Form of Conversion Notice. Each convertible Security shall have attached thereto, or set forth on the reverse of the Security, a notice of conversion in substantially the following form: Conversion Notice To: Xxxxxxxx Offshore Services, Inc. The undersigned owner of this Security hereby: (i) irrevocably exercises the option to convert this Security, or the portion hereof below designated, for shares of Common Stock of Xxxxxxxx Offshore Services, Inc. in accordance with the terms of the Indenture referred to in this Security and (ii) directs that such shares of Common Stock deliverable upon the conversion, together with any check in payment for fractional shares and any Security(ies) representing any unconverted principal amount hereof, be issued and delivered to the registered holder hereof unless a different name has been indicated below. If shares are to be delivered registered in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Any amount required to be paid by the undersigned on account of interest accompanies this Security. Dated: Signature Fill in for registration of shares if to be delivered, and of Securities if to be issued, otherwise than to and in the name of the registered holder. (Name) Social Security or other Taxpayer Identification Number (Please print name and address) Principal amount to be converted: (if less than all) $ . Signature Guarantee* * Participant in a recognized Signature Guarantee Medallion Program (or other signature acceptable to the Trustee).
Form of Conversion Notice. The undersigned Holder of this Security hereby irrevocably exercises the option to convert this Security, or any portion of the principal amount hereof (which is $1,000 or an integral multiple of $1,000 in excess thereof, provided that the unconverted portion of such principal amount is at least $1,000) below designated, into shares of Common Stock in accordance with the terms of the Indenture referred to in this Security, and directs that such shares, together with a check in payment for any fractional share and any Securities representing any unconverted principal amount hereof, be delivered to and be registered in the name of the undersigned unless a different name has been indicated below. If shares of Common Stock or Securities are to be registered in the name of a Person other than the undersigned, (a) the undersigned will pay all applicable transfer taxes payable with respect thereto and (b) signature(s) must be guaranteed by an Eligible Guarantor Institution with membership in an approved signature guarantee program pursuant to Rule 17Ad-15 under the Securities Exchange Act of 1934. Any amount required to be paid by the undersigned on account of interest accompanies this Security. Dated:_______________ ----------------------------------- ----------------------------------- Signature(s) If shares or Securities are to be registered in the name of a Person other than the Holder, please print such Person's name and address: Name Address Social Security or other Identification Number, if any ----------------------------------- Signature Guaranteed If only a portion of the Securities is to be converted, please indicate:
Form of Conversion Notice. To: LTX-CREDENCE CORPORATION The undersigned owner of the Convertible Note hereby irrevocably exercises the option to convert this Convertible Note, or portion hereof (which is $100 or an integral multiple thereof) below designated, into shares of Common Stock of LTX-Credence Corporation in accordance with the terms of the Indenture referred to in this Convertible Note, and directs that the shares issuable and deliverable upon the conversion, together with any check in payment for fractional shares and Convertible Notes representing any unconverted principal amount hereof, be issued and delivered to the owner hereof unless a different name has been indicated below. If shares or any portion of this Convertible Note not converted are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Any amount required to be paid by the undersigned on account of interest and taxes accompanies this Convertible Note. Dated: Fill in for registration of shares if to be delivered, and Convertible Notes if to be issued, other than to and in the name of the owner (Please Print): Signature Principal amount to be converted (if less than all): (Name) $ ,000 (Street Address) Social Security or other Taxpayer Identification Number (City, State and Zip Code) Signature Guarantee: Signatures must be guaranteed by an eligible Guarantor Institution (banks, brokers, dealers, savings and loan associations and credit unions) with membership in an approved signature guarantee medallion program pursuant to Securities and Exchange Commission Rule 17Ad-15 if shares are to be issued, or Convertible Notes are to be delivered, other than to and in the name of the registered holder. ASSIGNMENT FORM To assign this Convertible Note, fill in the form below: (I) or (we) assign and transfer this Convertible Note to (Insert assignee’s social security or tax I.D. no.) (Print or type assignee’s name, address and zip code) and irrevocably appoint agent to transfer this Convertible Note on the books of the Company. The agent may substitute another to act for him. Your Signature: (Sign exactly as your name appears on the other side of the Convertible Note) Date: Medallion Signature Guarantee:
Form of Conversion Notice. The form of any conversion notice for the conversion of Securities into shares of Common Stock, Preferred Stock or other securities of the Company shall be in substantially the form included with the applicable form of Securities as shall be established pursuant to Section 2.02.
