Exhibit 29.1
SUBSCRIPTION AGREEMENT
OF
ELECTRIC AQUAGENICS UNLIMITED, INC.
1. PURCHASE. The undersigned hereby subscribes for the purchase of
__________________ shares of ELECTRIC AQUAGENICS UNLIMITED, INC., a Delaware
corporation (the "Company"). With this document the undersigned is submitting
the sum of $ ____________________ in cash, check, money order, or equivalent, as
payment for said shares at the price of $2.00 per share. Checks or money orders
are to be made payable to "Electric Aquagenics Unlimited, Inc. Proceeds Account"
until the offering closes.
2. REPRESENTATIONS. The undersigned hereby represents and warrants
that:
(a) He/she is aware that, pursuant to Section 14 of the
Securities Act of 1933, any provision is void that binds a person
acquiring a security to waive compliance with any provision under the
federal securities law;
(b) The undersigned, if a natural person, is over the age of
twenty-one years;
(c) The undersigned has received and read a copy of the
prospectus of the Company;
(d) The undersigned acknowledges that neither the United
States Securities and Exchange Commission, nor any other state or
federal agency has made any determination as to the merits of
purchasing any of such shares, and that the purchase of any interest
involves a very high degree of risk;
(e) The undersigned acknowledges that the application of
purchase may be accepted in whole or in part or rejected by the
Company, and that, to the extent the application may be rejected, the
accompanying payment will be refunded without the deduction of
expenses;
(f) The offer and sale of these shares to the undersigned were
made by means of the Company's prospectus only, and no other documents
or advertisements were used in connection therewith; and
(g) The undersigned was offered and is purchasing these shares
within the state of __________________.
3. TYPE OF OFFERING. The undersigned hereby further acknowledges that
these shares are being offered and sold pursuant to a registration statement on
Form SB-l under the Securities Act of 1933, as amended, and that such shares may
only be offered and sold in states in which the securities have been qualified
for sale.
AFFIRMATION
THE UNDERSIGNED HEREBY SWEARS AND AFFIRMS THAT HE OR SHE HAS READ THE FOREGOING
SUBSCRIPTION AGREEMENT OF ELECTRIC AQUAGENICS UNLIMITED, INC. AND IS FAMILIAR
WITH THE CONTENTS THEREOF AND THAT ALL OF THE REPRESENTATIONS CONTAINED THEREIN
ARE TRUE AND ACCURATE.
____________________________ _________________________________
[Printed Name of Subscriber] [Signature]
_________________________________
[Street Address and Number]
_________________________________
[City, State and Zip Code]
_________________________________
[Tax Identification or Social
Security Number of Subscriber]
The Company is requested to issue the stock certificate(s) as follows:
Name(s): _____________________________ No. of Shares ____________________
[Please Print]
Name(s): _____________________________ No. of Shares ____________________
[Please Print]
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