Fill and Sign the Purchase Short Form Agreement

OPTION TO PURCHASE STOCK THIS AGREEMENT ENTERED INTO this the _______ day of _____________, ______, by and between _______________ (the "Seller"), an adult, resident citizen of _______________ County, __________________, and _______________, (the "Purchaser") an adult, resident citizen of _______________ County, __________________. In consideration of Ten Dollars ($10.00) paid in hand, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree as follows: 1. Grant of Option. Seller hereby grants to Purchaser, or his designee or assign, an option to purchase, upon the terms and conditions hereinafter set forth, 510 shares of the common stock of _______________ for the sum of _______________ Dollars ($_______) per share. Said option may be exercised in whole or in part at any time before 5:00 P.M., _______, _____, ____. 2. Time of Payment for Shares. The option price of the shares to be purchased pursuant to each exercise of the option shall be paid in full in cash or certified funds at t he time of such exercise of the option. 3. Payment and Delivery of Shares. The Seller shall, at the date and time speci fied in such notice, deliver a bank, cashier's or treasurer's check or checks in the amount of the option price for the shares in respect to which the option is being exercised. Such delivery shall be made t o the Seller at such place as is designated by Purchaser in the notice of exercise of option and all checks shall be drawn to the order of Seller. Contemporaneously with such payments, the Seller shall deliver to the Purchaser, duly endorsed in proper form for transfer certificates representing the common shares of _______________ in respect of which the option is being exercised. 4. Modification. No modification or amendment to this Agreement shall be effective unless in writing and signed by the parties. 5. Governing Law. This Agreement shall be deemed to be make up and shall be construed in accordance with the laws of the State of __________________. 6. Binding Effect. This Agreement shall be binding upon and inure to the benefit of the Seller and its successors and assigns and the Purchaser and its successors and assigns. IN WITNESS WHEREOF the parties have caused this Agreement to execute as of the day a nd year first above written. SELLER: _________________________________ _______________ PURCHASER:_________________________________ _______________