Exhibit 10.1


 


THIS SUBSCRIPTION AGREEMENT IS EXECUTED
IN RELIANCE UPON THE EXEMPTION PROVIDED BY SECTION 4(2) AND REGULATION D, RULE 506 FOR TRANSACTIONS NOT INVOLVING A PUBLIC OFFERING
UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “SECURITIES ACT”). THIS OFFERING IS BEING MADE TO ACCREDITED INVESTORS
PURSUANT TO REGULATION D PROMULGATED UNDER THE SECURITIES ACT. NONE OF THE SECURITIES TO WHICH THIS SUBSCRIPTION RELATES HAVE BEEN
REGISTERED UNDER THE SECURITIES ACT, OR ANY U.S. STATE SECURITIES LAWS, AND, UNLESS SO REGISTERED, NONE MAY BE OFFERED OR SOLD,
DIRECTLY OR INDIRECTLY, EXCEPT IN ACCORDANCE WITH THE PROVISIONS OF REGULATION D OR UNDER THE SECURITIES ACT, PURSUANT TO AN EFFECTIVE
REGISTRATION STATEMENT UNDER THE SECURITIES ACT, OR PURSUANT TO AN AVAILABLE EXEMPTION FROM, OR IN A TRANSACTION NOT SUBJECT TO,
THE REGISTRATION REQUIREMENTS OF THE SECURITIES ACT AND IN EACH CASE ONLY IN ACCORDANCE WITH APPLICABLE STATE SECURITIES LAWS.
IN ADDITION, HEDGING TRANSACTIONS INVOLVING THE SECURITIES MAY NOT BE CONDUCTED UNLESS IN ACCORDANCE WITH THE SECURITIES ACT.


PLEASE PRINT:


 


NAME OF SUBSCRIBER:  _______________________


 


PRINCIPAL AMOUNT OF SECURITIES PURCHASED:
USD$______________________


 


SUBSCRIPTION AGREEMENT


 


This Subscription Agreement
(this “Agreement”) is being delivered to you in connection with your investment in ordinary shares, (the “Securities”)
of TDH Holdings, Inc., a publicly-traded company organized under the laws of the British Virgin Islands (the “Company”)
in connection with the private placement of such Securities. This Offering (as defined below) will continue until the earlier of:
(i) December 31, 2020 or (ii) the Company’s receipt of the purchase consideration for the Securities in the total amount
of USD$[_], unless extended without notice by the Company for additional thirty (30) days (the “Termination Date”).
All funds received in the Offering shall be, upon fulfillment of the other conditions precedent set forth herein, delivered to
the Company, at which time the Securities subscribed for shall be delivered, subject to the terms and provisions hereof and as
further described below, to the Investor.


 


1.  Subscription and Purchase Price


 


(a)  Subscription.
Subject to the conditions set forth in Section 2 hereof, the undersigned hereby subscribes for and agrees to purchase the
number of Securities indicated above on the terms and conditions described herein. The principal amount of the Securities purchased
is USD$[_], which purchase price may be paid in accordance with payment instructions set forth in Schedule I. The Company
and the Investor understand and agree that in order for the Company to remain in compliance with the Nasdaq Stock Market continued
listing requirements, the total number of Securities which may be sold by the Company in this Offering (as defined below) shall
not exceed in the aggregate 19.99% of the number of the Company’s ordinary shares issued and outstanding as of the date of
the Closing (as defined below).


 


Subscriptions for lesser
amounts may be accepted at the discretion of the Company. The Company may accept this Subscription Agreement at any time for all
or any portion of the Securities subscribed for by executing a copy hereof as provided and notifying me within a reasonable time
thereafter. In the event of the rejection of this subscription, the Investor’s subscription payment will be promptly returned
to him, her or it without interest or deduction and this Subscription Agreement shall have no force or effect.


