Dxxxxxx Xxxxxxxx. E. Dxxxxxx Xxxxxxxx, President Attest: /s/ Rxxxx Xxxxxx ----------------------------- Rxxxx Xxxxxx, Secretary Dated: July 3, 2000 ----------------------------------- PURCHASE FORM ------------------------ ------------------------ ------------------------ The undersigned hereby irrevocably elects to exercise the right of purchase represented by the within Option for, and to purchase thereunder, _____ shares of Common Stock (the "Shares") provided for therein, and requests that certificates for the Shares be issued in the name of: (Please Print Name, Address and Social Security Number) _____________ ______________________________________________________________________________ _____________________________________________________________ and, if said number of Shares shall not be all the Shares purchasable hereunder, that a new Option certificate for the balance of the Shares purchasable under the within Option certificate be registered in the name of the undersigned Optionholder or his Assignee as below indicated and delivered to the address stated below: Dated:____________________, 20__ Name of Optionholder: (Please Print) Address:_____________________________________________________ Signature:___________________________________________________
Appears in 3 contracts
Samples: Option Agreement (Powersource Corp), Option Agreement (Powersource Corp), Option Agreement (Powersource Corp)
Dxxxxxx Xxxxxxxx. E. Dxxxxxx Xxxxxxxx, President Attest: /s/ Rxxxx Xxxxxx ----------------------------- Rxxxx Xxxxxx, -------------------------- Secretary Dated: July 3, 2000 ----------------------------------- PURCHASE FORM ------------------------ ------------------------ ------------------------ The undersigned hereby irrevocably elects to exercise the right of purchase represented by the within Option for, and to purchase thereunder, _____ shares of Common Stock (the "Shares") provided for therein, and requests that certificates for the Shares be issued in the name of: (Please Print Name, Address and Social Security Number) _____________ ______________________________________________________________________________ _____________________________________________________________ and, if said number of Shares shall not be all the Shares purchasable hereunder, that a new Option certificate for the balance of the Shares purchasable under the within Option certificate be registered in the name of the undersigned Optionholder or his Assignee as below indicated and delivered to the address stated below: Dated:____________________, 20__ Name of Optionholder: (Please Print) Address:_____________________________________________________ Signature:___________________________________________________
Appears in 1 contract
Samples: Option Agreement (Powersource Corp)
Dxxxxxx Xxxxxxxx. E. Dxxxxxx Xxxxxxxx, President Attest: /s/ Rxxxx Xxxxxx ----------------------------- --------------------------- Rxxxx Xxxxxx, Secretary Dated: July 3, 2000 ----------------------------------- PURCHASE FORM ------------------------ ------------------------ ------------------------ The undersigned hereby irrevocably elects to exercise the right of purchase represented by the within Option for, and to purchase thereunder, _____ shares of Common Stock (the "Shares") provided for therein, and requests that certificates for the Shares be issued in the name of: (Please Print Name, Address and Social Security Number) _____________ ______________________________________________________________________________ _____________________________________________________________ and, if said number of Shares shall not be all the Shares purchasable hereunder, that a new Option certificate for the balance of the Shares purchasable under the within Option certificate be registered in the name of the undersigned Optionholder or his Assignee as below indicated and delivered to the address stated below: Dated:____________________, 20__ Name of Optionholder: (Please Print) Address:_____________________________________________________ Signature:___________________________________________________
Appears in 1 contract
Samples: Option Agreement (Powersource Corp)