Unassociated Document


     

    Exhibit
10.3

     

    To:          Surf
A Movie Solutions, Inc.

    


    FORMOF
SURF A MOVIE SOLUTIONS, INC.

    INVESTMENT
CONFIRMATION

    


    The undersigned, intending to be
legally bound, hereby irrevocably subscribes for and agrees to purchase ________
shares of the common stock of Surf A Movie Solutions, Inc., a Nevada corporation
(the “Company”), for an aggregate purchase price of $__________, or $0.10 per
share. Simultaneous with the execution and delivery of this confirmation to the
Company, the undersigned is either delivering a check, money order or certified
funds made payable to “Surf A Movie Solutions, Inc.”. 

    


    The
undersigned acknowledges that he has received a copy of the prospectus of the
Company dated _________, 200__
filed with the Securities and Exchange Commission (“Prospectus”) with
respect to the offer and sale of the shares of stock being purchased.


    


    The undersigned further acknowledges
that although the shares of common stock being purchased from the Company are
registered securities under the U.S. Securities Act of 1933, as amended, there
may be restrictions on the resale of the shares imposed by the particular state
law where the undersigned resides or in a jurisdiction outside of the United
States. Accordingly, the undersigned will not offer to sell or sell the shares
in any jurisdiction unless the undersigned obtains all required consents, if
any. 

    


    
      
         


      

      
         


        
          

        

      

      
         


      

    


    Date:
______________, 200__

    


    
      
        
          
            
              
                
                  
                    
                      
                        	
                                Amount
      of Investment:

                              	
                                $

                              	 
      	
                                Number
      of Shares:

                              	 
      


                      

                    

                  

                

              

            

          

        

      

    

    


    
      
        
          
            
              
                
                  
                    
                      
                        
                          
                            
                              
                                
                                  
                                    	
                                            1.

                                          	
                                            Print
      Full Name of Investor:

                                          	 
      	
                                            Individual:

                                          
	 	 	 	 
	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	
                                            First,
      Middle, Last

                                          
	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	
                                            Partnership,
      Corporation, Trust,

                                            Custodial
      Account, Other:

                                          
	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	
                                            Name
      of Entity

                                          
	 
      	 
      	 
      	 
      
	
                                            2.

                                          	
                                            Permanent
      Address of Investor:

                                          	 
      	 
      
	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      
	
                                            3.

                                          	
                                            Name
      of Primary Contact Person:

                                          	 
      	 
      
	 
      	
                                            Title:

                                          	 
      	 
      
	 
      	 
      	 
      	 
      
	
                                            4.

                                          	
                                            Telephone
      Number:

                                          	 
      	 
      
	 
      	 
      	 
      	 
      
	
                                            5.

                                          	
                                            E-Mail
      Address:

                                          	 
      	 
      
	 
      	 
      	 
      	 
      
	 	 	 	 
	
                                            6.

                                          	
                                            Facsimile
      Number:

                                          	 
      	 
      
	 
      	 
      	 
      	 
      
	
                                            7.

                                          	
                                            Social
      Security or EIN of Investor:

                                          	 
      	 
      
	 
      	
                                            (attach
      an executed Form W-8)

                                          	 
      	 
      


                                  

                                

                              

                            

                          

                        

                      

                    

                  

                

              

            

          

        

      

    

    


    
      
        
          
            
              	
                      8.

                    	
                      Authorized
      Signatory:

                    	 
      	 
      
	 
      	
                      Title:

                    	 
      	 
      


            

          

        

      

    

    


    If
Investor is an entity, provide copy of Articles of Incorporation, Certificate of
Formation or other evidence of existence, as well as a copy of board resolution
or other evidence of authorization to purchase the shares of the
Company.