EX-99.1 7 puradyn084434_ex99-1.txt SUBSCRIPTION AGREEMENT FOR COMMON STOCK EXHIBIT 99.1 PURADYN FILTER TECHNOLOGIES INCORPORATED SUBSCRIPTION AGREEMENT FOR COMMON STOCK Puradyn Filter Technologies Incorporated 2017 High Ridge Road Boynton Beach, Florida 33426 Ladies and Gentlemen: I desire to purchase _____________________shares of Puradyn Filter Technologies Incorporated (the "Company") at $[ ] per share for a total investment of $------------------- pursuant to the terms of the prospectus dated [ ], 200_. Accompanying this subscription is the undersigned's check in the full amount of the subscription payable to "Puradyn Filter Technologies Incorporated." The undersigned represents to the Company that it has received and read the Company's prospectus dated [ ], 200_ and that the undersigned has the authority to enter into this subscription agreement on behalf of the person(s) or entity registered above.
The Shares are to be issued in ____________________________________________ (check one box): Print Name of Investor |_|____ individual name ____________________________________________ Print Name of Joint Investor (if applicable) |_|____ joint tenants with rights of survivorship ____________________________________________ |_|____ tenants in entirety Signature of Investor |_|____ corporation (an officer must sign) ____________________________________________ Signature of Joint Investor |_|____ partnership (all general partners must sign) ____________________________________________ Print Name of Corporation, Partnership or other Institutional Investor By:_________________________________________ Title:______________________________________ Investor's complete address: (Street) (City) (State) (Zip) (Country) Please check one of the following |_| U.S. Citizen |_| U.S. Citizen residing outside the U.S. |_| Resident Alien |_| Non-U.S. Citizen |_| Entity formed in the U.S. (specify domicile:_______) |_| Non-U.S. Entity
Social Security Number (if individual investor) Taxpayer Identification Number (if applicable) Accepted as of this ______________ day of ______________ 200__ Puradyn Filter Technologies Incorporated By:________________________________ Joseph V. Vittoria, Chairman and CEO