 






    1


     


    

 


(b)  Purchase
of Securities. The undersigned understands and acknowledges that the purchase price to be remitted to the Company in exchange
for the Securities shall be USD$[_], for an aggregate purchase price as set forth on Page 10 hereof (the “Purchase Price”).
The undersigned understands and agrees that, subject to Section 2 hereof and applicable laws, by executing this Agreement,
he, she or it is entering into a binding agreement.


 


2.  Acceptance, Offering Term and Closing Procedures


 


(a)  Acceptance
or Rejection. The obligation of the undersigned to purchase the Securities shall, subject to the investor accreditation process,
applicable securities laws and the closing conditions contained in this Section, be irrevocable and the undersigned shall be legally
bound to purchase the Securities subject to the terms set forth in this Agreement.


 


(b)  Closing.
The closing (“Closing”) of this offering may occur any time and from time to time before the Termination Date.
There is no minimum offering. The Securities subscribed for herein shall not be deemed issued to or owned by me until one copy
of this Subscription Agreement has been executed by the Investors and countersigned by the Company and the Closing with respect
to such Securities has occurred. The Investor understands and acknowledges that (i) no fees or commission are paid in connection
with the purchase of the Securities, and (ii) the Company will utilize the proceeds of this purchase for general corporate and
working capital purposes.


 


3.  Investor’s Representations and Warranties


 


The undersigned hereby
acknowledges, agrees with and represents and warrants to the Company, as follows:


 


(a)        Because
this Offering is limited to accredited investors as defined in Section 2(15) of the Securities Act, and Rule 501 promulgated thereunder,
in reliance upon the exemption contained in Section 4(2) of the Securities Act and applicable state securities laws, the Investor
understands that the Securities are being sold without registration under the Securities Act. The Investor has received and reviewed
all information and materials regarding the Company that he, she or it has requested, including, without limitation, all reports
and other filings made by the Company with the Securities and Exchange Commission (the “SEC”) that are available
through EDGAR at the SEC’s website (www.sec.gov), including, but not limited to: (i) the Company’s Annual Report on
Form 20-F for the year ended December 31, 2019, (ii) the Company’s GAAP financial information contained in Exhibit 99.1 of
the Company’s Current Reports on Form 6-K furnished to the SEC, and (iii) the Company’s Current Reports on Form 6-K
furnished to the SEC on Commission on February 24, April 28, September 21, October 29, November 16 and 25, 2020, respectively,
with any amendments to any of the foregoing, as well as the risk factors relating to the Company and purchase of the Securities
set forth in the Company’s publicly available filings.


 


(b)       The
undersigned has full power and authority to enter into and deliver this Agreement and to perform the obligations hereunder, and
the execution, delivery and performance of this Agreement has been duly authorized, if applicable, and this Agreement constitutes
a valid and legally binding obligation of the undersigned.


 


(c)  The undersigned
acknowledges his, her or its understanding that the offering and sale of the Securities is intended to be exempt from registration
under the Securities Act of 1933, as amended (the “Securities Act”), by virtue of Section 4(2) of the Securities
Act and the provisions of Regulation D promulgated thereunder (“Regulation D”). In furtherance thereof, the
undersigned represents and warrants to the Company as follows:


 


(i)  The undersigned
realizes that the basis for the exemption from registration may not be available if, notwithstanding the undersigned’s representations
contained herein, the undersigned is merely acquiring the Securities for a fixed or determinable period in the future, or for a
market rise, or for sale if the market does not rise. The undersigned does not have any such intention.


 






    2


     


    

 


(ii)  The
undersigned is acquiring the Securities solely for the undersigned’s own beneficial account, for investment purposes, and
not with view to, or resale in connection with, any distribution of the Securities.


 


(iii)  The
undersigned has the financial ability to bear the economic risk of his, her or its investment, has adequate means for providing
for its current needs and contingencies, and has no need for liquidity with respect to the investment in the Company.


 


(iv)  The
undersigned and the undersigned’s attorney, accountant, purchaser representative and/or tax advisor, if any (collectively,
“Advisors”), have received, carefully reviewed and understand the information contained in various documents
and agreements provided by the Company, together with all appendices and exhibits thereto (as such documents may be amended or
supplemented, the “Transaction Documents”), relating to the Offering.


 


(v)  The undersigned
(together with his, her or its Advisors, if any) has such knowledge and experience in financial and business matters as to be capable
of evaluating the merits and risks of the prospective investment in the Securities. If other than an individual, the undersigned
also represents it has not been organized solely for the purpose of acquiring the Securities.


 


(d) The information
in the Confidential Investor Questionnaire attached hereto as Exhibit A and completed and executed by the undersigned is
true and accurate in all respects, and the undersigned is an “accredited investor,” as that term is defined in Rule
501(a) of Regulation D.


 


(e)  The undersigned
is not relying on the Company or its affiliates or agents with respect to economic considerations involved in this investment.
The undersigned has relied on the advice of, or has consulted with, only his, her or its Advisors. Each Advisor, if any, is capable
of evaluating the merits and risks of an investment in the Securities, and each Advisor, if any, has disclosed to the undersigned
in writing (a copy of which is annexed to this Agreement) the specific details of any and all past, present or future relationships,
actual or contemplated, between the Advisor or any affiliate or sub-agent thereof.


 


(f) The undersigned
represents, warrants and agrees that he, she or it will not sell or otherwise transfer the Securities without registration under
the Securities Act or an exemption therefrom, and fully understands and agrees that the undersigned must bear the economic risk
of his, her or its purchase because, among other reasons, the Securities have not been registered under the Securities Act or under
the securities laws of any state and, therefore, cannot be resold, pledged, assigned or otherwise disposed of unless they are subsequently
registered under the Securities Act and under the applicable securities laws of such states, or an exemption from such registration
is available. In particular, the undersigned is aware that the Securities are “restricted securities,” as such term
is defined in Rule 144 promulgated under the Securities Act (“Rule 144”), and they may not be sold pursuant
to Rule 144 unless all of the conditions of Rule 144 are met. The undersigned understands that any sales or transfers of the Securities
are further restricted by state securities laws and the provisions of this Agreement.


 


(g)       The
undersigned understands and agrees that the certificates for the Securities shall bear substantially the following legend until
(i) the Securities shall have been registered under the Securities Act and effectively disposed of in accordance with a registration
statement that has been declared effective or (ii) in the opinion of counsel for the Company, the Securities may be sold without
registration under the Securities Act, as well as any applicable “blue sky” or state securities laws:


 


THE SECURITIES REPRESENTED BY THIS CERTIFICATE
HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “SECURITIES ACT”), OR ANY APPLICABLE STATE
SECURITIES LAWS. SUCH SECURITIES HAVE BEEN ACQUIRED FOR INVESTMENT PURPOSES AND MAY NOT BE OFFERED FOR SALE, SOLD, DELIVERED AFTER
SALE, TRANSFERRED, PLEDGED OR HYPOTHECATED IN THE ABSENCE OF AN EFFECTIVE REGISTRATION STATEMENT FILED BY THE ISSUER WITH THE U.S.
SECURITIES AND EXCHANGE COMMISSION COVERING SUCH SECURITIES UNDER THE SECURITIES ACT OR AN OPINION OF COUNSEL SATISFACTORY TO THE
ISSUER THAT SUCH REGISTRATION IS NOT REQUIRED.


 






    3


     


    

 


(h) No representations
or warranties have been made to the undersigned by the Company or any of its respective officers, employees, counsel, agents, sub-agents,
affiliates or subsidiaries, other than any representations of the Company contained in the transaction agreements in connection
with the Offering, and in subscribing for the Securities the undersigned is not relying upon any representations other than those
contained in the transaction agreements in connection with the Offering.


 


(i) The undersigned
understands and acknowledges that his, her or its purchase of the Securities is a speculative investment that involves a high degree
of risk and the potential loss of the undersigned’s entire investment and has carefully read and considered the matters set
forth in the agreements in connection with the Offering, and, in particular, acknowledges that the Company has a limited operating
history.


