ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: Holder’s Address:
Appears in 150 contracts
Samples: Common Stock Purchase Warrant (Cyclacel Pharmaceuticals, Inc.), Common Stock Purchase Warrant (PaxMedica, Inc.), Letter Agreement (Applied Therapeutics Inc.)
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: Holder’s Address:
Appears in 34 contracts
Samples: Warrant Agency Agreement (Palisade Bio, Inc.), Common Stock Purchase Warrant (Ainos, Inc.), Common Stock Purchase Warrant (SOS Hydration Inc.)
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: Holder’s Address:
Appears in 20 contracts
Samples: S Warrant Agreement (Gain Therapeutics, Inc.), Common Stock Purchase Warrant (Gain Therapeutics, Inc.), Common Stock Purchase (Acelrx Pharmaceuticals Inc)
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: Holder’s Address:
Appears in 16 contracts
Samples: Purchase Agreement (Alimera Sciences Inc), Purchase Agreement (Alimera Sciences Inc), Purchase Agreement (Alimera Sciences Inc)
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _____________________ __, ______ Holder’s Signature: Holder’s Address:
Appears in 15 contracts
Samples: Common Stock Purchase Warrant (MAIA Biotechnology, Inc.), Underwriting Agreement (AppTech Payments Corp.), Alta Global Group LTD
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: Holder’s Address:
Appears in 13 contracts
Samples: Common Stock Purchase (Bio-Path Holdings Inc), Common Stock Purchase (Bio-Path Holdings Inc), Common Stock Purchase (Panbela Therapeutics, Inc.)
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: _______________________________ Holder’s Address:: ________________________________
Appears in 9 contracts
Samples: Common Stock Purchase Warrant (Clip Interactive, LLC), Intrusion Inc, Intrusion Inc
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ 20 Holder’s Signature: Holder’s Address:
Appears in 8 contracts
Samples: Zoo Entertainment, Inc, Zoo Entertainment, Inc, Zoo Entertainment, Inc
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: (Please Print) ______________________________________ ______________________________________ Dated: _______________ __, ______ Holder’s Signature: Holder’s Address:
Appears in 8 contracts
Samples: Common Stock Purchase Warrant (Coya Therapeutics, Inc.), Common Stock Purchase Warrant (Achieve Life Sciences, Inc.), Common Stock Purchase Warrant (Biocept Inc)
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to exercise the Warrant to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: Holder’s Address:
Appears in 7 contracts
Samples: Common Stock Purchase Warrant (Harbor Custom Development, Inc.), First Wave BioPharma, Inc., Dermata Therapeutics, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: _____________________________ Holder’s Address:: ______________________________
Appears in 7 contracts
Samples: Common Stock Purchase Warrant (RenovoRx, Inc.), Common Stock Purchase Warrant (Gold Royalty Corp.), Common Stock Purchase Warrant (Gold Royalty Corp.)
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: Phone Number:Email Address: (Please Print) Phone Number: Email Address: )____________________________________________________________________________ Dated: _______________ __, ______ Holder’s Signature: Holder’s Address:
Appears in 6 contracts
Samples: Placement Agent Common Stock Purchase Warrant (HTG Molecular Diagnostics, Inc), Revelation Biosciences, Inc., Revelation Biosciences, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: :__________________________ Holder’s Address:__________________________
Appears in 6 contracts
Samples: Better Choice Co Inc., Nature's Miracle Holding Inc., New Horizon Aircraft Ltd.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: Holder’s Address:
Appears in 5 contracts
Samples: Cellectar Biosciences, Inc., NXT-Id, Inc., Long Island Iced Tea Corp.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVEDFor Value Received, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: Holder’s Address:
Appears in 5 contracts
Samples: Switchback Energy Acquisition Corp, Switchback Energy Acquisition Corp, Zhongchao Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, _ ______ Holder’s Signature: Holder’s Address:
Appears in 4 contracts
Samples: Common Stock Purchase (Bioquest Corp), Common Stock Purchase Warrant (Metatron Apps, Inc.), Common Stock Purchase Warrant (Greene Concepts, Inc)
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: ______________________________________ (Please Print) Address: ______________________________________ (Please Print) Phone Number: ______________________________________ Email Address: ______________________________________ Dated: _______________ __, ______ Holder’s Signature: Holder’s Address:
Appears in 4 contracts
Samples: Intrusion Inc, Intrusion Inc, Agile Therapeutics Inc
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: :______________________ Holder’s Address:: ______________________
Appears in 4 contracts
