City, State, Zip Code. Enter the city, state and zip code. This MUST be part of the physical address.
City, State, Zip Code. 1 Subject to adjustment under Section 4.1 of the Terms. 2 Subject to early termination under Section 4.2 or 4.3 of the Terms.
City, State, Zip Code. This Stock Option Agreement is intended to set forth the terms and conditions on which a Stock Option (an “Option”) has been granted under the Xxxxxx City Bancorp, Inc. 2006 Stock Incentive Plan. Set forth below are the specific terms and conditions applicable to this Option. Attached as Exhibit A are its general terms and conditions. Option Xxxxx Xxxxx Date: Class of Optioned Shares* Common No. of Optioned Shares* Exercise Price per Share* Option Type (ISO or NQSO) NQSO VESTING: Earliest Exercise Date* Option Expiration Date* 7/20/2016 * Subject to adjustment as provided in the Xxxxxx City Bancorp, Inc. 2006 Stock Incentive Plan and Exhibit A attached hereto. By signing where indicated below, Xxxxxx City Bancorp, Inc. (the ACompany@) grants this Option upon the specified terms and conditions, and the Recipient acknowledges receipt of this Stock Option Agreement, including Exhibit A, and agrees to observe and be bound by the terms and conditions set forth herein. Xxxxxx City Bancorp, Inc. Recipient By Name: Name: Title: INSTRUCTIONS: This Stock Option Agreement should be completed by or on behalf of the Compensation Committee. Any blank space intentionally left blank should be crossed out. An Option grant consists of a number of optioned shares with uniform terms and conditions. Where Options are granted on the same date with varying terms and conditions (for example, varying exercise prices or earliest exercise dates), the Options should be recorded as a series of grants each with its own uniform terms and conditions. EXHIBIT A Xxxxxx City Bancorp, Inc. 2006 Stock Incentive Plan
City, State, Zip Code. Cell Phone: Printed Name of Attendee Signed Name of Attendee (Age 18 & Over) If Attendee is a minor, under the age of eighteen, signature of Parent or Guardian is required:
City, State, Zip Code. The date of receipt of any notice shall be, if delivered, the date of personal delivery to the other party during normal business hours. If mailed, the date of receipt of the notice shall be three- (3) business Days after deposit in the U.S. mail. In addition, notices required or permitted pursuant to terms of this Agreement may be faxed or electronically mailed to the other party. The date of receipt of a faxed or electronically mailed notice shall be the date of transmission of the fax or electronic mail so long as the date of transmission is a business day between 8:00 a.m. and 5:00 p.m. Otherwise, the faxed or electronically mailed notice shall be deemed delivered on the first business day thereafter.
City, State, Zip Code. If a situation occurs where we are talking and we get disconnected and you are in crisis, you agree to call 911, go to your local emergency room immediately, or contact the National Suicide Prevention Hotline at 000-000-XXXX or dial 988 to be connected. If I have concerns about your safety at any time during a phone session, I will break confidentiality and call 911 (if located in the same county or emergency services in the area you are located at the time of the call) and/or your emergency contact immediately. Please note that everything in our informed consent that you signed, including all the confidentiality exceptions, still applies during phone/video sessions. Consent to Participate in Telehealth Counseling Sessions: By signing below, you agree that you have read and understand all of the above sections of the telehealth informed consent. You agree that you also understand the limitations associated with participating in telehealth counseling sessions and consent to attend sessions under the terms described in this document. Client Printed Name & Signature Date
