Fill and Sign the Louisiana Shares Form

SUBSCRIPTION FOR SHARES OF [_CORPORATION_] Each of the undersigned does hereby subscribe for the number of shares of capital stock of the Corporation indicated below, and does hereby represent, warrant, and agree and represent that: 1. The shares subscribed for by each of the undersigned are subscribed and purchased only for the account of that person and not on behalf of any other person; 2. Each of the undersigned subscribe for said shares only for the purpose of holding for investment and not with any intent to distribute; 3. None of the undersigned has any agreement, arrangement, or understanding for transfer of any of said shares or any interest therein to any other person or persons; 4. None of the undersigned shall offer for sale or sell any of said shares or any interest therein except (i) upon effective registration of said shares under the Securities Act of 1933 and the Louisiana Securities Law (Louisiana R.S. 51:701 et seq.) as now in effect or any legislation substituted therefor and the rules and regulations thereunder or (ii) upon acceptance by the Corporation of an opinion of counsel in such form and by such counsel or of other documentation as satisfactory to counsel for the Corporation that registration is not required; 5. The price of each share subscribed hereto shall be, unless otherwise agreed by and among a majority of the subscribers hereto, [_$Price_] per share which shall be payable in cash or tangible personal property upon call of the Board of Directors of this Corporation; 6. Each of the undersigned (i) either has such knowledge and experience in financial and business matters, or has the advice or representation of a person having such knowledge and experience, to be able to evaluate the merits and risks of an investment in such securities of such an issuer; (ii) has been given or had access to sufficient information regarding the Corporation to evaluate the merits and risks of the investment in the Corporation's capital stock being acquired; and (iii) is able to bear the economic risk of the investment in the Corporation's capital stock to enable the undersigned to hold the same for purposes of investment; 7. Each of the undersigned understands that the shares subscribed are not publicly traded and that no market may exist for such shares at the time of any resale; 8. Each of the undersigned understands and agrees that each stock certificate representing the shares shall bear a legend in substantially the following form: The shares represented by this certificate have been acquired for investment and have not been registered under the Securities Act of 1933 or the Louisiana Securities Law (Louisiana R.S. 51:701 et seq.). The shares may not be offered, sold or transferred in the absence of such registration or exemption. The sale, assignment, transfer, pledge or other disposition of this stock is subject to restrictive agreements in the articles, by-laws, and agreements between shareholders on file in the corporation's registered office. Further, each of the undersigned agrees that he or she shall indemnify and hold harmless the Corporation, its officers, directors, agents, and employees from any and all liabilities, claims, demands, suits or proceedings arising out of any breach or alleged breach of any of the foregoing agreements and representations. Subscriber Number of Shares Subscribed [_SUBSCRIBER_1_] [_Number_1_] [_SUBSCRIBER_2_] [_Number_2_] ___________________________ [_SUBSCRIBER_1_] ___________________________ [_SUBSCRIBER_2_] [_Date_] DATE LANGUAGE TO BE ADDED TO STOCK CERTIFICATE The shares represented by this certificate have been acquired for investment and have not been registered under the Securities Act of 1933 or the Louisiana Securities Law (Louisiana R.S. 51:701 et seq.). The shares may not be offered, sold or transferred in the absence of such registration or exemption. The sale, assignment, transfer, pledge or other disposition of this stock is subject to restrictive agreements in the articles, by-laws, and agreements between shareholders on file in the corporation's registered office. * * * * * * * * * * STOCK SUBSCRIPTION, STOCK CERTIFICATE LEGEND - F1CCRP02 : The first document is a subscription for corporate stock, prepared in written form as required by R.S. 12:71A. This example assumes that there are two subscribers, and that the stock will be purchased by Louisiana residents and for investment purposes (not for resale) so that no securities registration will be necessary. The second document is an appropriate paragraph for addition to printed stock certificates. WORD KEY : EXPLANATION : [_CORPORATION_] Name of corporation. [_$Price_] Price paid per share (with $). [_SUBSCRIBER_1_] Name of first shareholder. [_Number_1_] Number of shares purchased by first shareholder. [_SUBSCRIBER_2_] Name of second shareholder. [_Number_2_] Number of shares purchased by second shareholder. [_Date_] Date shares purchased.