Samples: Novo Integrated Sciences, Inc., Recon Technology, LTD, Novo Integrated Sciences, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: Holder’s Address:
Appears in 4 contracts
Samples: Common Stock Purchase (Triad Pro Innovators, Inc.), Triad Pro Innovators, Inc., Triad Pro Innovators, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: Name (Please Print) Address: Address (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: _______________ Holder’s Address:: _______________
Appears in 4 contracts
Samples: Know Labs, Inc., Know Labs, Inc., Know Labs, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: ______________________ Holder’s Address:: _______________________
Appears in 4 contracts
Samples: Common Stock Purchase Warrant (MamaMancini's Holdings, Inc.), GBS Inc., Aptorum Group LTD
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: _______________ Email Address: ____________________________ Dated: _______________ __, ______ Holder’s Signature: :_________________________ Holder’s Address:__________________________
Appears in 4 contracts
Samples: Common Stock Purchase (Grom Social Enterprises, Inc.), Nature's Miracle Holding Inc., New Horizon Aircraft Ltd.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: ____________________________ Holder’s Address:: _____________________________
Appears in 4 contracts
Samples: Revelation Biosciences, Inc., Coya Therapeutics, Inc., Coya Therapeutics, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: ______________________________________ (Please Print) Address: ______________________________________ (Please Print) Phone Number: ______________________________________ Email Address: ______________________________________ Dated: _______________ __, ______ Holder’s Signature: Holder’s Address:: Exhibit 2
Appears in 3 contracts
Samples: Warrant Agency Agreement (Envision Solar International, Inc.), Warrant Agency Agreement (Envision Solar International, Inc.), Warrant Agency Agreement (Envision Solar International, Inc.)
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ____20__ Holder’s Signature: Holder’s Address:
Appears in 3 contracts
Samples: Goff John C, Eyetel Imaging Inc, Omnicell Inc /Ca/
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to to: Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: Holder’s Address:
Appears in 3 contracts
Samples: Preferred Stock Purchase Warrant (Stratus Capital Corp), Preferred Stock Purchase Warrant (Stratus Capital Corp), Preferred Stock Purchase Warrant (Stratus Capital Corp)
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVEDFor Value Received, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ____20__ Holder’s Signature: Holder’s Address:
Appears in 3 contracts
Samples: EBR Systems, Inc., Northwest Biotherapeutics Inc, Northwest Biotherapeutics Inc
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: :____________________________ Holder’s Address:_____________________________
Appears in 3 contracts
Samples: Sonnet BioTherapeutics Holdings, Inc., Sonnet BioTherapeutics Holdings, Inc., Sonnet BioTherapeutics Holdings, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply the required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: ______________________ __, ______ Holder’s Signature: Holder’s Address:
Appears in 3 contracts
Samples: Wisa Technologies, Inc., Wisa Technologies, Inc., Kalera Public LTD Co
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: ___________________________________ Holder’s Address:: ____________________________________
Appears in 3 contracts
Samples: Agile Therapeutics Inc, Agile Therapeutics Inc, Agile Therapeutics Inc
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: :_______________________ Holder’s Address:________________________
Appears in 3 contracts
Samples: Sintx Technologies, Inc., Sintx Technologies, Inc., Sintx Technologies, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: _____________________ Holder’s Address:: ______________________
Appears in 3 contracts
Samples: Common Stock Purchase Warrant (Propanc Biopharma, Inc.), Lianluo Smart LTD, Lianluo Smart LTD
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: Holder’s Address:
Appears in 2 contracts
Samples: Agreement and Plan of Merger (Cardax, Inc.), Akebia Therapeutics, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s 's Signature: Holder’s 's Address:
Appears in 2 contracts
Samples: Warrant Purchase Agreement (Viveve Medical, Inc.), Warrant Purchase Agreement (Viveve Medical, Inc.)
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVEDFor Value Received, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: Holder’s Address:
Appears in 2 contracts
Samples: Trulite Inc, Trulite Inc
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to to: Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: Holder’s Address:
Appears in 2 contracts
Samples: Series D Preferred Stock Purchase Warrant (TPT Global Tech, Inc.), Series D Preferred Stock Purchase Warrant (TPT Global Tech, Inc.)
