FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Certificate.) To: CD Radio Inc. The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Certificate to purchase the Series B Shares (or fractions thereof) issuable upon the exercise of such Rights (or such other securities of the Company or of any other entity that may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying number: ___________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 2 contracts
Samples: Rights Agreement (Cd Radio Inc), Rights Agreement (Cd Radio Inc)
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. SCIENTIFIC-ATLANTA, INC. The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: ------------------------------------------------------------ (Please print name and address) ------------------------------------------------------------ Please insert social security or other identifying number: ___________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ------------------------------- If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: ------------------------------------------------------------ (Please print name and address) ----------------------------------------------------------- Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ number:-------------------------------- ------------------------------------------------------------ Dated: __________________------------------, 19__ _________________________ -- ---------------------------------- Signature Signature Guaranteed: CERTIFICATE Guaranteed:-------------------------- Certificate The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 2 contracts
Samples: Rights Agreement (Scientific Atlanta Inc), Rights Agreement (Scientific Atlanta Inc)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. BETZDEARBORN INC. The undersigned hereby irrevocably elects to exercise __________ Rights represented by this Right Rights Certificate to purchase the Series B Common Shares (or fractions thereof) issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity person that may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Please insert social security or other identifying number: ___________________________________ ___________________________________________________________________ number -------------------------------------------------------------------------------- (Please print name and address) ___________________________________________________________________ -------------------------------------------------------------------------------- If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ number -------------------------------------------------------------------------------- (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- Dated: __________________, 19__ _________________________ ----------- ------ ------------------------------------ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 2 contracts
Samples: Rights Agreement (Betzdearborn Inc), Rights Agreement (Betzdearborn Inc)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Certificate.) To: CD Radio Inc. OMEGA WORLDWIDE, INC. The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Certificate to purchase the Series B Preferred Shares (or fractions thereof) issuable upon the exercise of such the Rights (or such other securities of the Company Corporation or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying number: ___________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) _______________:____________________________________________________ ________________________________________________________________________________ Dated(Please print name and address) If such number of Rights shall not be all the Rights represented by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number:____________________________________________________ ________________________________________________________________________________ (Please print name and address) Date:______________ , 19__ ______________________________ Signature Signature Guaranteed: CERTIFICATE Certificate The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 2 contracts
Samples: Rights Agreement (Omega Worldwide Inc), Omega Worldwide Inc
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. INTERNET CAPITAL GROUP, INC. The undersigned hereby irrevocably elects to exercise __________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Please insert social security or other identifying number: ___________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ (Please print social security or other identifying number) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) __________________________________________________ (Please print social security or other identifying number) Dated:_______________, _____ __________________________________________ Signature Signature Guaranteed:__________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 2 contracts
Samples: Rights Agreement (Internet Capital Group Inc), Rights Agreement (Internet Capital Group Inc)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. The undersigned hereby irrevocably elects to exercise To _________ ______: The undersigned hereby irrevocably elects to exercise Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Please insert social security or other identifying number: ________________________ ____________ ___________________________________________________________________ (Please print name and address) __________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: ________________________ ______________ ___________________________________________________________________ (Please print name and address) __________________________________________________________________________ Dated: _________, 20____ ___________________________________________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 2 contracts
Samples: Rights Agreement (Forgent Networks Inc), Rights Agreement (Forgent Networks Inc)
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) ToTo CBL & Associates Properties, Inc.: CD Radio Inc. The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying numberof and delivered to: ___________________________________ ___________________________________________________________________ (Please print name and address) address ________________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: __________________ If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: ____________________ ___________________________________________________________________ (Please print name and address) address ________________________________________________________________________________ Please insert social security or other identifying number: Dated: _________, _____________________________ ______________________________ Dated: __________________, 19__ _________________________ Signature [Signature] Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 2 contracts
Samples: Rights Agreement (CBL & Associates Properties Inc), Rights Agreement (CBL & Associates Properties Inc)
