SoCal Harvest, Inc.
The Investor named below, by payment of the purchase price for such Common Shares, by the delivery of a check payable to SoCal Harvest, Inc., hereby subscribes for the purchase of the number of Common Shares indicated below of SoCal Harvest, Inc., at a purchase of $0.01 per Share as set forth in the Prospectus.
By such payment, the named Investor further acknowledges receipt of the Prospectus and the Subscription Agreement, the terms of which govern the investment in the Common Shares being subscribed for hereby.
A. INVESTMENT: (1) Number of Shares ___________________________
(2) Date of Investor's check _______________________
(3) Registered owner: __________________________
(4) Mailing address: ___________________________
City, State & zip: _________________________
(5) Residence Address (if different from above):
(6) Birth Date: ______/______/______
(7) Employee or Affiliate: Yes ______ No ______
(8) Social Security: #: ______/______/______
U.S. Citizen [ ] Other [ ] __________________________
Co-Owner Social Security:
U.S. Citizen [ ] Other [ ]
Corporate or Custodial:
Taxpayer ID #: ______/______/______
U.S. Citizen [ ] Other [ ] ___________________________
(9) Telephone (H) ( ) ______________________
(10) *email address:__________________________
*Please note that by providing your email address, you accept that all further communications between you and the Company shall be by email, unless otherwise required by law and/or the rules and regulations of any governing body of traded securities.
[ ] Individual Ownership [ ] IRA or Keogh
[ ] Joint Tenants with Rights of Survivorship
[ ] Trust/Date Trust Established_______________
[ ] Pension/Trust (S.E.P.)
[ ] Tenants in Common [ ] Tenants by the Entirety
[ ] Corporate Ownership [ ] Partnership
[ ] Other_____________________
Registered Owner: _____________________________
Print Name of Custodian or Trustee: _____________________________
Authorized Signature: _____________________________
MAIL TO: SoCal Harvest, Inc.
Attn: Mark Botsford
6755 Mira Mesa, Blvd., Ste 123 #187
San Diego, CA 92121
FOR: SoCal Harvest, Inc., OFFICE USE ONLY:
Date Received: ________________________________________________
Date Accepted/Rejected ________________________________________
Subscriber's Check Amount: _______________________
Check No. ___________________ Date Check ________________