Background Information. Name of Beneficial Owner of the Securities: Business Address: (Number and Street) (City) (State) (Zip Code) Telephone Number: ( ) If a corporation, partnership, limited liability company, trust or other entity: Type of entity: State of formation: Approximate Date of formation: Were you formed for the purpose of investing in the securities being offered? Yes o No o If an individual: Residence Address: (Number and Street) (City) (State) (Zip Code)
Appears in 8 contracts
Samples: Securities Purchase Agreement (GTT Communications, Inc.), Securities Purchase Agreement (GTT Communications, Inc.), Securities Purchase Agreement (GTT Communications, Inc.)
Background Information. Name of Beneficial Owner of the Securities: Business Address: (Number and Street) (City) (State) (Zip Code) Telephone Number: ( ) If a corporation, partnership, limited liability company, trust or other entity: Type of entity: State of formation: Approximate Date of formation: Were you formed for the purpose of investing in the securities being offered? Yes o No o If an individual: Residence Address: (Number and Street) (City) (State) (Zip Code)
Appears in 3 contracts
Samples: Securities Purchase Agreement (Anthera Pharmaceuticals Inc), Securities Purchase Agreement (Aveo Pharmaceuticals Inc), Securities Purchase Agreement (Athersys, Inc / New)
Background Information. Name of Beneficial Owner of the Securities: Business Address: (Number and Street) (City) (: State) (: Zip Code) : Telephone Number: ( ) If a corporation, partnership, limited liability company, trust or other entity: Type of entity: Country/State of formation: Approximate Date of formation: Were you formed for the purpose of investing in the securities being offered? Yes o ☐ No o ☐ If an individual: Residence Address: (Number and Street) (City) (: State) (: Zip Code): Telephone Number:
Appears in 3 contracts
Samples: Subscription Agreement (Better Choice Co Inc.), Subscription Agreement (Better Choice Co Inc.), Subscription Agreement (Better Choice Co Inc.)
Background Information. Name of Beneficial Owner of the Securities: Business Address: (Number and Street) (City) (State) (Zip Code) Telephone Number: ( ) If a corporation, partnership, limited liability company, trust or other entity: Type of entity: State of formation: Approximate Date of formation: Were you formed for the purpose of investing in the securities being offered? Yes o No o If an individual: Residence Address: (Number and Street) (City) (State) (Zip Code) Telephone Number: ( )
Appears in 1 contract
Background Information. Name of Beneficial Owner of the Securities: Business Address: (Number and Street) (City) (State) (Zip Code) Telephone Number: ( ) If a corporation, partnership, limited liability company, trust or other entity: Type of entity: State of formation: Approximate Date of formation: Were you formed for the purpose of investing in the securities being offered? Yes o No o If an individual: Residence Address: (Number and Street) (City) (State) (Zip Code):
Appears in 1 contract
Background Information. Name of Beneficial Owner of the Securities: Business Address: (Number and Street) (City) (State) (Zip Code) Telephone Number: ( ) If a corporation, partnership, limited liability company, trust or other entity: Type of entity: State of formation: Approximate Date of formation: Were you formed for the purpose of investing in the securities being offered? Yes o ¨ No o ¨ If an individual: Residence Address: (Number and Street) (City) (State) (Zip Code)
Appears in 1 contract
Samples: Securities Purchase Agreement (Pieris Pharmaceuticals, Inc.)
Background Information. Name of Beneficial Owner of the Securities: Business Address: (Number and Street) (City) (State) (Zip Code) Telephone Number: :( ) If a corporation, partnership, limited liability company, trust or other entity: Type of entity: State of formation: Approximate Date of formation: Were you formed for the purpose of investing in the securities being offered? Yes o No o Noo If an individual: Residence Address: (Number and Street) (City) (State) (Zip Code)
Appears in 1 contract
Samples: Securities Purchase Agreement (GTT Communications, Inc.)
Background Information. Name of Beneficial Owner of the Securities: Business Address: (Number and Street) (City) (: State) (: Zip Code) : Telephone Number: ( ) If a corporation, partnership, limited liability company, trust or other entity: Type of entity: State of formation: Approximate Date of formation: Were you formed for the purpose of investing in the securities being offered? Yes o ¨ No o ¨ If an individual: Residence Address: (Number and Street) (City) (: State) (: Zip Code):
Appears in 1 contract
Background Information. Name of Beneficial Owner of the Securities: Business Address: (Number and Street) (City) (State) (Zip Code) Telephone Number: ( ) If a corporation, partnership, limited liability company, trust or other entity: Type of entity: State of formation: Approximate Date of formation: Were you formed for the purpose of investing in the securities being offered? Yes o ☐ No o ☐ If an individual: Residence Address: (Number and Street) (City) (State) (Zip Code)
Appears in 1 contract
Samples: Securities Purchase Agreement (Blue Ridge Bankshares, Inc.)