FORM OF ELECTION TO PURCHASE. (To be executed by the registered holder if such holder desires to exercise the Rights represented evidenced by the Right this Rights Certificate.) To: CD Radio Inc. MIM CORPORATION The undersigned hereby irrevocably elects to exercise ________________ Rights represented evidenced by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) Units issuable upon the exercise of such the Rights (or such other securities securities, cash or property of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares Units (or such other securities which may be issuable upon the exercise of the Rights) be issued in the name ofof and delivered to: Please insert social security or other identifying number: ___________________________________ ___________________________________________________________________ (Please print name and addressname) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ Dated(Please print address) If such number of Rights shall not be all of the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: __________________, 19______________ __________________________________________________ (Please print name) __________________________________________________ __________________________________________________ (Please print address) Dated: ______________________________________, Signature: _______________________________________ (Sign exactly as your name appears on the other side of this Rights Certificate) Signature Signature GuaranteedGuarantee: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:_____________________________
Appears in 2 contracts
Samples: Rights Agreement (Mim Corp), Rights Agreement (Mim Corp)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. XXXXXX GREETINGS, INC. The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Certificate to purchase the Series B Shares (or fractions thereof) issuable upon the exercise of such Rights (or such other securities of the Company or of any other entity that may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying number: ___________________________________ ___Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of and delivered to: Please insert social security or other identifying number ________________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ __number _________________________________________________________________ (Please print name and address) Dated:_______________________________________________________________, ____ _________________________________________________________ Signature Signature Guaranteed: Certificate ___________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 2 contracts
Samples: Rights Agreement (Gibson Greetings Inc), Rights Agreement (Gibson Greetings Inc)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) ToTO: CD Radio Inc. VERADIGM INC. The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares (or other securities) be issued in the name ofof and delivered to: Please insert social security or other identifying number: ___________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 2 contracts
Samples: Rights Agreement (Veradigm Inc.), Rights Agreement (Veradigm Inc.)
FORM OF ELECTION TO PURCHASE. (To be executed by the registered holder if such holder desires to exercise the Rights represented evidenced by the Right this Rights Certificate.) To: CD Radio Inc. THE BISYS GROUP, INC. The undersigned hereby irrevocably elects to exercise ________________ Rights represented evidenced by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Company Common Stock issuable upon the exercise of such the Rights (or such other securities securities, cash or property of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares Company Common Stock (or such other securities which may be issuable upon the exercise of the Rights) be issued in the name ofof and delivered to: Please insert social security or other identifying number: ___________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and addressname) _______________________________________________________________________________ _______________________________________________________________________________ Dated(Please print address) If such number of Rights shall not be all of the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: __________________, 19________ _______________________________________________________________________________ (Please print name) _______________________________________________________________________________ _______________________________________________________________________________ (Please print address) Dated: ___________________, _______ Signature: ____________________________ (Sign exactly as your name appears on the other side of this Rights Certificate) Signature Signature GuaranteedGuarantee: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:___________________
Appears in 2 contracts
Samples: Rights Agreement (Bisys Group Inc), Rights Agreement (Bisys Group Inc)
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. -------------------------------------------------- The undersigned hereby irrevocably elects to exercise _________ ------------ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Common Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: ---------------------------------------------------------------- (Please print name and address) ---------------------------------------------------------------- Please insert social security or other identifying number: ___________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ----------------------------------- If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: ---------------------------------------------------------------- (Please print name and address) ---------------------------------------------------------------- Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ ----------------------------------- ---------------------------------------------------------------- Dated: __________________, 19__ _________________________ 19 ---------------- -- ------------------------------ Signature Signature Guaranteed: CERTIFICATE Certificate ----------- The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 2 contracts
Samples: Rights Agreement (Cordis Corp), Rights Agreement (Cordis Corp)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Certificate.) ToTo The Sherxxx-Xxxxxxxx Xxxpany: CD Radio Inc. The undersigned hereby irrevocably elects to exercise ________________ Rights represented by this Right Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying number: _____________________________________________ _______________________________________________________________________ (Please print name and address) _______________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________________ _______________________________________________________________________ (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ Dated: _:_________________, 19__ _________________________ ----------------------------------- Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 2 contracts