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ 2012 Holder’s Signature: Holder’s Address:
Appears in 2 contracts
Samples: Tetralogic Pharmaceuticals Corp, Tetralogic Pharmaceuticals Corp
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to to: Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: Signature Holder’s Address:
Appears in 2 contracts
Samples: Remark Holdings, Inc., Remark Holdings, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: :____________________ Holder’s Address:_____________________
Appears in 2 contracts
Samples: Intelligent Bio Solutions Inc., Cancer Genetics, Inc
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: Phone Number: E-mail Address: (Please Print) Phone Number: Email Address: ______________________________________ ______________________________________ Dated: _______________ __, ______ Holder’s Signature: Holder’s Address:
Appears in 2 contracts
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: __________________________ Holder’s Address:: __________________________
Appears in 2 contracts
Samples: Aclarion, Inc., Aclarion, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: :___________________________ Holder’s Address:____________________________
Appears in 2 contracts
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: :______________________________ Holder’s Address:_______________________________
Appears in 2 contracts
Samples: Stryve Foods, Inc., enVVeno Medical Corp
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: __________________ Holder’s Address:: ___________________
Appears in 2 contracts
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ____20__ Holder’s Signature: Holder’s Address:
Appears in 2 contracts
Samples: Auddia Inc., Auddia Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: _______________________ Holder’s Address:: _______________________
Appears in 2 contracts
Samples: Aptorum Group LTD, Adial Pharmaceuticals, Inc.
ASSIGNMENT FORM. (To assign the foregoing Purchase Warrant, execute this form and supply required information. Do not use this form to purchase sharesShares.) FOR VALUE RECEIVED, the foregoing Purchase Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: _____________________ Holder’s Address:: _____________________
Appears in 2 contracts
Samples: Underwriting Agreement (Silo Pharma, Inc.), Common Stock Purchase Warrant (Silo Pharma, Inc.)
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to to: Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: Holder’s Address:
Appears in 2 contracts
Samples: Warrant Agency Agreement (Planet 13 Holdings Inc.), Planet 13 Holdings Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: _______________________ Holder’s Address:: ________________________
Appears in 2 contracts
Samples: Transcode Therapeutics, Inc., Sintx Technologies, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ____20__ Holder’s Signature: Holder’s Address: Holder’s Signature: Holder’s Address:
Appears in 2 contracts
Samples: www.sec.gov, Horizon Pharma, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: ______________________________ Holder’s Address:: _______________________________
Appears in 2 contracts
Samples: Lexaria Bioscience Corp., Sorrento Therapeutics, Inc.
ASSIGNMENT FORM. (To assign the foregoing WarrantOption, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVEDFor Value Received, the foregoing Warrant Option and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ____20__ Holder’s Signature: Holder’s Address:
Appears in 2 contracts
Samples: Firer Oleg, Net Element, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: :________________________________ Holder’s Address:_________________________________
Appears in 2 contracts
Samples: Common Stock Purchase Warrant (Marathon Patent Group, Inc.), Biohitech Global, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to to: Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: Holder’s Address:
Appears in 2 contracts
Samples: Securities Purchase Agreement (NeuroMetrix, Inc.), NeuroMetrix, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: :___________________ Holder’s Address:: ___________________
Appears in 2 contracts
Samples: DelMar Pharmaceuticals, Inc., DelMar Pharmaceuticals, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase sharesexercise the Warrant.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: Holder’s Address:
Appears in 2 contracts
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: ________________ __, _______ Holder’s Signature: ____________________________ Holder’s Address:: _____________________________
Appears in 2 contracts
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: Holder’s Address:: EXHIBIT B
Appears in 2 contracts
Samples: Warrant Agreement (Hancock Jaffe Laboratories, Inc.), Warrant Agreement (Hancock Jaffe Laboratories, Inc.)
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVEDFor Value Received, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ________ Holder’s Signature: _____________________________________ Holder’s Address:: ______________________________________
Appears in 2 contracts
Samples: Subscription Agreement (VerifyMe, Inc.), Investment Agreement (VerifyMe, Inc.)
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: :_____________________ Holder’s Address:___________________
Appears in 2 contracts
Samples: Galmed Pharmaceuticals Ltd., Galmed Pharmaceuticals Ltd.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: _____________________________ Holder’s Address:: _____________________________
Appears in 1 contract
Samples: Sorrento Therapeutics, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, __________,_______ Holder’s Signature: Holder’s Address:
Appears in 1 contract
Samples: Common Stock Purchase (Kaival Brands Innovations Group, Inc.)
