: Payment for
the amount of the Shares subscribed for shall be made at the time of delivery of
the properly executed Subscription Agreement, or such date as the Company shall
specify by written notice to subscribers (unless such period is extended in the
sole discretion of the President of the Company), of a check or wire transfer of
immediately available funds to the Company at the address set forth below or an
account specified by the Company. The closing of the transactions contemplated
hereby (the "Closing") will be held on 90 days from ______________ or such
earlier date specified in such notice (unless the closing date is extended in
the sole discretion of the President of the Company by up to an additional 90
days). There is no minimum aggregate amount of Shares which must be sold as a
condition precedent to the Closing, and the Company may provide for one or more
Closings while continuing to offer the Shares that constitute the unsold portion
of the Offering.
B. Communications.
All
documents and check should be forwarded to:
000 Xxxxx
Xxxxx Xxxxxx
Xxxxxx
Xxxx Xxxxxx, 00000
THE
PURCHASE OF SHARES OF REVIVAL RESOURCES, INC. INVOLVES A HIGH DEGREE OF RISK AND
SHOULD BE CONSIDERED ONLY BY PERSONS WHO CAN BEAR THE RISK OF THE LOSS OF THEIR
ENTIRE INVESTMENT.
EVERY
POTENTIAL INVESTOR PRIOR TO ANY INVESTMENT OR PURCHASE OF REVIVAL RESOURCES,
INC.'S SHARES SHOULD READ THE PROSPECTUS RELATING TO THIS
OFFERING.
SUBSCRIPTION AGREEMENT
SIGNATURE PAGE
The
undersigned (the "Subscriber") hereby irrevocably subscribes for that number of
Shares set forth below, upon and subject to the terms and conditions set forth
in the Corporation's Effective Final Prospectus filed on Form S-1 and dated on
or around _______ __, 2010.
Total
Number of Shares to be Acquired: _____________________________
Amount to
be Paid (price of $0.03 per Share): _____________________________
IN
WITNESS WHEREOF, the undersigned has executed this Subscription
Agreement
this
________ of ________________________________, 2010.
NAME:
(PRINT) as it should appear on the Certificate:
__________________________
ADDRESS:
_______________________________________________________________________
_______________________________________________________________________
If Joint
Ownership, check one (all parties must sign above):
|_| Joint
Tenants with Right of Survivorship
|_|
Tenants in Common
|_|
Community Property
If
Fiduciary or a Business or an Organization, check one:
|_|
Trust
|_|
Estate
|_| Power
of Attorney
Name and
Type of Business Organization:
________________________________________
IDENTIFICATION
AUTHENTICATION REQUIRED:
Below is
my (circle one) Social Security # - Passport# - Drivers License# -
Tax
ID# -
Other ___________________
#
____________________________________________
SIGNATURE:
___________________________________
ACCEPTANCE OF
SUBSCRIPTION
The
foregoing Subscription is hereby accepted for and on behalf of Revival
Resources, Inc. this _______ day of ____________________________,
2010.
By:
_________________________________________
Xxxxxxxx
Xxxxx, President
