Dated. Signed: ------------------ ------------------------ (Sign exactly as name appears on the other side of this Security) Signature Guarantee: ----------------------------------------- TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Security for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ------------------ -------------------------------- NOTICE: To be executed by an executive officer OPTION OF HOLDER TO ELECT PURCHASE If you want to elect to have this Security purchased by the Company pursuant to Section 4.15 or Section 4.16 of the Indenture, check the appropriate box:
Appears in 1 contract
Samples: Indenture (Avado Brands Inc)
Dated. Signed: ------------------ ------------------------ ------------------------------- (Sign exactly as name appears on the other side of this Security) Signature Guarantee: ----------------------------------------- TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Security Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ------------------ -------------------------------- ------------------------------- NOTICE: To be executed by an executive officer OPTION OF HOLDER TO ELECT PURCHASE If you want to elect to have this Security Note purchased by the Company pursuant to Section 4.15 or Section 4.16 of the Indenture, check the appropriate box:
Appears in 1 contract
Dated. Signed: ------------------ ------------------------ ---------------------- ----------------------------------- (Sign exactly as name appears on the other side of this Security) Signature Guarantee: ----------------------------------------- ----------------------------------------------------- TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Security for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ------------------ -------------------------------- NOTICE: To be executed by an executive officer OPTION OF HOLDER SECURITYHOLDER TO ELECT PURCHASE If you want to elect to have all or any part of this Security purchased by the Company pursuant to Section 4.15 4.6 or Section 4.16 4.8 of the Indenture, Indenture check the appropriate box:
Appears in 1 contract
Samples: Indenture (H R Window Supply Inc)
Dated. Signed: ------------------ ------------------------ ---------------------------- ------------------------------------- (Sign exactly as your name appears on the other side of this SecurityNote) Signature Guarantee: ----------------------------------------- ----------------------------- TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Security Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ------------------ -------------------------------- ---------------------------- -------------------------------------- NOTICE: To be executed by an executive officer A-10 106 [OPTION OF HOLDER TO ELECT PURCHASE PURCHASE] If you want to elect to have this Security Note purchased by the Company pursuant to Section 4.15 or Section 4.16 of the Indenture, check the appropriate box:
Appears in 1 contract
Samples: Icn Pharmaceuticals Inc
Dated. Signed: ------------------ ------------------------ -------------------- ----------------------------------------- (Sign exactly as name appears on the other side of this SecurityNote) Signature Guarantee: ----------------------------------------- TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Security Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ------------------ -------------------------------- -------------- ---------------------------------------------------- NOTICE: To be executed by an executive officer [OPTION OF HOLDER TO ELECT PURCHASE PURCHASE] If you want to elect to have this Security Note purchased by the Company pursuant to Section 4.15 4.14 or Section 4.16 4.15 of the Indenture, check the appropriate box:
Appears in 1 contract
Samples: Financing and Security Agreement (Kimberton Enterprises Inc)
Dated. Signed: ------------------ ------------------------ --------------------------- --------------------------------- (Sign exactly as name appears on the other side of this Security) Signature Guarantee: ----------------------------------------- ------------------------------------------------- TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Security Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ------------------ -------------------------------- ----------------------- ---------------------------------------- NOTICE: To be executed by an executive officer [OPTION OF HOLDER TO ELECT PURCHASE PURCHASE] If you want to elect to have this Security Note purchased by the Company pursuant to Section 4.15 or Section 4.16 of the Indenture, check the appropriate box:
Appears in 1 contract
Samples: Coinmach Corp
Dated. Signed: ------------------ ------------------------ ------------------- ---------------------------------------------- (Sign exactly as name appears on the other side of this SecurityNote) Signature Guarantee: ----------------------------------------- ------------------------------------------------------------ TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Security Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ------------------ -------------------------------- --------------------- --------------------------------------- NOTICE: To be executed by an executive officer [OPTION OF HOLDER TO ELECT PURCHASE PURCHASE] If you want to elect to have this Security Note purchased by the Company pursuant to Section 4.15 4.14 or Section 4.16 4.15 of the Indenture, check the appropriate box:
Appears in 1 contract
Samples: Indenture (Penhall Co)
Dated. Signed: ------------------ ------------------------ ------------------------- ------------------------------------ (Sign exactly as name appears on the other side of this Security) Signature Guarantee: ----------------------------------------- TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Security Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ------------------ -------------------------------- ------------------------- ------------------------------------ NOTICE: To be executed by an executive officer [OPTION OF HOLDER TO ELECT PURCHASE PURCHASE] If you want to elect to have this Security Note purchased by the Company pursuant to Section 4.15 or Section 4.16 of the Indenture, check the appropriate box:
Appears in 1 contract
Samples: Gaylord Container Corp /De/
Dated. : Signed: ------------------ ------------------------ (Sign exactly as name appears on the other side of this Security) Signature Guarantee: ----------------------------------------- TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Security Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ------------------ -------------------------------- NOTICE: To be executed by an executive officer [OPTION OF HOLDER TO ELECT PURCHASE PURCHASE] If you want to elect to have this Security Note purchased by the Company pursuant to Section 4.15 or Section 4.16 of the Indenture, check the appropriate box:
Appears in 1 contract
Samples: Indenture (Del Monte Foods Co)
Dated. Signed: ------------------ ------------------------ ---------------------------- (Sign exactly as name appears on the other side of this Security) Signature Guarantee: ----------------------------------------- TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Security Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ------------------ -------------------------------- ---------------------------- NOTICE: To be executed by an executive officer [OPTION OF HOLDER TO ELECT PURCHASE PURCHASE] If you want to elect to have this Security Note purchased by the Company pursuant to Section 4.15 or Section 4.16 of the Indenture, check the appropriate box:
Appears in 1 contract
Samples: International Knife & Saw Inc
Dated. Signed: ------------------ ------------------------ -------------------- ------------------------------ (Sign exactly as name appears on the other side of this Security) Signature Guarantee: ----------------------------------------- ------------------------------------------------ TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Security for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ------------------ -------------------------------- -------------------- ------------------------------ NOTICE: To be executed by an executive officer OPTION OF HOLDER TO ELECT PURCHASE If you want to elect to have this Security purchased by the Company pursuant to Section 4.15 or Section 4.16 of the Indenture, check the appropriate box:
Appears in 1 contract
Samples: Building One Services Corp
Dated. Signed: ------------------ ------------------------ (Sign exactly as name appears on the other side of this Security) Signature Guarantee: ----------------------------------------- TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Security Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ------------------ -------------------------------- NOTICE: To be executed by an executive officer 143 [OPTION OF HOLDER TO ELECT PURCHASE PURCHASE] If you want to elect to have this Security Note purchased by the Company pursuant to Section 4.15 or Section 4.16 of the Indenture, check the appropriate box:
Appears in 1 contract
Samples: McMS Inc
Dated. Signed: ------------------ ------------------------ ---------------------------- -------------------------------- (Sign exactly as name appears on the other side of this Security) Signature Guarantee: ----------------------------------------- ---------------------------------------- TO BE COMPLETED BY PURCHASER IF (2( 2 ) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Security Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information informa tion regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's undersigned s foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ------------------ -------------------------------- ----------------------- ---------------------------------------------- NOTICE: To be executed by an executive officer [OPTION OF HOLDER TO ELECT PURCHASE PURCHASE] If you want to elect to have this Security Note purchased by the Company pursuant to Section 4.15 or Section 4.16 of the Indenture, check the appropriate box:
Appears in 1 contract
Samples: Collins & Aikman Floor Coverings Inc
Dated. Signed: ------------------ ------------------------ --------------- -------------------------------------------------- (Sign exactly as name appears on the other side of this SecurityNote) Signature Guarantee: ----------------------------------------- -------------------- TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Security Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company Issuers as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ------------------ -------------------------------- ------------- ---------------------------------------- NOTICE: To be executed by an executive officer OPTION OF HOLDER TO ELECT PURCHASE If you want EXHIBIT C Form of Certificate To Be Delivered in Connection with Transfers to elect to have this Security purchased by the Company pursuant to Section 4.15 or Section 4.16 of the Indenture, check the appropriate boxNon-QIB Accredited Investors Ladies and Gentlemen:
Appears in 1 contract
Samples: Supplemental Indenture (Canadian Abraxas Petroleum LTD)
Dated. Signed: ------------------ ------------------------ ---------------------- ------------------------------ (Sign exactly as name appears on the other side of this SecurityNote) Signature Guarantee: ----------------------------------------- ----------------------------------------------------- TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Security Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. DatedDate: ------------------ -------------------------------- ------------------------- ------------------------------------- NOTICE: To be executed by an executive officer OPTION OF HOLDER TO ELECT PURCHASE If you want to elect to have this Security Note purchased by the Company pursuant to Section 4.15 4.14 or Section 4.16 4.15 of the this Indenture, check the appropriate box:
Appears in 1 contract
Samples: Cambridge Industries Inc /De
Dated. Signed: ------------------ ------------------------ (Sign exactly as name appears on the other side of this SecurityNote) Signature Guarantee: ----------------------------------------- TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Security Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "“qualified institutional buyer" ” within the meaning of Rule 144A under the Securities Act and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company Issuer as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's ’s foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ------------------ -------------------------------- NOTICE: To be executed by an executive officer OPTION OF HOLDER TO ELECT PURCHASE If you want to elect to have this Security Note purchased by the Company Issuer pursuant to Section 4.15 4.09 or Section 4.16 4.13 of the Indenture, check the appropriate box:
Appears in 1 contract
Samples: PGT Innovations, Inc.
Dated. Signed: ------------------ ------------------------ ------------------------------------ (Sign exactly as name appears on the other side of this Security) Signature Guarantee: ----------------------------------------- ------------------------------------------------------------ TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Security for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ------------------ -------------------------------- ----------------------------- ----------------------------------------- NOTICE: To be executed by an executive officer OPTION OF HOLDER TO ELECT PURCHASE If you want to elect to have this Security purchased by the Company pursuant to Section 4.15 4.12 or Section 4.16 4.13 of the Indenture, check the appropriate box:
Appears in 1 contract
Samples: Bway Corp
Dated. Signed: ------------------ ------------------------ ------------------------- ---------------------------- (Sign exactly as your name appears on the other side of this SecurityNote) Signature Guarantee: ----------------------------------------- -------------------------- TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Security Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ------------------ -------------------------------- ______________________ _______________________________________________ NOTICE: To be executed by an executive officer [OPTION OF HOLDER TO ELECT PURCHASE PURCHASE] If you want to elect to have this Security Note purchased by the Company pursuant to Section 4.15 or 4.15, Section 4.16 or 4.23 of the Indenture, check the appropriate box:
Appears in 1 contract
Samples: Article Twelve Agreement (Golfsmith International Holdings Inc)
Dated. Signed: ------------------ ------------------------ (Sign exactly as name appears on the other side of this Security) Signature Guarantee: ----------------------------------------- TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Security Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ------------------ -------------------------------- NOTICE: To be executed by an executive officer 129 [OPTION OF HOLDER TO ELECT PURCHASE PURCHASE] If you want to elect to have this Security Note purchased by the Company pursuant to Section 4.15 or Section 4.16 of the Indenture, check the appropriate box:
Appears in 1 contract
Samples: McMS Inc
Dated. Signed: ------------------ ------------------------ -------------------------------- ---------------------------------- (Sign exactly as name appears on the other side of this SecurityNote) Signature Guarantee: ----------------------------------------- ------------------------------------------------------------ TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Security Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ------------------ -------------------------------- ---------------------------- ----------------------------------------- NOTICE: To be executed by an executive officer OPTION OF HOLDER TO ELECT PURCHASE If you want to elect to have this Security Note purchased by the Company pursuant to Section 4.15 4.13 or Section 4.16 4.14 of the Indenture, check the appropriate box:
Appears in 1 contract
Samples: Covenants (Railworks Corp)