Common use of Countersigned Clause in Contracts

Countersigned. By: -------------------------------- Authorized Signature A-3 [Form of Reverse Side of Right Certificate] FORM OF ASSIGNMENT (To be executed by the registered holder if such holder desires to transfer the Right Certificate.) FOR VALUE RECEIVED __________________________________ hereby sells, assigns and transfers unto _____________________________________________ _______________________________________________________________________________ (Please print name and address of transferee) this Right Certificate, together with all right, title and interest therein, and does hereby irrevocably constitute and appoint _____________________ Attorney to transfer the within Right Certificate on the books of the within-named Corporation, with full power of substitution. Dated: _________________, __________ _________________________________ Signature Signature Guaranteed:

Countersigned. as Rights Agent By: -------------------------------- :_________________________ Authorized Signature A-3 [Form of Reverse Side of Right Rights Certificate] FORM OF ASSIGNMENT ------------------ (To be executed by the registered holder if such holder desires to transfer the Right Rights Certificate.) FOR VALUE RECEIVED ___________________________________________ hereby sells, assigns assigns, and transfers unto _____________________________________________ (Please print name and address of transferee) _______________________________________________________________________________ (Please print name and address of transferee) this Right Rights Certificate, together with all right, title title, and interest therein, and does hereby irrevocably constitute and appoint _____________________ Attorney Attorney, to transfer the within Right Rights Certificate on the books of the within-named CorporationCompany, with full power of substitution. Dated: ___________________, __________ _________________________________ -------------------------- Signature Signature Guaranteed: Certificate ----------- The undersigned hereby certifies by checking the appropriate boxes that:

Countersigned. ByBy ------------------------------ Name: -------------------------------- Authorized Signature A-3 Title: [Form of Reverse Side of Right Rights Certificate] FORM OF ASSIGNMENT (To be executed by the registered holder if such holder desires to transfer the Right Rights Certificate.) FOR VALUE RECEIVED __________________________________ hereby sells, assigns and transfers unto __________________ hereby sells, assigns, and transfers to ___________________________________ _______________________________________________________________________________ (Please print name and address of transferee) this Right Certificate, together with all right, title and interest therein, and does hereby irrevocably constitute and appoint _____________________ Attorney to transfer the within Right Certificate on the books of the within-named Corporation, with full power of substitution. Dated: _________________, __________ _________________________________ this Rights Certificate, together with all right, title, and interest therein, and does hereby irrevocably constitute and appoint _____________________ as attorney, to transfer the within Rights Certificate on the books of xxxxx-xxxxxxxxxx.xxx, corp., with full power of substitution. Dated: _____________, _____ ___________________________ (Signature) Medallion Signature Signature GuaranteedGuaranty: ------------------------------------------------------------------------------- Assignment Certification The undersigned hereby certifies by checking the appropriate boxes that:

Countersigned. By[--------------------------], as Rights Agent --------------------------- Authorized Signatory Date of countersignature: -------------------------------- Authorized Signature A-3 [Form of Reverse Side of Right Certificate] FORM OF ASSIGNMENT (To be executed by the registered holder if such holder desires to transfer the Right Certificate.) FOR VALUE RECEIVED __________________________________ hereby sells, assigns and transfers unto _____________________________________________ ___________________________________________(Please print name and address of transferee) ____________________________________ (Please print name and address of transferee) this Right Certificate, together with all right, title and interest therein, and does hereby irrevocably constitute and appoint _____________________ Attorney Attorney, to transfer the within Right Certificate on the books of the within-named CorporationCompany, with full power of substitution. Dated: _________________, __________ _________________________________ ------------------- ---- ----------------------------- Signature Signature Guaranteed: -------------- CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:

Countersigned. By: -------------------------------- ------------------------------ Authorized Signature A-3 [B-3 48 Form of Reverse Side of Right Certificate] Certificate FORM OF ASSIGNMENT (To be executed by the registered holder if such holder desires to transfer the Right Certificate.) FOR VALUE RECEIVED ___________________RECEIVED, _______________ hereby sells, assigns and transfers unto _____________________________________________ _______________________________________________________________________________ -------------------------------------------------------------------------------- (Please print name and address of transferee) -------------------------------------------------------------------------------- this Right Certificate, together with all right, title and interest therein, and does hereby irrevocably constitute and appoint _____________________ Attorney Attorney, to transfer the within Right Certificate on the books of the within-named CorporationCompany, with full power of substitution. Dated: _________________, __________ _________________________________ --------------------------- Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:

Countersigned. By[ ], ---------------------------- as Rights Agent ------------------------------------- Authorized Signatory Date of countersignature: -------------------------------- Authorized Signature A-3 [Form of Reverse Side of Right Certificate] FORM OF ASSIGNMENT ------------------ (To be executed by the registered holder if such holder desires to transfer the Right Certificate.) FOR VALUE RECEIVED __________________________________ hereby sells, assigns and transfers unto _____________________________________________ _____________________________________________________(Please print name and address of transferee) __________________________ (Please print name and address of transferee) this Right Certificate, together with all right, title and interest therein, and does hereby irrevocably constitute and appoint _____________________ Attorney Attorney, to transfer the within Right Certificate on the books of the within-named CorporationCompany, with full power of substitution. Dated: _________________, __________ _________________________________ ---------------- -------------------------------------------- Signature Signature Guaranteed: ----------------------------- CERTIFICATE ----------- The undersigned hereby certifies by checking the appropriate boxes that:

Countersigned. By: -------------------------------- as Rights Agent By ------------------------ Authorized Signature A-3 [Form of Reverse Side of Right Certificate] Certificate FORM OF ASSIGNMENT (To be executed by the registered holder if such holder desires to transfer the Right Certificate.) FOR VALUE RECEIVED __________________________________ hereby sells, assigns and transfers unto _______________________ hereby sells, assigns and transfers unto _______________________ ________________________________________________________________ (Please print name and address of transferee) _______________________________________________________________ (Please print name and address of transferee) this Right Certificate, together with all right, title and interest therein, and does hereby irrevocably constitute and appoint _____________________ Attorney Attorney, to transfer the within Right Certificate on the books of the within-named CorporationBank, with full power of substitution. Dated: _________________, __________ _________________________________ Signature . --------------------------------- Signature Guaranteed: Signature Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Countersigned. As Rights Agent By: -------------------------------- Authorized Signature A-3 [Form of Reverse Side of Right CertificateFORM OF REVERSE SIDE OF RIGHTS CERTIFICATE] FORM OF ASSIGNMENT --------------------- (To be executed by the registered holder if such holder desires to transfer the Right Rights Certificate.) FOR VALUE RECEIVED ______________________________________ hereby sells, assigns and transfers unto _____________________________________________ _______________________________________________________________________________ (Please print name and address of transferee) this Right Rights Certificate, together with all right, title and interest therein, and does hereby irrevocably constitute and appoint _____________________ Attorney Attorney, to transfer the within Right Rights Certificate on the books of the within-named CorporationCompany, with full power of substitution. Dated: _________________, __________ _________________________________ ------------------------------ Signature Signature Guaranteed: CERTIFICATE -------------- The undersigned hereby certifies by checking the appropriate boxes that:

Countersigned. By: -------------------------------- By ---------------------------------- Authorized Signature A-3 42 [Form of Reverse Side of Right Rights Certificate] FORM OF ASSIGNMENT (To be executed by the registered holder if such holder desires to transfer the Right Rights Certificate.) FOR VALUE RECEIVED __________________________________ hereby sells, assigns and transfers unto _____________________________________________ _____________________________hereby sells, assigns and transfers unto __________________________________________________ (Please print name and address of transferee) this Right Rights Certificate, together with all right, title and interest therein, and does hereby irrevocably constitute and appoint _____________________ Attorney ________, Attorney, to transfer the within Right Rights Certificate on the books of the within-named CorporationCompany, with full power of substitution. Dated: _________________, __________ . ________________________________________ Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Countersigned. By: By -------------------------------- Authorized Signature A-3 [Form of Reverse Side of Right Rights Certificate] ) FORM OF ASSIGNMENT ------------------ (To be executed by the registered holder if such holder desires to transfer the Right Rights Certificate.) FOR VALUE RECEIVED ____________________________________________________________ hereby sells, assigns and transfers unto ______unto_______________________________________ _______________________________________________________________________________ (Please print name and address of transferee) _______________________________________________________________________________ this Right Rights Certificate, together with all right, title and interest therein, and does hereby irrevocably constitute and appoint _____________________ Attorney Attorney, to transfer the within Right Rights Certificate on the books of the within-named CorporationCompany, with full power of substitution. Dated: _________________, __________ __________________________________ Signature Signature Guaranteed: Certificate ----------- The undersigned hereby certifies by checking the appropriate boxes that:

