Common use of AMERIGON INCORPORATED Clause in Contracts

AMERIGON INCORPORATED. By: ---------------------------------- Name: Title: APPENDIX A AMERIGON INCORPORATED WARRANT EXERCISE FORM To: Amerigon Incorporated The undersigned hereby irrevocably elects to exercise the right of purchase represented by the within Warrant ("Warrant") for, and to purchase thereunder by the payment of the Warrant Price and surrender of the Warrant, ------------- shares of Common Stock ("Warrant Shares") provided for therein, and requests that certificates for the Warrant Shares be issued as follows: ------------------------------- Name -------------------------------- Address ------------------------------- ------------------------------- Federal Tax ID or Social Security No. and delivered by (euro) certified mail to the above address, or (euor) electronically (provide DWAC Instructions: ), or ------ (euor) other (specify: ). ------------------------------------ and, if the number of Warrant Shares shall not be all the Warrant Shares purchasable upon exercise of the Warrant, that a new Warrant for the balance of the Warrant Shares purchasable upon exercise of this Warrant be registered in the name of the undersigned Warrantholder or the undersigned's Assignee as below indicated and delivered to the address stated below. Dated: , ------------------- ---- Note: The signature must correspond with Signature: the name of the registered holder as written ---------------------- on the first page of the Warrant in every particular, without alteration or enlargement -------------------------------- or any change whatever, unless the Warrant Name (please print) has been assigned. -------------------------------- -------------------------------- Address -------------------------------- Federal Identification or Social Security No.

Appears in 1 contract

Samples: Warrant Agreement (Amerigon Inc)

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AMERIGON INCORPORATED. By: ---------------------------------- --------------------------- Name: Title: APPENDIX A AMERIGON INCORPORATED WARRANT EXERCISE FORM To: Amerigon Incorporated The undersigned hereby irrevocably elects to exercise the right of purchase represented by the within Warrant ("Warrant") for, and to purchase thereunder by the payment of the Warrant Price and surrender of the Warrant, ------------- --------------- shares of Common Stock ("Warrant Shares") provided for therein, and requests that certificates for the Warrant Shares be issued as follows: ------------------------------- -------------------------------- Name -------------------------------- Address ------------------------------- ------------------------------- -------------------------------- -------------------------------- Federal Tax ID or Social Security No. and delivered by (euro) certified mail to the above address, or (euoreuro) electronically (provide DWAC Instructions: ), or ------ ------------------- (euoreuro) other (specify: ). ------------------------------------ -------------------------------------------------------------- and, if the number of Warrant Shares shall not be all the Warrant Shares purchasable upon exercise of the Warrant, that a new Warrant for the balance of the Warrant Shares purchasable upon exercise of this Warrant be registered in the name of the undersigned Warrantholder or the undersigned's Assignee as below indicated and delivered to the address stated below. Dated: , ------------------- ---- Note: The signature must correspond with Signature: ------------------------------ the name of the registered holder as written ---------------------- on the first page of the Warrant in every particular, without alteration or enlargement -------------------------------- --------------------------- or any change whatever, unless the Warrant Name (please print) has been assigned. -------------------------------- -------------------------------- --------------------------- --------------------------- Address -------------------------------- --------------------------- Federal Identification or Social Security No.

Appears in 1 contract

Samples: Warrant Agreement (Amerigon Inc)

