Kavita Suri: (Investor) - MedSerVentures Inc.




Investor's Name:  Kavita Suri

Shareholder's Name:

Mailing Address:  Vinehill Circle, Fremont, CA. 94539

Residential/Business Address:

E-mail address:  kavimsuri@aol.com

Home Phone Number: 

Cell Phone Number: 

Notes (any additional information)

Files:

Accredited Investor Questionnaire
Copy of Wire Transfer/check where applicable
Shareholder Certificate
Subscription Agreement (Signature Page)
Subscription Agreement (Number of Shares Page)