Samples: Rights Agreement (Sherwin Williams Co), Rights Agreement (Sherwin Williams Co)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right CertificateTO BE EXECUTED IF HOLDER DESIRES TO EXERCISE THE RIGHT CERTIFICATE.) ToTo FAIRMARKET, INC.: CD Radio Inc. The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying taxpayer number: ___________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ________________________________________________________________________________ Dated(Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Certificate or if the Rights are being exercised pursuant to Section 11(a)(ii) of the Rights Agreement, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying taxpayer number: ____________ __________________, 19______________________________________________________________ ________________________________________________________________________________ (Please print name and address) Dated: _________, __ __________________________________ __________________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:______________________________
Appears in 2 contracts
Samples: Shareholder Rights Agreement (Fairmarket Inc), Shareholder Rights Agreement (Fairmarket Inc)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. INSTINET GROUP INCORPORATED The undersigned hereby irrevocably elects to exercise __________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Please insert social security or other identifying number: number _______________________________________________________________________________ (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number _______________________________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ Dated: _______________, ___, 19__ ______________________________ Signature Signature Guaranteed: CERTIFICATE Certificate The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 2 contracts
Samples: Rights Agreement (Instinet Group Inc), Rights Agreement (Instinet Group LLC)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. State Street Bank and Trust Company The undersigned hereby irrevocably elects to exercise ___________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Common Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Please insert social security or other identifying number: number __________________________________________________ ___________________________________________________________________________ (Please print name and address) ___________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number __________________________________________________ ___________________________________________________________________________ (Please print name and address) ___________________________________________________________________________ Dated: ______________ ___________________________________________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE Reverse Side of Rights Certificate Certificate The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 2 contracts
Samples: Rights Agreement (Lifeline Systems Inc), Rights Agreement (Lifeline Systems Inc)
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented evidenced by the Right Rights Certificate.) To: CD Radio Inc. BURLINGTON INDUSTRIES, INC. The undersigned hereby irrevocably elects to exercise _________ Rights represented evidenced by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) Units of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity person or other property that may be issuable upon the exercise of the Rights) and requests that certificates for such shares Units be issued in the name ofof and delivered to: Please insert social security or other identifying number: ___________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ _______If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: ____________________________________________________________ (Please print name and address) ___________________________________________________________________ _____________________________________Please insert social security or other identifying number: ______________________________ Dated: __________________, 19__ _________________________ 199 /200 ---------------------- Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 2 contracts
Samples: Rights Agreement (Burlington Industries Inc /De/), Rights Agreement (Burlington Industries Inc /De/)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. INTERPHASE CORPORATION The undersigned hereby irrevocably elects to exercise ____________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Common Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Please insert social security or other identifying number: ___________________________________ ___________________________________________________________________ number ---------------------------- -------------------------------------------------------------------------------- (Please print name and address) ___________________________________________________________________ -------------------------------------------------------------------------------- If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ number ---------------------------- -------------------------------------------------------------------------------- (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- Dated: __________________, 19__ _________________________ --------------------- ----- ----------------------------------------- Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 2 contracts
Samples: Rights Agreement (Interphase Corp), Rights Agreement (Interphase Corp)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Certificate.) ToTo Owens Corning: CD Radio Inc. The undersigned hereby irrevocably herexx xxrevocably elects to exercise _________ Rights represented by this Right Certificate to purchase the Series B Shares (or fractions thereof) issuable upon the exercise of such Rights (or such other securities of the Company or of any other entity that may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying number: ____________________exer cise _______________ _________Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number __________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced evi denced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ _________number __________________________________________________________ (Please print name and address) ___________________________________________________________________ Dated:__________________, ________________________ [Form of Election to Purchase -- continued] __________________________ Dated: __________________, 19__ _________________________ Signature (Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking must conform in all respects to name of holder as specified on the appropriate boxes that:face of this Right Certificate.)
