Facsimile or Digital Signature. This Warrant may be executed by facsimile or digital signature. EXECUTED as of the Date of Issuance indicated above. XXXX ENERGY, INC. By: ______________________________________ Xxxx Xxxxxx President EXHIBIT A PURCHASE FORM To: Xxxx Energy, Inc. Dated: _________________________ 0000 00xx Xxxxxx XX Pipestone, MN 56164 The undersigned, pursuant to the provisions set forth in the attached Warrant (No. [ ]), hereby exercises the Warrant and elects to: [check one box] ☐ Purchase __________ Shares of Company Common Stock (the “Shares”) pursuant to the Warrant. This notice is accompanied by full payment of the Exercise Price in cash or by check or in another manner permitted by the Warrant Agreement ☐ Surrender the rights to purchase __________ Shares upon exercise of the Warrant and receive __________ Shares by reason of a “cashless” exercise pursuant to the Agreement if permitted by the Board. [THIS METHOD OF EXERCISE IS AVAILABLE ONLY WITH ADVANCE BOARD APPROVAL]. Address: EXHIBIT B ASSIGNMENT FORM To: Xxxx Energy, Inc. Dated: _________________________ 0000 00xx Xxxxxx XX Pipestone, MN 56164 FOR VALUE RECEIVED, the Holder hereby sells, assigns and transfers all of the rights of the undersigned under the attached Warrant (No. [ ]) with respect to the number of shares of Common Stock of Xxxx Energy, Inc. covered thereby set forth below unto: Name of Assignee: Address of Assignee: Number of Shares: Address: Signature Guaranteed: By:
Facsimile or Digital Signature. This Warrant may be executed by facsimile or digital signature. EXECUTED as of the Date of Issuance indicated above. XXXX WIND, INC. By: ______________________________________ Xxxx Xxxxxx President EXHIBIT A PURCHASE FORM To: Xxxx Wind, Inc. Dated: _________________________ 000 000xx Xxxxxx Xxxxxxxxx, XX 00000 The undersigned, pursuant to the provisions set forth in the attached Warrant (No. _____), hereby elects to purchase ________ shares of the Common Stock of Xxxx Wind, Inc. covered by such Warrant. The undersigned herewith makes payment of the full purchase price for such shares at the price per share provided for in such Warrant in the amount of $1.25 per share. By: ______________________________________ Its: ______________________________________ Address: ___________________________________ __________________________________ EXHIBIT B ASSIGNMENT FORM (Entity Owner) To: Xxxx Wind, Inc. Dated: _________________________ 000 000xx Xxxxxx Xxxxxxxxx, XX 00000 FOR VALUE RECEIVED, ________________________________ hereby sells, assigns and transfers all of the rights of the undersigned under the attached Warrant (No. _____) with respect to the number of shares of Common Stock of Xxxx Wind, Inc. covered thereby set forth below unto: Name of Assignee: _____________________________________ Address of Assignee: ___________________________________ ___________________________________ Number of Shares: ____________________ By: ______________________________________ Its: ______________________________________ Address: ___________________________________ __________________________________ Signature Guaranteed: By: _______________________________________