AMERIGON INCORPORATED. By: ---------------------------------- -------------------------------- Name: Title: APPENDIX A AMERIGON INCORPORATED WARRANT EXERCISE FORM To: Amerigon Incorporated The undersigned hereby irrevocably elects to exercise the right of purchase represented by the within Warrant ("Warrant") for, and to purchase thereunder by the payment of the Warrant Price and surrender of the Warrant, ------------- ----------------- shares of Common Stock ("Warrant Shares") provided for therein, and requests that certificates for the Warrant Shares be issued as follows: ------------------------------- Name -------------------------------- Address ------------------------------- ------------------------------- -------------------------------- -------------------------------- Federal Tax ID or Social Security No. and delivered by (euro) certified mail to the above address, or (euoreuro) electronically (provide DWAC Instructions: ), or ------ ------------------- (euoreuro) other (specify: ). ------------------------------------ ------------------------------------------ and, if the number of Warrant Shares shall not be all the Warrant Shares purchasable upon exercise of the Warrant, that a new Warrant for the balance of the Warrant Shares purchasable upon exercise of this Warrant be registered in the name of the undersigned Warrantholder or the undersigned's Assignee as below indicated and delivered to the address stated below. Dated: , ------------------- ---- Note: The signature must correspond with Signature: ------------------------------ the name of the registered holder as written ---------------------- on the first page of the Warrant in every particular, without alteration or enlargement -------------------------------- ------------------------------ or any change whatever, unless the Warrant Name (please print) has been assigned. -------------------------------- -------------------------------- ------------------------------ ------------------------------ Address -------------------------------- ------------------------------ Federal Identification or Social Security No.

Appears in 1 contract

Samples: Warrant Agreement (Amerigon Inc)

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AMERIGON INCORPORATED. By: ---------------------------------- Name--------------------------------- Xxx X. Xxxx, Ph.D., President (Corporate Seal) Attest: Title: APPENDIX A AMERIGON INCORPORATED WARRANT EXERCISE ---------------------------- PURCHASE FORM To: Amerigon Incorporated (To be signed only upon exercise of option) The undersigned undersigned, the holder of the foregoing Option, hereby irrevocably elects to exercise the right of purchase rights represented by the within Warrant ("Warrant") such Option for, and to purchase thereunder by the thereunder,______ Units of Amerigon Incorporated, each Unit consisting of 280 shares of Class A Common Stock, no par value, and 280 Class A Warrant(s) to purchase Class A Common Stock, and herewith makes payment of the Warrant Price and surrender of the Warrant, ------------- shares of Common Stock ("Warrant Shares") provided for therein, and requests that certificates for the Warrant Shares be issued as follows: ------------------------------- Name -------------------------------- Address ------------------------------- ------------------------------- Federal Tax ID or Social Security No. and delivered by (euro) certified mail to the above address, or (euor) electronically (provide DWAC Instructions: ), or ------ (euor) other (specify: ). ------------------------------------ and, if the number of Warrant Shares shall not be all the Warrant Shares purchasable upon exercise of the Warrant, that a new Warrant for the balance of the Warrant Shares purchasable upon exercise of this Warrant be registered in the name of the undersigned Warrantholder or the undersigned's Assignee as below indicated and delivered to the address stated below$______________ thereof. Dated: Instructions for Registration ----------------- of Stock and Warrants ----------------------------- Print Name ----------------------------- Address ----------------------------- Signature OPTION EXCHANGE The undersigned, ------------------- ---- Note: The signature must correspond with Signature: pursuant to the name provisions of the registered holder as written ---------------------- foregoing Option, hereby elects to exchange its Option for ______________ Units of Amerigon Incorporated, each Unit consisting of 280 shares of Class A Common Stock, no par value, and 280 Class A Warrant(s) to purchase Class A Common Stock, pursuant to the Option Exchange provisions of the Option. Dated: ----------------- ----------------------------- Print Name ----------------------------- Address ----------------------------- Signature TRANSFER FORM (To be signed only upon transfer of the Option) For value received, the undersigned hereby sells, assigns, and transfers unto ____________________ the right to purchase Units represented by the foregoing Option to the extent of _____ Units, and appoints ______________ attorney to transfer such rights on the first page books of Amerigon Incorporated, with full power of substitution in the Warrant in every particular, without alteration or enlargement -------------------------------- or any change whatever, unless the Warrant Name (please print) has been assignedpremises. -------------------------------- -------------------------------- Address -------------------------------- Federal Identification or Social Security No.Dated:

Appears in 1 contract

Samples: Option to Purchase (Amerigon Inc)

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