Common use of Date of Conversion Clause in Contracts

Date of Conversion. Conversion Price: _____________________________________________________ Shares To Be Delivered: _____________________________________________________ Signature: _____________________________________________________ Print Name: _____________________________________________________ Address: _____________________________________________________ Holder DWAC instructions _____________________________________________________

Date of Conversion. Conversion Price: _____________________________________________________ -------------------------------------------------------- Shares To Be Delivered: _____________________________________________________ -------------------------------------------------------- Signature: _____________________________________________________ -------------------------------------------------------- Print Name: _____________________________________________________ -------------------------------------------------------- Address: _____________________________________________________ -------------------------------------------------------- -------------------------------------------------------- Holder DWAC instructions _____________________________________________________--------------------------------------------------------

Date of Conversion. Conversion Price: _____________________________________________________ --------------------------------------------------- Shares To Be Delivered: _____________________________________________________ --------------------------------------------------- Signature: _____________________________________________________ --------------------------------------------------- Print Name: _____________________________________________________ --------------------------------------------------- Address: _____________________________________________________ --------------------------------------------------- Holder DWAC instructions _____________________________________________________---------------------------------------------------

Date of Conversion. Conversion Price: _____________________________________________________ Shares To Be Delivered: _____________________________________________________ Signature: _____________________________________________________ Print Name: _____________________________________________________ Address: _____________________________________________________ Holder DWAC instructions _____________________________________________________

Date of Conversion. Conversion Price: _____________________________________________________ ------------------------------------------------------ Shares To Be Delivered: _____________________________________________________ ------------------------------------------------------ Signature: _____________________________________________________ ------------------------------------------------------ Print Name: _____________________________________________________ ------------------------------------------------------ Address: _____________________________________________________ ------------------------------------------------------ ------------------------------------------------------ Holder DWAC instructions _____________________________________________________------------------------------------------------------

Date of Conversion. Conversion Price: _____________________________________________________ --------------------------------------------------- Shares To Be Delivered: _____________________________________________________ --------------------------------------------------- Signature: _____________________________________________________ --------------------------------------------------- Print Name: _____________________________________________________ --------------------------------------------------- Address: _____________________________________________________ --------------------------------------------------- --------------------------------------------------- --------------------------------------------------- Holder DWAC instructions _____________________________________________________---------------------------------------------------