EX-4.1 4 v384556_ex4-1.htm EXHIBIT 4.1

 

Exhibit 4.1

INVESTOR SUBSCRIPTION AGREEMENT FOR

CTI INDUSTRIES CORPORATION

Please print or type. Use ink only. (All Parties Must Sign)

 

The undersigned Investor hereby subscribes for the purchase of Common Shares of CTI Industries Corporation as set forth herein and certifies that he (i) has received and relied solely upon the the Prospectus, the documents incorporated by reference in the Prospectus and their respective exhibits and schedules, and (ii) agrees to all the terms and conditions of this Subscription Agreement.

 

Dollar Amount of Common Shares Subscribed for:  $______________________ Date: ________________

 

Name of Investor   If other than individual check one and indicate
  capacity of signatory
     
    ¨  Trust  ¨  Estate  ¨  Uniforms Gifts to Minors Act
(Print)   ¨  Corporation  ¨ Attorney-in-fact
    ¨  Other: ______________  
     
Signature of Investor    
    If Joint Ownership, check one:
    ¨  Tenants in Common ¨ Tenants by the Entirety
Name of Joint Investor (if any) (Print)   ¨  Joint Tenants with Rights of Survivorship
    ¨  Community Property
     
Signature of Joint Investor    

 

 
Social Security or Taxpayer Identification Number

 

  Backup Withholding Statement:
Investor Address: ¨  Please check this box only if the investor is
    subject to backup withholding
  ¨  Please check this box only if investor is a
Street Address   nonresident alien, Foreign partnership, foreign
    trust, Corporation or foreign estate
City/State Zip Code  
     

Telephone (_____________________) Country ____________________Email: _______________________
   
Passport # _________________________ ID # _______________________________
  ID Type

 

Address for Delivery of Common Shares (if different from above):

 

     
Street Address City/State Zip Code        

 

THIS SUBSCRIPTION FOR COMMON SHARES OF CTI INDUSTRIES CORPORATION BY THE ABOVE NAMED INVESTOR(S) IS ACCEPTED THIS _____ DAY OF _______________, 2014.

 

  CTI INDUSTRIES CORPORATION
     
  By:   
    Stephen M. Merrick, President