Appears in 2 contracts
Samples: Rights Agreement (Owens Corning), Rights Agreement (Owens Corning)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. INTEGRATED DEFENSE TECHNOLOGIES, INC. The undersigned hereby irrevocably elects to exercise __________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: ------------------------------------------------- ------------------------------------------------- ------------------------------------------------- (Please print name and address) ------------------------------------------------- (Please insert social security or other identifying number: ___________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: ------------------------------------------------- ------------------------------------------------- ------------------------------------------------- (Please print name and address) ------------------------------------------------- (Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ Dated: __________________, 19__ _________________________ ------------------------------ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 2 contracts
Samples: Rights Agreement (Integrated Defense Technologies Inc), Rights Agreement (Integrated Defense Technologies Inc)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. NEOSE TECHNOLOGIES, INC.: The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Rights Certificate to purchase the Series B Preferred Shares (or fractions thereof) issuable upon the exercise of such the Rights (or Common Shares or such other securities of the Company or of any other entity person that may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Please insert social security or other identifying number: number ___________________________________ ___________________________________________________________________ (Please print name and address) _______________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number _____________________________________ ___________________________________________________________________ (Please print name and address) _______________________________________________________________________________ _______________________________________________________________________________ Dated: __________________, 19__ _________________________ 19 -------------- --- -------------------------- Signature Signature Guaranteed: CERTIFICATE Certificate The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 2 contracts
Samples: Rights Agreement (Neose Technologies Inc), Rights Agreement (Neose Technologies Inc)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Certificate.) To: CD Radio Inc. Xxxx-Xxxxx Company: The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Certificate to purchase the Series B Shares (or fractions thereof) issuable upon the exercise of such Rights (or such other securities of the Company or of any other entity that may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying number: ___________________________________ Rights represented by this Right Certificate to purchase the shares of Common Stock issuable upon the exercise of such Rights (or such other securities of the Company or of any other Person which may be issuable upon the exercise of the Rights), and requests that certificates for such shares (or other securities) be issued in the name of: _____________________________________________________________________________ (Please print name and address) ____________________Please insert social security or other identifying number: _______________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________Please insert social security or other identifying number: ________________________________________________ ___________________________________________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies certifies, by checking marking the appropriate boxes boxes, that:
Appears in 2 contracts
Samples: Stockholder Rights Agreement (Nash Finch Co), Stockholder Rights Agreement (Nash Finch Co)
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Certificate.) To: CD Radio Inc. Masco Corporation The undersigned hereby irrevocably elects to exercise ____________ Rights represented by this Right Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares securities be issued in the name ofof and delivered to: Please insert social security or other identifying number: number __________________________________________________________ (Please print name and address) ___________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ___________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ Dated: __________________, 19__ ___________________________ Signature Signature Guaranteed: CERTIFICATE Certificate The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 2 contracts
Samples: Rights Agreement (Masco Corp /De/), Rights Agreement (Masco Corp /De/)
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. AMSURG CORP. The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Certificate to purchase the Series B Shares (or fractions thereof) issuable upon the exercise of such Rights (or such other securities of the Company or of any other entity that may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying number: ___________________________________ ___________________________________________________________________ Rights represented by this Rights Certificate to purchase the Units of Preferred Stock, issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such Units be issued in the name of and delivered to: -------------------------------------------------------------------------------- (Please print name and address) ___________________________________________________________________ -------------------------------------------------------------------------------- Please insert social security or other identifying number: ---------------------- If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: -------------------------------------------------------------------------------- (Please print name and address) -------------------------------------------------------------------------------- Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ ---------------------- Dated: __________________, 19__ _________________________ -------------------------- ------------------------------------------- Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 2 contracts
Samples: Rights Agreement (Amsurg Corp), Rights Agreement (Amsurg Corp)
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) ToTO: CD Radio Inc. ONEIDA LTD. The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) Units of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that Person or other property which may be issuable upon the exercise of the Rights) and requests that certificates for such shares Units be issued in the name of: Please insert social security or other identifying numberof and delivered to: ___________________________________ ___________________________________________________________________ (Please print name and address) _______________________________________________________________________________ Please insert social security or other identifying number: If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes thatPlease insert social security or other identifying number:
Appears in 2 contracts
Samples: Rights Agreement (Oneida LTD), Rights Agreement (Oneida LTD)
