EXHIBIT 4.1

 

SUBSCRIPTION AGREEMENT

 

1PM Industries, Inc.

312 S. Beverly Drive #3401 

Beverly Hills, California 90212

 

The undersigned has received the prospectus dated __________, 2015 (“Prospectus”), and hereby subscribes for _____________ shares of $.0001 par value common stock of 1PM Industries, Inc., a Colorado corporation (“Company”), for a subscription price of $_____ per share (“Offered Shares”). The undersigned hereby agrees that this subscription shall be irrevocable and shall survive the death or disability of the undersigned. Payment of the purchase price for the Offered Shares is due upon subscription.

 

The undersigned acknowledges that (i) the Company has the right to accept or reject this subscription in whole or in part, (ii) this subscription shall be deemed to be accepted by the Company only when the Company signs this Subscription Agreement; and (iii) the undersigned has relied only on that information specified in the Prospectus.

 

Number of Offered Shares: _________________. Subscription Amount: ___________ (number of Offered Shares multiplied by $____)

 

Send wires to or make checks payable to: “1PM Industries, Inc.”

 

(wire instructions will forward to you upon the acceptance of your subscription agreement by the Company.

 

Please print name(s) or title, residence address, and SSN or Tax ID for which the Offered Shares are to be registered. Please notify the Company in writing if your address changes before you either receive your shares or are notified that your subscription has not been accepted.

 

	
Name 


	
Street 


	
City

	 	
State

	 	
Zip Code




 

SSN or Tax ID No. (For joint ownership, both parties must provide a Social Security Number or similar tax identification)

 

Indicate type of ownership:

 

	
 ̈

	
 Individual Ownership

	
 ̈

	
 Joint Tenants with Right of Survivorship


	 	 	 	 
	
 ̈

	
 Community Property

	
 ̈

	
 Tenants in Common


	 	 	 	 
	
 ̈

	
 Tenants by the Entirety

	
 ̈

	
 Corporate Ownership


	 	 	 	 
	
 ̈

	
 Partnership Ownership

	
 ̈

	
 Custodian for a Minor


	 	 	 	 
	
 ̈

	
 Trust (see below)

	
 ̈

	
 IRA or Pension Plan




 

	 
	
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Date Trust Established: _________________________________________________________

 

Name of Trustee or other Administrator

 

Each subscriber represents that: ___________________________________________________

 

	
(a)

	
The information contained herein is complete and accurate and may be relied upon, and


	 	 
	
(b)

	
The undersigned will notify the Company immediately of any material change in any such information occurring prior to the acceptance of the undersigned’s subscription, including any changes in address or other contact information.




 

IN WITNESS WHEREOF, the undersigned has executed this Subscription Agreement as of this ______ day of ____________ 2014.

 

FOR INDIVIDUALS:

 

	 
	
Print Name


	 
	
Signature




 

NAME AND SIGNATURE OF JOINT TENANT OR TENANT IN COMMON

 

	 
	
Print Name


	 
	
Signature




 

FOR TRUSTS, CORPORATIONS, PARTNERSHIPS

 

	 
	
Print Name of Entity


	
 


	
By:


	
Print name and capacity (Trustee, President or General Partner) of person making investment decision


	
	 
	
Signature




 

Agreed to and accepted:

 

	
By:

	
1PM Industries, Inc., a Colorado corporation

	
 


	 	 	
	
By:

	
Joseph Wade

	
 


	 	 	
	
Its:

	
President

	
 




  

 

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