Exhibit 10.12
Form of Subscription Agreement
ESSENTIAL INNOVATIONS TECHNOLOGY CORP.
STOCK SUBSCRIPTION
The undersigned hereby subscribes for the purchase of Essential
Innovations Technology Corporation (the "Company") Common Stock as follows:
Subscriber:
Name: _____________________________________
Address: __________________________________
___________________________________________
___________________________________________
SS or Tax ID No.: _________________________
Number of shares purchased _____________________
Price per share _____________________
Total purchase price $____________________
The total purchase price shall be paid on or before ____________, 2003.
PURCHASER:
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(Signature)
The foregoing subscription shall be void if payment in good funds is
not received on or before the close of business on the date specified above.
Within five business days after receipt of funds for the above purchase (either
on the collection of checks or the receipt of a wire transfer), the Company
shall deliver to the above subscriber at the address stated certificates for the
shares purchased.
DATED: __________________, 2003.
ESSENTIAL INNOVATIONS
TECHNOLOGY CORP.
By:
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▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇, President
NOTE: Funds transferred by wire should be transmitted according to instructions
provided by the Company under separate cover.