 


(j) The undersigned’s
overall commitment to investments that are not readily marketable is not disproportionate to the undersigned’s net worth,
and an investment in the Securities will not cause such overall commitment to become excessive.


 


(k)  Neither the
SEC nor any state securities commission has approved the Securities or passed upon or endorsed the merits of the Offering or confirmed
the accuracy or determined the adequacy of the in the agreements in connection with the Offering. The agreements in connection
with the Offering have not been reviewed by any federal, state or other regulatory authority. Any representation to the contrary
is a crime.


 


(l) The undersigned
and his, her or its Advisors, if any, have had a reasonable opportunity to ask questions of and receive answers from a person or
persons acting on behalf of the Company concerning the offering of the Securities and the business, financial condition, results
of operations and prospects of the Company, and all such questions have been answered to the full satisfaction of the undersigned
and his, her or its Advisors, if any. The undersigned believes that the investment in the Securities is suitable for him, her or
it based upon his, her or its investment objectives and financial needs, and he, she or it has adequate means for providing for
his, her or its current financial needs and contingencies and have no need for liquidity with respect to such investment in the
Company.


 


(m) The
undersigned is unaware of, is in no way relying on, and did not become aware of the offering of the Securities through or as a
result of, any form of general solicitation or general advertising including, without limitation, any article, notice, advertisement
or other communication published in any newspaper, magazine or similar media or broadcast over television or radio, or electronic
mail over the Internet, in connection with the offering and sale of the Securities and is not subscribing for Securities and did
not become aware of the offering of the Securities through or as a result of any seminar or meeting to which the undersigned was
invited by, or any solicitation of a subscription by, a person not previously known to the undersigned in connection with investments
in securities generally.


 


(n) The undersigned
has taken no action which would give rise to any claim by any person for brokerage commissions, finders, fees or the like relating
to this Agreement or the transactions contemplated hereby.


 






    4


     


    

 


(o) The undersigned
is not relying on the Company or any of its respective employees, agents or sub-agents with respect to the legal, tax, economic
and related considerations of an investment in the Securities, and the undersigned has relied on the advice of, or has consulted
with, only his, her or its own Advisors.


 


(p) The undersigned
acknowledges that any estimates or forward-looking statements or projections included in the Transaction Documents were prepared
by the future management of the Company in good faith, but that the attainment of any such projections, estimates or forward-looking
statements cannot be guaranteed by the Company or its respective management and should not be relied upon.


 


(q) No oral or
written representations have been made, or oral or written information furnished, to the undersigned or his, her or its Advisors,
if any, in connection with the offering of the Securities which are in any way inconsistent with the information contained in the
agreements in connection with the Offering.


 


(r) The
Investor is an “accredited investor” as defined in Section 2(15) of the Securities Act and in Rule 501 promulgated
thereunder and have attached the completed Confidential Investor Questionnaire to indicate an appropriate “accredited investor”
category. The Investor can bear the entire economic risk of the investment in the Securities for an indefinite period of time and
is knowledgeable about and experienced in investments in the equity securities of early stage publicly traded companies. The Investor
is not acting as an underwriter or a conduit for sale to the public or to others of unregistered securities, directly or indirectly,
on behalf of the Company or any person with respect to such securities.


 


(s) The
Investor is not a member of the Financial Industry Regulatory Authority, Inc. (“FINRA”); the Investor is not
and has not, for a period of 12 months prior to the date of this Subscription Agreement, been affiliated or associated with any
company, firm, or other entity which is a member of FINRA; and the Investor does not own any stock or other interest in any member
of FINRA (other than interests acquired in open market purchases).


 


(t) The
information contained in the Confidential Investor Questionnaire, as well as any information which the Investor has furnished to
the Company with respect to his, her or its financial position and business experience, is correct and complete as of the date
of this Subscription Agreement and, if there should be any material change in such information prior to the Closing of the offering,
the Investor will furnish such revised or corrected information to the Company.