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Certificate.) To: CD Radio Inc. Adobe Systems Incorporated The undersigned hereby irrevocably elects to exercise ________________ Rights represented by this Right Certificate to purchase the Series B Shares (or fractions thereof) Units of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person or other property which may be issuable upon the exercise of the Rights) and requests that certificates for such shares Units be issued in the name ofof and delivered to: Please insert social security or other identifying number: ___________________________________ ___________________________________________________________________ (Please print name and address) _______________________________________________________ Please insert social security or other identifying number: _____________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ____________________________________________ Please insert social security or other identifying number: _____________ Dated: _________________ ____, _______ ___________________________________________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 2 contracts
Samples: Rights Agreement (Adobe Systems Inc), Rights Agreement (Adobe Systems Inc)
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. WINSTAR COMMUNICATIONS, INC. The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) Units of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person or other property which may be issuable upon the exercise of the Rights) and requests that certificates for such shares Units be issued in the name ofof and delivered to: Please insert social security or other identifying number: ___________________________________ ___________________________________________________________________ (Please print name and address) ____________________________________________________ Please insert social security or other identifying number: ________________ If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) _____________________________________________ Please insert social security or other identifying number: ________________ Dated: _________ __, ____ ___________________________________________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 2 contracts
Samples: Rights Agreement (Winstar Communications Inc), Rights Agreement (Winstar Communications Inc)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Certificate.) ToTo ANDOVER BANCORP, INC.: CD Radio Inc. The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying taxpayer number: __________________ __________________ ___________________________________________________________________ (Please print name and address) ________________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: ________________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate or if the Rights are being exercised pursuant to Section 11(a)(ii) of the Rights Agreement, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying taxpayer number: _____________________ ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ ________________________________________________________________________________ Dated: _________, __ _________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:____________________
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. MARITRANS INC.: The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Rights Certificate to purchase the Series B Preferred Shares (or fractions thereof) issuable upon the exercise of such the Rights (or Common Shares or such other securities of the Company or of any other entity person that may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Please insert social security or other identifying number: number ___________________________________ ___________________________________________________________________ (Please print name and address) ________________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number _____________________________________ ___________________________________________________________________ (Please print name and address) ________________________________________________________________________________ ________________________________________________________________________________ Dated: _____________, 20__ _____, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. Optical Sensors Incorporated The undersigned irrevocably hereby irrevocably elects to exercise ___________ Rights represented by this Right Rights Certificate to purchase the Series B Preferred Shares (or fractions thereof) issuable upon the exercise of such the Rights (or Common Shares or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Please insert social security or other identifying number: ___________________________________ ___________________________________________________________________ number -------------------------------------------------- ------------------------------------------------------------------------------- (Please print name and address) ___________________________________________________________________ ------------------------------------------------------------------------------- If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ number -------------------------------------------------- ------------------------------------------------------------------------------- (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ ------------------------------------------------------------------------------- Dated: __________________, 19__ _________________________ ----------------------------------------- ----------------------- Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. R&B FALCON CORPORATION: The undersigned hereby irrevocably elects to exercise __________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Please insert social security or other identifying number: ___________________________________ _______number ____________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ _______number ____________________________________________________________ (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ Dated: _______________, ___, 19_ __ __________________________ Signature Signature Guaranteed: CERTIFICATE Certificate The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
Samples: Rights Agreement (R&b Falcon Corp)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Certificate.) ToTo Xxxxxx International Industries, Incorporated: CD Radio Inc. The undersigned hereby irrevocably elects to exercise __________ Rights represented by this Right Certificate to purchase the Series B Shares (one one-hundredths of a Preferred Share or fractions thereof) other securities issuable upon the exercise of such Rights (or such other securities of the Company or of any other entity that may be issuable upon the exercise of the Rights) and requests that certificates for such shares securities be issued in the name of: Please insert social security or other identifying number: ___________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and addressaddress of transferee) _________________________________________________________________ If such number of Rights is not all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights will be registered in the name of and delivered to: Please insert social security or other identifying number: _______________________________________________________________ ___________________________________________________________________ Dated: (Please print name and address of transferee) __________________, 19_____________________________________________ Dated: __________, ____ _____________________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
Samples: Rights Agreement (Harman International Industries Inc /De/)
