SUBSCRIPTION AGREEMENT
The undersigned hereby subscribes to purchase
common stock ("Common Stock") of Power Save
International, Inc., a Nevada corporation (the
"Corporation"). In this regard, enclosed is $___
for the purchase of Common Stock.
In connection with its purchase, the undersigned
warrants and represents the following:
The Common Stock is not being issued for
services performed by the undersigned;
The undersigned understands that the Common
Stock being acquired hereunder have been registered
under the Securities Act of 1933, as amended, and
the applicable securities laws of his state of
residence;
The undersigned represents and warrants that
it has not acted as a Purchaser Representative for
any person in connection with this purchase of
Common Stock by the undersigned;
The undersigned requests that the Common Stock be
issued in the name of the undersigned and delivered
to the undersigned at the address below.
Dated:___________
I will hold title to my shares as follows:
(check one)
[ ] Community Property [ ] Joint tenancy (both
must sign)
[ ] Tenancy in common [ ] Individual ownership
(all must sign) [ ] Trust or Xxxxx Plan
[ ] As custodian under State [ ] Partnership
Gifts to Minors Act [ ] Other (please
describe):
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Intending to be legally bound hereby, the parties
hereto have set their hands and seals on this
day of _______________________________.
X ___________________ X________________________
(Signature of Authorize (Signature of
Representative) Subscriber)(Seal)
___________________________________________________
(Title of Authorized Representative
(Print Name of Subscriber)
(Residence Address)
2
(City) (State) (Zip Code)
/ /
(Social Security Number)
Please type or print the following information:
________________________________ _________________________________
Full name(s) of subscriber(s) Social security or employer
as it (they) should appear I.D. number(s) of subscriber(s)
on schedule of Corporation
________________________________________________________________________
Street Address City State Zip Code
Dated: Dated:_________________________.
X______________________________ X________________________
Signature Signature
_________________________________________________
Title or capacity of signing party if the
subscriber is partnership, corporation, trust or
other nonindividual entity.
Remittance should be payable to Power Save
International, Inc.
Completed subscription agreements and checks should
be sent to
Power Save International, Inc.
0000 XX 00 Xxxxxx
Xxxxxxxx 00, #000
Xxxxxxx, XX 00000
ACCEPTANCE OF SUBSCRIPTIONS BY CORPORATION
Power Save International, Inc.
Accepted as of
Received and Subscription Accepted
Check No.
Power Save International, Inc.
____________________________________
, President