Countersigned. By: -------------------------------- By ----------------------------------- Authorized Signature A-3 [Form of Reverse Side of Right Rights Certificate] FORM OF ASSIGNMENT (To be executed by the registered holder if such holder desires to transfer the Right CertificateRights certificate.) FOR VALUE RECEIVED __________________________________ hereby sells, assigns and transfers unto _________________ hereby sells, assigns, and transfers unto ____________________________________ _______________________________________________________________________________ (Please print name and address of transferee) this Right Rights Certificate, together with all right, title title, and interest therein, and does hereby irrevocably constitute and appoint _____________________ Attorney , Attorney, to transfer the within Right Rights Certificate on the books of the within-named CorporationCompany, with full power of substitution. Dated: _________________, __________ _______Dated __________________________ ---------------------------------- Signature Signature Guaranteed: Certificate ----------- The undersigned hereby certifies by checking the appropriate boxes that:

Countersigned. By: -------------------------------- Authorized Signature A-3 ---------------------------------- Name: Title: [Form of Reverse Side of Right Rights Certificate] FORM OF ASSIGNMENT ------------------ (To be executed by the registered holder if such holder desires to transfer the Right Rights Certificate.) FOR VALUE RECEIVED __________________________________ RECEIVED, the undersigned hereby sells, assigns and transfers unto _____________________________________________ _______________________________________________________________________________ -------------------------------------------------------------- -------------------------------------------------------------- (Please print name and address of transferee) -------------------------------------------------------------- this Right Rights Certificate, together with all right, title and interest therein, therein and does hereby irrevocably constitute and appoint _____________________ Attorney Attorney, to transfer the within Right Rights Certificate on the books of the within-named CorporationCompany, with full power of substitution. Dated: _________________, __________ _________________________________ ------------------------ -------------------------------------------- Signature Signature Guaranteed: Certificate ----------- The undersigned hereby certifies by checking the appropriate boxes that:

Countersigned. By: -------------------------------- ---------------------------- Authorized Signature A-3 [47 Form of Reverse Side of Right Certificate] Certificate FORM OF ASSIGNMENT ------------------ (To be executed by the registered holder if such holder desires to transfer the Right Certificate.) FOR VALUE RECEIVED ___________________RECEIVED, _______________ hereby sells, assigns and transfers unto _____________________________________________ _______________________________________________________________________________ (Please print name and address of transferee) ________________________________________________________________________________ this Right Certificate, together with all right, title and interest therein, and does hereby irrevocably constitute and appoint _____________________ Attorney Attorney, to transfer the within Right Certificate on the books of the within-named CorporationCompany, with full power of substitution. Dated: _________________, __________ _________________________________ Signature Signature Guaranteed: CERTIFICATE ----------- The undersigned hereby certifies by checking the appropriate boxes that:

Countersigned. By: -------------------------------- ---------------------------- Authorized Signature A-3 [B-4 63 Form of Reverse Side of Right Certificate] Certificate FORM OF ASSIGNMENT (To be executed by the registered holder if such holder desires to transfer the Right Certificate.) FOR VALUE RECEIVED __________________________________ RECEIVED, hereby sells, assigns and transfers --------------- unto _____________________________________________ _______________________________________________________________________________ ---------------------------------------------------------------------------- -------------------------------------------------------------------------------- (Please print name and address of transferee) -------------------------------------------------------------------------------- this Right Certificate, together with all right, title and interest therein, and does hereby irrevocably constitute and appoint _____________________ Attorney Attorney, --------------- to transfer the within Right Certificate on the books of the within-named CorporationCompany, with full power of substitution. Dated: _________________------------, __________ _________________________________ ---- ------------------------------------ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:

Countersigned. By: -------------------------------- ---------------------- Authorized Signature A-3 [Form of Reverse Side of Right Certificate] FORM OF ASSIGNMENT (To be executed by the registered holder if such holder desires to transfer the Right Certificate.) FOR VALUE RECEIVED __________________________________ hereby sells, assigns and transfers unto _____________________________________________ ___________________. ____________________________________________________________ (Please print name and address of transferee) this Right Certificate, together with all right, title and interest therein, and does hereby irrevocably constitute and appoint _____________________ Attorney to transfer the within Right Certificate on the books of the within-named Corporation, with full power of substitution. Dated: _________________, __________ _________________________________ 19 ------------ -- ------------------------------ Signature Signature Guaranteed:

Countersigned. By: -------------------------------- Authorized Signature A-3 By --------------------- 44 [Form of Reverse Side of Right Certificate] FORM OF ASSIGNMENT Form of Assignment ------------------ (To be executed by the registered holder if such the holder desires to transfer the Right Certificate.) FOR VALUE RECEIVED __________________________________ hereby sells, assigns and transfers unto _____________________________________________ _______________________________________________________________________________ ---------------------------------------------------------------------- (Please print name and address of transferee) this Right Certificate, together with all right, title and interest therein, and does hereby irrevocably constitute and appoint _____________________ Attorney as attorney, to transfer the within Right Certificate on the books of the within-named STERIS Corporation, with full power of substitution. Dated: _________________, __________ _________________________________ 19 ------------------ --- -------------------------------- Signature Signature Guaranteed: Certificate ----------- The undersigned hereby certifies by checking the appropriate boxes that:

Countersigned. By: -------------------------------- By ------------------------------------ Authorized Signature A-3 Officer -B-4- [Form of Reverse Side of Right Rights Certificate] FORM OF ASSIGNMENT (To be executed by the registered holder if such holder desires to transfer the Right Rights Certificate.) FOR VALUE RECEIVED ________________________________________ hereby sells, assigns and transfers unto _____________________________________________ _______________________________________________________________________________ (Please print name and address of transferee) this Right Rights Certificate, together with all right, title and interest therein, and does hereby irrevocably constitute and appoint _____________________ Attorney Attorney, to transfer the within Right Rights Certificate on the books of the within-named CorporationCompany, with full power of substitution. Dated: _______________ ___, ________19__ _________________________________ -------------------------------------- Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Countersigned. By: -------------------------------- By ----------------------------- Authorized Signature A-3 [Form of Reverse Side of Right Certificate] FORM OF ASSIGNMENT (To be executed by the registered holder if such holder desires to transfer the Right CertificateCertificates.) FOR VALUE RECEIVED _________________________________________________ hereby sells, assigns and transfers unto _____________________________________________ ________________________________________________________________________________ (Please print name and address of transferee) ________________________________________________________________________________ Rights evidenced by this Right Certificate, together with all right, title and interest therein, and does hereby irrevocably constitute and appoint ________________________ Attorney to transfer the within Right Certificate on the books of the within-named Corporation, with full power of substitution. Dated: _______________ ___, __________ ______________________________________ Signature Signature Guaranteed:4

Countersigned. By[ ], ----------------------------------- as Rights Agent ----------------------------------- Authorized Signatory Date of countersignature: -------------------------------- Authorized Signature A-3 [Form of Reverse Side of Right Certificate] FORM OF ASSIGNMENT (To be executed by the registered holder if such holder desires to transfer the Right Certificate.) FOR VALUE RECEIVED __________________________________ hereby sells, assigns and transfers unto _____________________________________________ ___________________________________________(Please print name and address of transferee) ____________________________________ (Please print name and address of transferee) this Right Certificate, together with all right, title and interest therein, and does hereby irrevocably constitute and appoint _____________________ Attorney Attorney, to transfer the within Right Certificate on the books of the within-named CorporationCompany, with full power of substitution. Dated: _________________, __________ _________________________________ ------------------ -- ------------------------------ Signature Signature Guaranteed: ------------------------- CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:

