EX-10.1





 Exhibit 10.1 

Name: [●] 
 No. of
Options: [●] 
 Grant Price: [●] 

Grant Date: [●] 

Expiration Date: [●] 

Grant Type: [●] 

DOMINO’S PIZZA, INC. 

2004 EQUITY INCENTIVE PLAN 

NON-QUALIFIED STOCK OPTION AGREEMENT 

Domino’s Pizza, Inc., a Delaware corporation (the “Company”), hereby grants this
non-qualified stock option (the “Stock Option”) to the above named individual (the “Participant”), pursuant to the Company’s 2004 Equity Incentive Plan (as from time to time in effect,
the “Plan”). Under the Stock Option, the Participant may purchase, from the Company during the period commencing on the Grant Date set forth above, and expiring on the Expiration Date set forth above (“Expiration Date”), the
aggregate number of shares set forth above (the “Shares”) of the Common Stock of the Company at the price per Share set forth above (the “Grant Price”), all in accordance with and subject to the following terms and conditions:

 1. Vesting. The term “vest” as used herein with respect to the Stock Option or any portion thereof means to become
exercisable and the term “vested” with respect to the Stock Option (or any portion thereof) means that the Stock Option (or portion thereof) is then exercisable. Unless earlier terminated, forfeited, relinquished or expired, the
Stock Option will vest as provided for in Exhibit A hereto. 
 2. Exercise of Stock Option. Each election to exercise the Stock Option
shall be made, in the manner prescribed by the Company, with the third party stock plan administrator appointed by the Company, by the Participant or the Participant’s executor, administrator, or legally appointed representative (in the event
of the Participant’s incapacity) or the person or persons to whom the Stock Option is transferred by will or the applicable laws of descent and distribution (collectively, the “Option Holder”) and received by the third party stock
plan administrator, accompanied by this Agreement and payment in full as provided in the Plan. The purchase price shall be paid to the third party stock plan administrator appointed by the Company by either (i) delivery of cash or check;
(ii) wire transfer; or (iii) through a broker-assisted cashless exercise program implemented in connection with the Plan. In the event that the Stock Option is exercised by an Option Holder other than the Participant, the Company will be
under no obligation to deliver Shares hereunder unless and until it is satisfied as to the authority of the Option Holder to exercise the Stock Option. Subject to such earlier exercise periods as are set forth in Exhibit A, the latest date on
which the Stock Option or any portion thereof may be exercised is the Expiration Date and, if not exercised by such date, the Stock Option or any remaining portion thereof will thereupon immediately terminate. 

3. Restrictions on Transfer of Shares. If at the time the Stock Option is exercised the Company or any of its stockholders is a party to any
agreement restricting the transfer of any outstanding shares of the Company’s Common Stock, the Administrator may provide that the Stock Option may be exercised only if the Shares so acquired are made subject to the transfer restrictions set
forth in that agreement (or if more than one such agreement is then in effect, the agreement or agreements specified by the Administrator). 
 4.
Withholding; Agreement to Provide Security. The Company will not deliver Shares being purchased upon any exercise of the Stock Option unless it has received payment in a form acceptable to the Company for all applicable withholding taxes (or
the Participant makes other arrangements satisfactory to the Company for the payment of such taxes). 












 5. Nontransferability of Stock Option. The Stock Option is not transferable by the Participant
otherwise than by will or the laws of descent and distribution, and is exercisable during the Participant’s lifetime only by the Participant (or in the event of the Participant’s incapacity, the person or persons legally appointed to act
on the Participant’s behalf). 
 6. Provisions of the Plan. The Stock Option is subject to the provisions of the Plan, which are
incorporated herein by reference. A copy of the Plan as in effect on the date of the grant of the Stock Option is available from the Company. By exercising all or any part of the Stock Option, the Participant agrees to be bound by the terms of the
Plan and this Agreement. All initially capitalized terms used herein will have the meaning specified in the Plan, unless another meaning is specified herein. 

7. Non-Statutory Option. The Stock Option evidenced by this Agreement is intended to be, and is hereby
designated, a non-statutory option, that is, an option that does not qualify as an incentive stock option as defined in section 422 of the Internal Revenue Code of 1986, as amended from time to time
(the “Code”). 
 8. Governing Law. The Stock Option is governed by, and subject to, the laws of the State of Delaware, as provided
in the Plan. For purposes of litigating any dispute that arises under this Agreement or the Plan, the parties hereby submit to and consent to the jurisdiction of the State of Delaware, agree that such litigation shall be conducted in the
courts of Delaware, or the federal courts for the United States for the District of Delaware, where this grant is made and/or to be performed. 
 9.
Electronic Delivery. The Company may, in its sole discretion, decide to deliver any documents related to the Stock Option and participation in the Plan or future options that may be granted under the Plan by electronic means or to request the
Participant’s consent to participate in the Plan by electronic means. The Participant hereby consents to receive such documents by electronic delivery and, if requested, to agree to participate in the Plan through an on-line or electronic system established and maintained by the Company or another third party designated by the Company. 

10. Severability. The provisions of this Agreement are severable and if any one or more provisions are determined to be illegal or otherwise
unenforceable, in whole or in part, the remaining provisions shall nevertheless be binding and enforceable. 
 IN WITNESS WHEREOF, the
Company has caused this instrument to be executed by its duly authorized officer. 
  

			
	DOMINO’S PIZZA, INC.
	
	  

	Name:	 	Richard E. Allison, Jr.
	Title:	 	Chief Executive Officer


  

			
	Dated:	 	
	
	Acknowledged and Agreed:


			
		
	By:	 	  

	[●]	 	


  
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