Fill and Sign the Stock Form

OPTION TO PURCHASE STOCK THIS AGREEMENT ENTERED INTO this the _______ day of _____________, 20_____, 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 ($10.00) paid in hand, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree as follows: 1. Grant of Option. Seller hereby grants to Purchaser, or his designee or assign, an option to purchase, upon the terms and conditions hereinafter set forth, ______ shares of the common stock of _______________ for the sum of _______ and no/100 Dollars ($______) per share. 2. Interim Non-Cash Dividend. If dividends are declared on the common shares of _______________ payable other than in cash, such non-cash dividends attributable to each such common share shall be transferred by Seller to Purchaser upon the exercise of his option, without extra costs. 3. Adjustment of Option Shares. If the outstanding common shares of _______________ are changed into or exchanged for a different number or kind of shares or other securities of _______________ or of another corporation, whether through reorganization, recapitalization, shares split up, combination of sales, merger or consolidation, there shall be substituted for each common share of _______________ then subject to this option the number and kinds of shares of other securities which each such outstanding common share is so changed or for each such share as exchanged. Thereafter, the words "common shares of _______________" shall mean such substituted shares or other securities and the option price of ______ and no/100 Dollars ($_____) for each common share of _______________ as specified in paragraph 1 shall apply to and be the option price for all the shares or other securities substituted for each such common share of _______________. - 1 - 4. Option Rights Under Option Shares. Seller shall notify the Purchaser of any right to purchase additional shares or securities of _______________ granted to Seller which arise out of Seller's ownership at the time of all or part of the 510 common shares of _______________ which are subject to this option, and the Purchaser shall have ten (10) business days after such notice is given within which to notify the Seller that the Purchaser is exercising such an option and is delivering, as provided in paragraph 8, the funds required for the purchase which the Purchaser shall have elected to make. If such notice and payment are received by the Seller within said ten (10) day period, the Seller, in addition to delivery to the Purchaser of the shares so purchased by it, shall assign to the Purchaser the rights attributable to such shares. If, however, the Purchaser shall not so notify the Seller and pay such purchase price, the Seller shall be released from any further obligation to the Purchaser in respect of such rights and shall be free to exercise such rights or to dispose of them as it may elect for the account of the Seller. 5. 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 the time of such exercise of the option. 6. Time for Exercise of Option. The option may be exercised by Purchaser in whole at any time, or in part in multiples of 100 shares, from time to time, on or before ________ ______, 20_____. 7. Method of Exercising Option. At least five (5) days prior to the date upon which all or any portion of the option is to be exercised, the Purchaser shall deliver to the Seller written notice of its election to exercise the option, which notice shall specify the date and time for the transfer of shares pursuant to the exercise of the option and the number of shares in respect of which the option is to be exercised. The date specified in such notice shall be a business day, the time specified shall be during regular business hours. 8. Payment and Delivery of Shares. The Seller shall, at the date and time specified in such notice, deliver a bank, cashier's or treasurer's check or checks in the amount of the option price for the - 2 - shares in respect to which the option is being exercised. Such delivery shall be made to 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. 10. Notices. All notices and other communications provided hereunder shall be in writing and shall be deemed to have been duly given if delivered or mailed first class, postage pre-paid: (a) If to the Seller at: _______________, __________________ (b) If to the Purchaser at: _______________, __________________ 11. Modification. This Agreement shall be effective as the date hereof, and unless sooner terminates shall remain until ___________ ________, 20_____. No modification or amendment to this Agreement shall be effective unless in writing and signed by the parties. 12. Governing Law. This Agreement shall be deemed to be make up and shall be construed in accordance with the laws of the State of __________________. 13. 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 and year first above written. SELLER: _________________________________ _______________ - 3 - PURCHASER: _________________________________ _______________ - 4 -