Countersigned. By: -------------------------------- Authorized Signature A-3 By ----------------------------- [Form of Reverse Side of Right Certificate] FORM OF ASSIGNMENT (To be executed by the registered holder if such the holder desires to transfer the Right Certificate.certificate) FOR VALUE RECEIVED ______________________________ hereby sells, assigns, and transfers unto _____ hereby sells, assigns and transfers unto ____________________________________________________________________________ ________________________________________________________________________________ (Please print name and address of transferee) this Right Certificate, together with all right, title title, and interest therein, and does hereby irrevocably constitute and appoint _____________________ Attorney as attorney, to transfer the within Right Certificate on the books of the within-named Nordson Corporation, with full power of substitution. Dated: :_________________, __________ ___________________________________ Signature Signature Guaranteed: CERTIFICATE (Applicable to Form of Assignment) The undersigned hereby certifies by checking the appropriate boxes that:

Countersigned. By: -------------------------------- By ------------------------------- Authorized Signature A-3 B-4 [Form of Reverse Side of Right Rights Certificate] FORM OF ASSIGNMENT (To be executed by the registered holder if such holder desires to transfer the Right CertificateRights certificate.) FOR VALUE RECEIVED __________________________________ hereby sells, assigns and transfers unto ___________________ hereby sells, assigns, and transfers unto ______________________________________ ________________________________________________________________________________ (Please print name and address of transferee) ________________________________________________________________________________ this Right Rights Certificate, together with all right, title title, and interest therein, and does hereby irrevocably constitute and appoint _____________________ Attorney , Attorney, to transfer the within Right Rights Certificate on the books of the within-named CorporationCompany, with full power of substitution. Dated: _____Dated ____________, 19__. __________ _________________________________ Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Countersigned. By: -------------------------------- By --------------------------------- Authorized Signature A-3 [Form of Reverse Side of Right Certificate] FORM OF ASSIGNMENT ------------------ (To be executed by the registered holder if such holder desires to transfer the Right CertificateCertificates.) FOR VALUE RECEIVED __________________________________________ hereby sells, assigns and transfers unto _____________________________________________ _______________________________________________________________________________ -------------------------------------------------------------------------------- (Please print name and address of transferee) -------------------------------------------------------------------------------- Rights evidenced by this Right Certificate, together with all right, title and interest therein, and does hereby irrevocably constitute and appoint ________________________ Attorney to transfer the within Right Certificate on the books of the within-named Corporation, with full power of substitution. Dated: _______________ ___, __________ _________________________________ ----------------------------- Signature Signature Guaranteed:

Countersigned. By: -------------------------------- ---------------------------------- Authorized Signature A-3 [48 Form of Reverse Side of Right Certificate] Certificate FORM OF ASSIGNMENT (To be executed by the registered holder if such holder desires to transfer the Right Certificate.) FOR VALUE RECEIVED ___________________RECEIVED, _______________ hereby sells, assigns and transfers unto _____________________________________________ _______________________unto________________________________________________________ (Please print name and address of transferee) ------------------------------------------------------------------------------ this Right Certificate, together with all right, title and interest therein, and does hereby irrevocably constitute and appoint _____________________ Attorney Attorney, to transfer the within Right Certificate on the books of the within-named CorporationCompany, with full power of substitution. Dated: _________________-----------, __________ _________________________________ ---- ------------------------------------ Signature Signature Guaranteed:: 49

Countersigned. as Rights Agent By: -------------------------------- Authorized Signature A-3 ---------------------------- Name: Title: [Form of Reverse Side of Right Rights Certificate] FORM OF ASSIGNMENT ------------------ (To be executed by the registered holder if such holder desires to transfer the Right Rights Certificate.) FOR VALUE RECEIVED _______________________________________________________ hereby sells, assigns and transfers unto _____________________________________________ ________________________________________________________________________________ (Please print name and address of transferee) ________________________________________________________________________________ this Right Rights Certificate, together with all right, title and interest therein, and does hereby irrevocably constitute and appoint _____________________________ Attorney Attorney, to transfer the within Right Rights Certificate on the books of the within-named CorporationCompany, with full power of substitution. Dated: _________________, __________ _________________________________ ------------------------------------------ Signature Signature Guaranteed: Certificate ----------- The undersigned hereby certifies by checking the appropriate boxes that:

Countersigned. [ ] -------------------------- By: -------------------------------- ------------------------------ Authorized Signature A-3 [Form of Reverse Side of Right Rights Certificate] FORM OF ASSIGNMENT (To be executed by the registered holder if such holder desires to transfer the Right Rights Certificate.) FOR VALUE RECEIVED __________________________________________ hereby sells, assigns and transfers unto _____________________________________________ _______________________________________________________________________________ (Please print name and address of transferee) this Right Rights Certificate, together with will all right, title and interest therein, and does hereby irrevocably constitute and appoint ________________________________ Attorney Attorney, to transfer the within Right Rights Certificate on the books of the within-named CorporationCompany, with full power of substitution. Dated: _________________, ____, 19__ ______ _________________________________ Signature Signature Guaranteed:

Countersigned. By: -------------------------------- as Rights Agent By ------------------------ Authorized Signature A-3 [Form of Reverse Side of Right Certificate] Certificate FORM OF ASSIGNMENT (To be executed by the registered holder if such holder desires to transfer the Right Certificate.) FOR VALUE RECEIVED _____________________________________________________________ hereby sells, assigns and transfers unto _____________________________________________ ________________________________________________________________________________ (Please print name and address of transferee) ________________________________________________________________________________ this Right Certificate, together with all right, title and interest therein, and does hereby irrevocably constitute and appoint _____________________ Attorney Attorney, to transfer the within Right Certificate on the books of the within-named CorporationBank, with full power of substitution. Dated: _________________, __________ _________________________________ Signature . --------------- ---- -------------------------------------------------- Signature Guaranteed: Signature Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Countersigned. By[---------------------------------], as Rights Agent ---------------------------------- Authorized Signatory Date of countersignature: -------------------------------- Authorized Signature A-3 [Form of Reverse Side of Right Certificate] FORM OF ASSIGNMENT (To be executed by the registered holder if such holder desires to transfer the Right Certificate.) FOR VALUE RECEIVED __________________________________ hereby sells, assigns and transfers unto _____________________________________________ ___________________________________________(Please print name and address of transferee) ____________________________________ (Please print name and address of transferee) this Right Certificate, together with all right, title and interest therein, and does hereby irrevocably constitute and appoint _____________________ Attorney Attorney, to transfer the within Right Certificate on the books of the within-named CorporationCompany, with full power of substitution. Dated: :_________________, _______,___ _________________________________ Signature Signature Guaranteed:___________

Countersigned. By: -------------------------------- ____________________ Authorized Signature A-3 Officer [Form of Reverse Side of Right Rights Certificate] FORM OF ASSIGNMENT (To be executed by the registered holder if such holder desires to transfer the Right Rights Certificate.) FOR VALUE RECEIVED ________________________________________ hereby sells, assigns and transfers unto _____________________________________________ _______________________________________________________________________________ --------------------------------------------- ------------------------------------------------------------------------- (Please print name and address of transferee) ------------------------------------------------------------------------ this Right Rights Certificate, together with all right, title and interest therein, and does hereby irrevocably constitute and appoint _____________________ Attorney Attorney, to transfer the within Right Rights Certificate on the books of the within-named CorporationCompany, with full power of substitution. Dated: _______________ ___, __________ _________________________________ ----------------------- Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Countersigned. By: -------------------------------- --------------------------- Authorized Signature A-3 [45 Form of Reverse Side of Right Certificate] Certificate FORM OF ASSIGNMENT ------------------ (To be executed by the registered holder if such holder desires to transfer the Right Certificate.) FOR VALUE RECEIVED ___________________RECEIVED, _______________ hereby sells, assigns and transfers unto _____________________________________________ _______________________________________________________________________________ -------------------------------------------------------------------------------- (Please print name and address of transferee) ------------------------------------------------------------------------------- this Right Certificate, together with all right, title and interest therein, and does hereby irrevocably constitute and appoint _____________________ Attorney Attorney, to transfer the within Right Certificate on the books of the within-named CorporationCompany, with full power of substitution. Dated: _________________, __________ _________________________________ -------------------------- Signature Signature Guaranteed: