ex41.htm












VET ONLINE SUPPLY, 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 VET ONLINE SUPPLY, INC. (the "Company"), hereby subscribes for the purchase of the number of Common Shares indicated below of VET ONLINE SUPPLY, 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:                              VET ONLINE SUPPLY, INC. 


            9612 West Hawthorne


                                        Crystal River, Florida 34428




 


 


____________________________________________________________________


FOR OFFICE USE ONLY:


Date Received: ________________________________________________


Date Accepted/Rejected ________________________________________


Subscriber's Check Amount: _______________________


Check No. ___________________ Date Check ________________


 






  





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