FORM OF ELECTION TO PURCHASE. (To be executed if the register holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. FROZEN FOOD EXPRESS INDUSTRIES, INC. The undersigned hereby irrevocably elects to exercise ________________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Common Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that Person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Please insert social security or other identifying number: ___________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ __If such number of Rights shall not be all the rights evidence by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: _________________________________________________________________ (Please print name and address) _________________________________________________________________ Please insert social security or other identifying number:_____________________________________ Dated: ______________, _______ ____________________________________ Signature Signature Guaranteed: ___________________________________________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE Certificate The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
Samples: Rights Agreement (Frozen Food Express Industries Inc)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) ToTO: CD Radio Inc. WMS HOTEL CORPORATION The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company WMS Hotel Corporation or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Please insert social security or other identifying number: number ___________________________________ ___________________________________________________________________ (Please print name and address) ________________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number _____________________________________ ___________________________________________________________________ (Please print name and address) ________________________________________________________________________________ Dated:_______________________, ____ ___________________________________________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
Samples: Rights Agreement (WMS Hotel Corp)
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Certificate.) To: CD Radio Sun Company, Inc. The undersigned hereby irrevocably elects to exercise ____________ Rights represented by this Right Certificate to purchase the shares of Series B Shares (or fractions thereof) Preference Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares securities be issued in the name ofof and delivered to: Please insert social security or other identifying number: number __________________________________________________________ (Please print name and address) ___________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ___________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ Dated: __________________, 19__ ___________________________ Signature Signature Guaranteed: CERTIFICATE Certificate The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
Samples: Rights Agreement (Sun Co Inc)
FORM OF ELECTION TO PURCHASE. (To be executed by the registered holder if such holder desires to exercise Rights represented by the Right this Rights Certificate.) ToTO: CD Radio Inc. ST. FRANXXX XXXITAL CORPORATION The undersigned hereby irrevocably elects to exercise __________ Rights represented by this Right Rights Certificate to purchase the Series B Preferred Shares (or fractions thereofother securities, cash or property) issuable upon the exercise of such Rights (or such other securities of the Company or of any other entity that may be issuable upon the exercise of the Rights) and requests that certificates for such shares Preferred Shares be issued in the name of: Please insert social security or other identifying number: ___________________________________ ___________________________________________________________________ (Please print name and address) : ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ______________________________________ ______________________________ (Please print name and address) ___________________________________________________________________ ______________________________________________________________________________ DatedPlease insert social security, taxpayer identification or other identifying number: ______________________________________ If such number of Rights shall not be all the Rights represented by this Rights Certificate, 19a new Rights Certificate for the remaining unexercised Rights shall be registered in the name of and delivered to: Please print name and address: ______________________________________ ______________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Please insert social security, taxpayer identification or other identifying number: ______________________________________ Dated: __________________ , ____ ______________________________________ Signature Signatures must be guaranteed by an Eligible Guarantor Institution, as defined in Rule 17Ad-15 promulgated under the Securities Exchange Act of 1934, as amended. Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:___________________________________________________________
Appears in 1 contract
Samples: Shareholder Rights Agreement (St Francis Capital Corp)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. TREDEGAR CORPORATION: The undersigned hereby irrevocably elects to exercise ____________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity person that may be issuable upon the exercise of the Rights) and requests that certificates for such shares (or other securities) be issued in the name ofof and delivered to: Please insert social security or other identifying number: number ___________________________________ ___________________________________________________________________ (Please print name and address) _______________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number _____________________________________ ___________________________________________________________________ (Please print name and address) _______________________________________________________________________ Date: _______________, ____ ___________________________________________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE Certificate The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
Samples: Rights Agreement (Tredegar Corp)
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. INTEGRATED TECHNOLOGY USA, INC. The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Common Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: ________________________________________________________________________________ (Please print name and address) Please insert social security or other identifying number: ___________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: ________________________________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ________________insert social security or other identifying number: ___________________________________________________ Dated: __________________, 19__ ______________________________ Signature Signature Guaranteed: CERTIFICATE ______________________________ Signature must be guaranteed by an Eligible Guarantor Institution as defined by SEC Rule 17Ad-15 (17 C.F.R. 240.17-Ad-15). Certificate The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. AEROCENTURY CORP. The undersigned hereby irrevocably elects to exercise ________________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) Units of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person or other property which may be issuable upon the exercise of the Rights) and requests that certificates for such shares Units be issued in the name of: Please insert social security or other identifying number: ___________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ____________________:_______________________________________________ ________________________________________________________________________ Dated: (Please print name and address) __________________, 19__ _________________________ (Please insert social security or other identifying number). If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to:_____________________ (Please print name and address) ______________________________________________ (Please insert social security or other identifying number). Dated ---------------- -------------------------------- Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