Form of Conversion Notice. Each convertible Security shall have attached thereto, or set forth on the reverse of the Security, a notice of conversion in substantially the following form: Conversion Notice To: Gasco Energy, Inc. The undersigned owner of this Security hereby: (i) irrevocably exercises the option to convert this Security, or the portion hereof below designated, for shares of Common Stock of Gasco Energy, Inc. in accordance with the terms of the Indenture referred to in this Security and (ii) directs that such shares of Common Stock deliverable upon the conversion, together with any check in payment for fractional shares and any Security(ies) representing any unconverted principal amount hereof, be issued and delivered to the registered holder hereof unless a different name has been indicated below. If shares are to be delivered registered in the name of a Person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Any amount required to be paid by the undersigned on account of interest accompanies this Security. Dated:
Form of Conversion Notice. Each convertible Security shall have attached thereto, or set forth on the reverse of the Security, a notice of conversion in substantially the following form:
Form of Conversion Notice. (To be executed by the Holder in order to convert all or part of that certain $50,000 Fixed Convertible Promissory Note identified as the Note) DATE: ____________________________ FROM: Tangiers Global, LLC (the “Holder”) Re: $50,000 Fixed Convertible Promissory Note (this “Note”) originally issued by Indoor Harvest Corp., a Texas corporation, to Tangiers Global, LLC on October 12, 2017. The undersigned on behalf of Tangiers Global, LLC, hereby elects to convert $_______________________ of the aggregate outstanding Principal Amount (as defined in the Note) indicated below of this Note into shares of Common Stock, $0.001 par value per share, of Indoor Harvest Corp. (the “Company”), according to the conditions hereof, as of the date written below. If shares are to be issued in the name of a person other than undersigned, the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except for such transfer taxes, if any. The undersigned represents as of the date hereof that, after giving effect to the conversion of this Note pursuant to this Conversion Notice, the undersigned will not exceed the “Restricted Ownership Percentage” contained in this Note. Conversion information: Date to Effect Conversion Aggregate Principal Sum of Note Being Converted Aggregate Interest/Fees of Principal Amount Being Converted Remaining Principal Balance Number of Shares of Common Stock to be Issued Applicable Conversion Price Signature Name Address EXHIBIT B WRITTEN CONSENT OF THE BOARD OF DIRECTORS OF INDOOR HARVEST CORP. The undersigned, being directors of Indoor Harvest Corp., a Texas corporation (the “Company”), acting pursuant to the Bylaws of the Corporation, do hereby consent to, approve and adopt the following preamble and resolutions:
Form of Conversion Notice. [To be executed only upon conversion of Warrant] To Aprisma Management Technologies, Inc. The undersigned registered holder of the within Warrant hereby irrevocably converts such Warrant with respect to __________/1/ shares of the Common Stock which such holder would be entitled to receive upon the exercise hereof, and requests that the certificates for such shares be issued in the name of, and delivered to , whose address is . Dated: --------------------------------- (Signature must conform in all respects to name of holder as specified on the face of Warrant) --------------------------------- (Street Address) --------------------------------- (City) (State) (Zip Code) ---------------------------- /1/ Insert here the number of shares called for on the face of this Warrant (or, in the case of a partial exercise, the portion thereof as to which this Warrant is being exercised), in either case without making any adjustment for additional shares of Common Stock or any other stock or other securities or FORM OF ASSIGNMENT property or cash which, pursuant to the adjustment provisions of this Warrant, may be delivered upon exercise. In case of a partial exercise, a new Warrant or [To be executed only upon transfer of Warrant] Warrants will be issued and delivered, representing the unexercised portion of the Warrant, to the holder surrendering the Warrant. FORM OF ASSIGNMENT [To be executed only upon transfer of Warrant] For value received, the undersigned registered holder of the within Warrant hereby sells, assigns and transfers unto the right represented by such Warrant to purchase __________/1/ shares of Common Stock of Aprisma Management Technologies, Inc. to which such Warrant relates, and appoints Attorney to make such transfer on the books of Aprisma Management Technologies, Inc. maintained for such purpose, with full power of substitution in the premises. Dated: --------------------------------- (Signature must conform in all respects to name of holder as specified on the face of Warrant) --------------------------------- (Street Address) --------------------------------- (City) (State) (Zip Code) Signed in the presence of:
Form of Conversion Notice. At the time of conversion of a Security in accordance with Article Twelve, the Holder of such Security shall deliver to the Trustee, the Conversion Agent, the Company and the Guarantor a notice of conversion in substantially the form attached to this Indenture as Exhibit C. ---------
Form of Conversion Notice. The undersigned Holder of this Security hereby irrevocably exercises the option to convert this Security, or any portion of the principal amount hereof (which is an integral multiple of $1,000, provided that the unconverted portion of such principal amount is $1,000 or any integral multiple of $1,000 in excess thereof) below designated, into shares of Common Stock in accordance with the terms of the Indenture referred to in this Security, and directs that such shares, together with a check in payment for any fractional share and any 4.50% Debentures representing any unconverted principal amount hereof, be delivered to and be registered in the name of the undersigned unless a different name has been indicated below. If shares of Common Stock or 4.50% Debentures are to be registered in the name of a Person other than the undersigned, (a) the undersigned will pay all transfer taxes payable with respect thereto and (b) signature(s) must be guaranteed by an Eligible Guarantor Institution with membership in an approved signature guarantee program pursuant to Rule 17Ad-15 under the Securities Exchange Act of 1934. Any amount required to be paid by the undersigned on account of interest accompanies this Security. Dated:________________________ _______________________________ Fill in for registration of _______________________________ shares of Common Stock if to Signature(s) be issued, and 4.50% Debentures if to be delivered, other than to and in the name of the registered holder: ------------------------------ (Name)