 


4. Insider Trading Prohibition


 


Until the filing by
the Company of a Current Report on Form 6-K describing, among other things, the Offering, the undersigned hereby agrees to refrain
from (A) engaging in any transactions with respect to the capital stock of the Company or securities exercisable or convertible
into or exchangeable for any shares of capital stock of the Company, and (B) entering into any transaction which would have the
same effect, or entering into any swap, hedge or other arrangement that transfers, in whole or in part, any of the economic consequences
of ownership of the capital stock of the Company.


 


5. Indemnification.


 


The
Investor hereby agrees to indemnify and hold harmless the Company and its officers, directors, stockholders, employees, agents,
and counsel against any and all losses, claims, demands, liabilities, and expenses (including reasonable legal or other expenses,
including reasonable attorneys’ fees) incurred by each such person in connection with defending or investigating any such
claims or liabilities, whether or not resulting in any liability to such person, to which any such indemnified party may become
subject under the Securities Act, under any other statute, at common law or otherwise, insofar as such losses, claims, demands,
liabilities and expenses (a) arise out of or are based upon any untrue statement or alleged untrue statement of a material fact
made by me and contained in this Subscription Agreement or Confidential Investor Questionnaire, or (b) arise out of or are based
upon any breach by the Investor of any representation, warranty, or agreement made by the Investor contained herein or therein..


 






    5


     


    

 


6. Notices to Subscribers


 


THE SECURITIES HAVE
NOT BEEN REGISTERED UNDER THE SECURITIES ACT OR THE SECURITIES LAWS OF ANY STATE AND ARE BEING OFFERED AND SOLD IN RELIANCE ON
EXEMPTIONS FROM THE REGISTRATION REQUIREMENTS OF THE SECURITIES ACT AND SUCH LAWS. THE SECURITIES HAVE NOT BEEN APPROVED OR DISAPPROVED
BY THE SEC, ANY STATE SECURITIES COMMISSION OR OTHER REGULATORY AUTHORITY, NOR HAVE ANY OF THE FOREGOING AUTHORITIES PASSED UPON
OR ENDORSED THE MERITS OF THIS OFFERING OR THE ACCURACY OR ADEQUACY OF THE OFFERING DOCUMENTATION. ANY REPRESENTATION TO THE CONTRARY
IS UNLAWFUL.


 


IN MAKING AN INVESTMENT
DECISION, INVESTORS MUST RELY ON THEIR OWN EXAMINATION OF THE PERSON OR ENTITY CREATING THE SECURITIES AND THE TERMS OF THE OFFERING,
INCLUDING THE MERITS AND RISKS INVOLVED. THE SECURITIES HAVE NOT BEEN RECOMMENDED BY ANY FEDERAL OR STATE SECURITIES COMMISSION
OR REGULATORY AUTHORITY. FURTHERMORE, THE FOREGOING AUTHORITIES HAVE NOT CONFIRMED THE ACCURACY OR DETERMINED THE ADEQUACY OF THE
OFFERING DOCUMENTS. ANY REPRESENTATION TO THE CONTRARY IS A CRIMINAL OFFENSE. THE UNITS ARE SUBJECT TO RESTRICTIONS ON TRANSFERABILITY
AND RESALE AND MAY NOT BE TRANSFERRED OR RESOLD EXCEPT AS PERMITTED UNDER THE SECURITIES ACT, AND THE APPLICABLE STATE SECURITIES
LAWS, PURSUANT TO REGISTRATION OR EXEMPTION THEREFROM. INVESTORS SHOULD BE MADE AWARE THAT THEY ARE REQUIRED TO BEAR THE FINANCIAL
RISKS OF THIS INVESTMENT FOR AN INDEFINITE PERIOD OF TIME.