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: ________________________ Holder’s Address:: ________________________
Appears in 1 contract
Samples: Aptorum Group LTD
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to to: Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: ____________ ____ __, ______ Holder’s Signature: Signature Holder’s Address:: _________________________
Appears in 1 contract
Samples: Nymox Pharmaceutical Corp
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: :_____________________ Holder’s Address:____________________
Appears in 1 contract
Samples: Azitra, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _____________________ __, ______ Holder’s Signature: Holder’s Address:: ANNEX D AUTHORIZED REPRESENTATIVES Name Title Signature
Appears in 1 contract
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: :________________________ Holder’s Address:_________________________
Appears in 1 contract
Samples: Lianluo Smart LTD
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: ___________________ Holder’s Address:: ___________________
Appears in 1 contract
Samples: Lianluo Smart LTD
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ _____________, ______ Holder’s Signature: ______________________ Holder’s Address:: _______________________
Appears in 1 contract
Samples: Subordinate Loan and Security Agreement (S&W Seed Co)
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _________________ ____, ________________ Holder’s Signature: Holder’s Address:
Appears in 1 contract
Samples: NeuroBo Pharmaceuticals, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: DWAC Account Number: Dated: _________________________________________ __, ______ Holder’s Signature: Holder’s Address:: Assignment Form
Appears in 1 contract
Samples: Common Stock Purchase Warrant (Precision Biosciences Inc)
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to to: Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: _______________ Holder’s Address:: _______________
Appears in 1 contract
Samples: Series D Preferred Stock Purchase Warrant (TPT Global Tech, Inc.)
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: :________________ __, _,_____ Holder’s Signature: Holder’s Address:: Exhibit 2
Appears in 1 contract
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: _______________________________ Holder’s Address:: _______________________________
Appears in 1 contract
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: :__________________ Holder’s Address:______________________
Appears in 1 contract
Samples: Sintx Technologies, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: :_______________ __, ______ Holder’s Signature: :_____________________ Holder’s Address:_______________________
Appears in 1 contract
Samples: Intelligent Bio Solutions Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: :__________________ Holder’s Address:___________________
Appears in 1 contract
Samples: Azitra, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to exercise the Warrant to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: Holder’s Address:
Appears in 1 contract
Samples: Genius Group LTD
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVEDRECEIVED , the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: Holder’s Address:
Appears in 1 contract
Samples: Trulite Inc
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase sharesShares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: Holder’s Address:
Appears in 1 contract
Samples: CannAssist International Corp
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: :_____________________ Holder’s Address:_____________________________
Appears in 1 contract
Samples: NightFood Holdings, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ ___, _______ Holder’s Signature: ______________________________ Holder’s Address:: _______________________________
Appears in 1 contract
Samples: Common Share Purchase (Avino Silver & Gold Mines LTD)
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: Holder’s Address:: ________________________________
Appears in 1 contract
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: Holder’s Address:: [Signature Guarantee]
Appears in 1 contract
Samples: Convertible Note Purchase Agreement (Integrated Media Technology LTD)
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: Phone Number: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: Holder’s Address:__________________
Appears in 1 contract
Samples: Versus Systems Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ,______ Holder’s Signature: __________________ Holder’s Address:: ___________________
Appears in 1 contract
Samples: Siyata Mobile Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: ________________________ ___, __________ Holder’s Signature: Holder’s Address:
Appears in 1 contract
Samples: Innovative Eyewear Inc
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: :_______________________ Holder’s Address:: _______________________
Appears in 1 contract
Samples: NeuroBo Pharmaceuticals, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: _________________ Holder’s Address:: __________________
Appears in 1 contract
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: ______________________ Holder’s Address:: ______________________
Appears in 1 contract
Samples: Siyata Mobile Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: Phone Number: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: Holder’s Address:
Appears in 1 contract
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase sharesWarrant Shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: Holder’s Address:
Appears in 1 contract
Samples: Fluent, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __ , ______ Holder’s Signature: Holder’s Address::
Appears in 1 contract
Samples: Timber Pharmaceuticals, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to exercise the Warrant to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: :___________________________ Holder’s Address:____________________________
Appears in 1 contract
Samples: NanoVibronix, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply the required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______________________, 20__ Holder’s Signature: Holder’s Address:
Appears in 1 contract
Samples: Purple Beverage Company, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: Holder’s Address:: DOCPROPERTY "CUS_DocIDChunk0" 30838158_v9
Appears in 1 contract
Samples: Nuburu, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: :_________________ Holder’s Address:____________________
Appears in 1 contract
Samples: RenovoRx, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to exercise the Warrant to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email E-mail Address: Dated: _______________ __, ______ Holder’s Signature: :____________________ Holder’s Address:_____________________
Appears in 1 contract
Samples: Genius Group LTD
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: ____________________ __, ______ Holder’s Signature: _____________________ Holder’s Address:: ______________________
Appears in 1 contract
Samples: Agile Therapeutics Inc
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: :_______________ __, ______ , Holder’s Signature: Holder’s Address:
Appears in 1 contract
Samples: Common Stock Purchase Warrant (Applied Therapeutics Inc.)
