BURRIS ENERGY, LLC - PHASE 1

    SUBSCRIPTION AGREEMENT - SECURITIES - S.E.C. Reg. D - Rule 506(c)


    I. INTRODUCTION

    The information provided here and on any attached supporting documentation will be protected for your privacy.

    The company will not disseminate any information or documents unless and until, by your signature on the subscription agreement, you authorize the release of same, and then, only for purposes of this purchase.

    Upon any purchase, the information and documents will be deleted, for your privacy.


    II. INFORMATION OF THE BUYER OR AGENT

    A . Please check the appropriate box section here:

    Name to appear on shares certificate


    B. My current, verifiable, actual information is :
    Name
    Address Line 1
    Address Line 2
    City
    State
    Zipcode
    Phone Number
    eMail Address


    III. AMOUNT OF THE PURCHASE FOR THIS CONTRACT

    I am requesting that the following U. S. dollar amount be placed on the subscription agreement as the amount of purchase for this contract
    $

    Shares to purchase :

    Click Here To Download a PDF of the Reg D Offering Memorandum

    regd_pps
    regd_fdap
    regd_fsp

    ACCREDITATION DOCUMENTS

    FOR JOBS ACT RULE 506(c)

    OFFERINGS

    BURRIS ENERGY, LLC - PHASE 1

    SUBSCRIPTION AGREEMENT - SECURITIES - S.E.C. Reg. D - Rule 506(c)


    I. INTRODUCTION

    The attached supporting documentation will be protected for your privacy.

    The company will not disseminate any information or documents unless and until, by your signature on the subscription agreement, you authorize the release of same, and then, only for purposes of this purchase.

    Upon any purchase, the information and documents will be deleted, for your privacy.

    The requests here are made, in order that you may be in compliance with the requirements of the United States Securities and Exchange Commission (S.E.C.). The S.E.C. requires that any purchasers for Rule 506(c) shares, be accredited investors.

    The items requested here are taken from a reading of the regulations.

    The S.E.C. did not create this list, makes no endorsement of your information, but does have the legal right to inspect your information, in order to confirm that it complies with the accreditation requirements.

    If you do not want the S.E.C. to view your documents, you should stop this accreditation process here, and cancel any purchase for Rule 506(c) shares.

    The information and documents required for accreditation are outlined in the United States Electronic Code of Federal of the United States. Viewers may visit www.ecfr.gov and search for section 230.506 for more information.


    II. OPTION CHOICE

    Please choose the accreditation option from your information sheet and place a checkmark at the appropriate choice:


    III. OPTION DOCUMENTS

    With respect to the option that you chose, please place a checkmark to show which documents you will upload for this accreditation process:

    AS TO OPTION # 1

    For the years, 2019 and 2020, any one of the following:

    AS TO OPTION # 2

    For the three months before the date on which you are completing this form, any one of the following:

    AS TO OPTION # 3

    A written confirmation from one of the persons or entities that such person or entity has taken reasonable steps to verify that the purchaser is an accredited investor within the past three months and has determined that the person is an accredited investor.

    Please attach your documentation :