 


THE PRESENCE OF A LEGEND
FOR ANY GIVEN STATE REFLECTS ONLY THAT A LEGEND MAY BE REQUIRED BY THAT STATE AND SHOULD NOT BE CONSTRUED TO MEAN AN OFFER OR SALE
MAY BE MADE IN ANY PARTICULAR STATE. THE OFFERING DOCUMENTS MAY BE SUPPLEMENTED BY ADDITIONAL STATE LEGENDS. IF YOU ARE UNCERTAIN
AS TO WHETHER OR NOT OFFERS OR SALES MAY BE LAWFULLY MADE IN ANY GIVEN STATE, YOU ARE ADVISED TO CONTACT THE COMPANY FOR A CURRENT
LIST OF STATES IN WHICH OFFERS OR SALES MAY BE LAWFULLY MADE. AN INVESTMENT IN THIS OFFERING IS SPECULATIVE AND INVOLVES A HIGH
DEGREE OF FINANCIAL RISK. ACCORDINGLY, PROSPECTIVE INVESTORS SHOULD CONSIDER ALL OF THE RISK FACTORS DESCRIBED HEREIN.


 


7. Miscellaneous
Provisions


 


(a)  Confidential
Information. The subscriber agrees that no portion of the Confidential Information (as defined below) shall be disclosed to
third parties, except as may be required by law, without the prior express written consent of the Company; provided, however,
that the subscriber may share such information with such of its officers and professional advisors as may need to know such information
to assist the subscriber in its evaluation thereof on the condition that such parties agree to be bound by the terms hereof. “Confidential
Information” means the existence and terms of this Agreement, the transactions contemplated hereby, and the disclosures
and other information contained herein or in the agreements in connection with the Offering, excluding any disclosures or other
information that are publicly available.


 


(b)  Modification.
Neither this Agreement, nor any provisions hereof, shall be waived, modified, discharged or terminated except by an instrument
in writing signed by the party against whom any waiver, modification, discharge or termination is sought.


 






    6


     


    

 


(c) Survival.
The undersigned’s representations and warranties made in this Agreement shall survive the execution and delivery of this
Agreement and the delivery of the Securities.


 


(d)  Notices.
Any party may send any notice, request, demand, claim or other communication hereunder to the undersigned at the address set forth
on the signature page of this Agreement or to the Company at the address set forth above using any means (including personal delivery,
expedited courier, messenger service, fax, ordinary mail or electronic mail), but no such notice, request, demand, claim or other
communication will be deemed to have been duly given unless and until it actually is received by the intended recipient. Any party
may change the address to which notices, requests, demands, claims and other communications hereunder are to be delivered by giving
the other parties written notice in the manner herein set forth.


 


(e) Binding
Effect. Except as otherwise provided herein, this Agreement shall be binding upon, and inure to the benefit of, the parties
to this Agreement and their heirs, executors, administrators, successors, legal representatives and permitted assigns. If the undersigned
is more than one person or entity, the obligation of the undersigned shall be joint and several and the agreements, representations,
warranties and acknowledgments contained herein shall be deemed to be made by, and be binding upon, each such person or entity
and his or its heirs, executors, administrators, successors, legal representatives and permitted assigns. This Agreement sets forth
the entire agreement and understanding between the parties as to the subject matter thereof and merges and supersedes all prior
discussions, agreements and understandings of any and every nature among them, as to the subject matter hereof.


 


(f) Assignability.
This Agreement is not transferable or assignable by the undersigned.


 


(g) Governing
Law. This Agreement shall be governed by and construed in accordance with the laws of the State of Delaware, without giving
effect to conflicts of law principles.


 


(h) Counterparts.
This Agreement may be executed in two or more counterparts, each of which shall be deemed an original, but all of which together
shall constitute one and the same instrument.


 


(i) Further
Assurances. Each of the parties shall execute such documents and perform such further acts (including, without limitation,
obtaining any consents, exemptions, authorizations, or other actions by, or giving any notices to, or making any filings with,
any governmental authority or any other person) as may be reasonably required or desirable to carry out or to perform the provisions
of this Agreement.


 


(j) Severability.
If any one or more of the provisions contained herein, or the application thereof in any circumstance, is held invalid, illegal
or unenforceable in any respect for any reason, the validity, legality and enforceability of any such provision in every other
respect and of the remaining provisions hereof shall not be in any way impaired, unless the provisions held invalid, illegal or
unenforceable shall substantially impair the benefits of the remaining provisions hereof.


