CLEANER YOGA MAT, INC. SUBSCRIPTION AGREEMENT
EX-4.2 5 ex42.htm FORM OF SUBSCRIPTION AGREEMENT ex42.htm
CLEANER YOGA MAT, INC.
SUBSCRIPTION AGREEMENT
The Investor named below, by payment of the purchase price for such Common Shares, by the delivery of a check payable to CLEANER YOGA MAT, INC., hereby subscribes for the purchase of the number of Common Shares indicated below of CLEANER YOGA MAT, INC., at a purchase of $0.10 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 _______________________
B. REGISTRATION:
(3) Registered owner: __________________________
Co-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.
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C. OWNERSHIP
[ ] 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_____________________
D. SIGNATURES
Registered Owner: _____________________________
Co-Owner: _____________________________
Print Name of Custodian or Trustee: _____________________________
Authorized Signature: _____________________________
Date: _____________________
Signature: ___________________________________
MAIL TO: Cleaner Yoga Mat, Inc.
1370 Sawleaf Ct.
San Luis Obispo, CA 93401
____________________________________________________________________
FOR OFFICE USE ONLY:
Date Received: ________________________________________________
Date Accepted/Rejected ________________________________________
Subscriber's Check Amount: _______________________
Check No. ___________________ Date Check ________________
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