 


[Remainder of page left intentionally
blank - signature pages follow]


 




    7


     


    

 


Signature Page to the Subscription Agreement


 


ALL SUBSCRIBERS MUST COMPLETE THIS PAGE


 


IN WITNESS WHEREOF, the undersigned has
executed this Agreement on the _ day of _ 2020.


 


 


	________________________	x $0.30 per share____ 	= $_____________________
	Securities subscribed for	 	     Aggregate Purchase Price


  


Manner in which title is to be held (please check one):


 


	1.	 ☐	Individual	7.	 ☐	
        Trust/Estate/Pension or Profit sharing Plan

        Date Opened:______________

	2.	 ☐	Joint Tenants with Right of Survivorship	8.	 ☐	
        As a Custodian for

        ________________________________

        Under the Uniform Gift to Minors Act of the State of

        ________________________________

	3.	 ☐	Community Property	9.	 ☐	Married with Separate Property
	4.	 ☐	Tenants in Common	10.	 ☐	Keogh
	5.	 ☐	Corporation/Partnership/ Limited Liability Company	11.	 ☐	Tenants by the Entirety
	6.	 ☐	IRA	 	 	 


 


IF MORE THAN ONE SUBSCRIBER, EACH SUBSCRIBER
MUST SIGN.


INDIVIDUAL SUBSCRIBERS MUST COMPLETE PAGE
11.


SUBSCRIBERS WHICH ARE ENTITIES MUST COMPLETE
PAGE 12.


  




    8


     


    

 


EXECUTION BY NATURAL PERSONS


 


	
        _____________________________________________________________________________

        Exact Name in Which Title is to be Held

	 	 	 
	
        _________________________________

         Name (Please Print)
	 	
        _________________________________

        Name of Additional Purchaser

	 	 	 
	
        _________________________________

         Residence: Number and Street
	 	
        _________________________________

        Address of Additional Purchaser

	 	 	 
	
        _________________________________

         City, State and Zip Code
	 	
        _________________________________

        City, State and Zip Code

	 	 	 
	
        _________________________________

         Social Security Number
	 	
        _________________________________

        Social Security Number

	 	 	 
	
        _________________________________

        Telephone Number
	 	
        _________________________________

        Telephone Number

	 	 	 
	
        _________________________________

        Fax Number (if available)
	 	
        ________________________________

        Fax Number (if available)

	 	 	 
	
        _________________________________

        E-Mail (if available)
	 	
        ________________________________

        E-Mail (if available)

	 	 	 
	
        __________________________________

        (Signature)
	 	
        ________________________________

        (Signature of Additional Purchaser)

	 	 	 
	
        ACCEPTED this __ day of _________ 2020, on behalf
of the Company.




  





	 	By:	 
	 	 	Name:
	 	 	Title:



  




    9


     


    

 


EXECUTION BY SUBSCRIBER WHICH IS AN ENTITY


(Corporation, Partnership, LLC, Trust, Etc.)


	
        _____________________________________________________________________________

        Name of Entity (Please Print)

	 
	Date of Incorporation or Organization: ____________________________________________
	 
	State of Principal Office: _______________________________________________________
	 
	
        Federal Taxpayer Identification Number:  ___________________________________________

         

        ____________________________________________

        Office Address

         

        ____________________________________________

        City, State and Zip Code

         

        ____________________________________________

        Telephone Number

         

        ____________________________________________

        Fax Number (if available)

         

        ____________________________________________

        E-Mail (if available)

	 	 
	
         By: _________________________

        Name:

        Title:
	 
	 	 
	ACCEPTED this ___ day of _________ 2020, on behalf of the Company.	


 





	 	By:	 
	 	 	Name:
	 	 	Title:


 






    10


     


    

 


Exhibit A


 


CONFIDENTIAL INVESTOR QUESTIONNAIRE


 


 


 


11