Samples: Rights Agreement (Aerocentury Corp)
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Global TeleSystems Group, Inc. The undersigned hereby irrevocably elects to exercise ____________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) Units of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person or other property which may be issuable upon the exercise of the Rights) and requests that certificates for such shares Units be issued in the name ofof and delivered to: ____________________________________________________________ (Please print name and address) ____________________________________________________________ Please insert social security or other identifying number: ___________________________________ _____If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: ______________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ Dated: , [199__] [200________________, 19__ _________________________ ] ------- -- ------------------------------ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:54
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed by the registered holder if such holder desires to exercise any or all of the Rights represented by the this Right Certificate.) To: CD Radio Inc. The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Certificate to purchase the Series B Shares (or fractions thereof) issuable upon the exercise of such Rights (or such other securities of the Company or of any other entity that may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying number: ___________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ If such ) of the Rights represented by this Right Certificate to purchase the shares of the Common Stock of the Company, or other securities or property issuable upon the exercise of said number of Rights shall not be all pursuant to the Rights evidenced by this Right Certificate, Agreement. The undersigned hereby requests that a new Right Certificate certificate for the balance of any such Rights shall securities and any such property be registered issued in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ________________________________________________________________________________ Dated(Name, address and social security or other identifying number of issuee) The undersigned hereby further requests that if said number of Rights shall not be all the Rights represented by this Right Certificate, a new Right Certificate for the remaining balance of such Rights be issued in the name of and delivered to: ________________________________________________________________________________ (Name, 19address and social security or other identifying number of issuee) Dated:______________________ ________________________________________ Signature (Signature) Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
Samples: Rights Agreement (Vantive Corp)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Albertson's, Inc. The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Please insert social security or other identifying number: _________- ______ - _______ ________________________________________________________________________________ (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _________- ______ - _______ ________________________________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ Dated: __________________, 19___ ____________________________________ Signature Signature Guaranteed: CERTIFICATE 75 Certificate The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. Xxxxx Limited The undersigned hereby irrevocably elects to exercise _________ [ ] Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) Units of Preferred Stock issuable upon the exercise of such Rights (or such other securities of the Company or of any other entity person or other property that may be issuable upon the exercise of the such Rights) and requests that certificates for such shares Units be issued in the name ofof and delivered to: ---------------------------------------------------- (Please print name and address) ---------------------------------------------------- ---------------------------------------------------- Please insert social security or other identifying number: ___________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: ---------------------------------------------------- (Please print name and address) ---------------------------------------------------- ---------------------------------------------------- Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ Dated: _________________ __, 19_200_ _________________________ --------------------------- Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
Samples: Rights Agreement (Bunge LTD)
FORM OF ELECTION TO PURCHASE. (To be executed by the registered holder if such holder desires to exercise the Rights represented by the Right Certificate.) ToTo Manatron, Inc.: CD Radio Inc. The undersigned hereby irrevocably elects to exercise _____________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) issuable upon the exercise of such Rights Preferred Stock (or such other securities of the Company or of any other entity person that may be issuable upon the exercise of the Rights) issuable upon the exercise of such Rights and requests that certificates for such shares be issued in the name of: Please insert social security or other tax identifying number: ___________________________________ ___________________________________________________________________ (Please print name and address) _______________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such remaining Rights shall be registered in the name of and delivered to: Please insert social security or other tax identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ Dated: __________________, 19_ __ ___________________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
Samples: Rights Agreement (Manatron Inc)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Certificate.) To: CD Radio Inc. UNI-MARTS INC. The undersigned hereby irrevocably elects to exercise __________________________ Rights represented by this Right Certificate to purchase the Series B Shares (or fractions thereof) Fractional Share issuable upon the exercise of such Rights (or such other securities of the Company or of any other entity that Person which may be issuable upon the exercise of the such Rights) and requests that certificates for such the shares of Common Stock be issued in the name of: Please insert social security or other identifying number: number _______________________________________ ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number _______________________________________ ________________________________________________________________________________ (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ Dated: _________________, _, 19___ ________________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies ____________________________ Signatures must be guaranteed by checking an eligible guarantor institution (a bank, stockbroker, savings and loan association or credit union with membership in an approved signature guarantee medallion program) pursuant to Rule 17Ad-15 of the appropriate boxes that:Securities Exchange Act of 1934.
Appears in 1 contract
Samples: Rights Agreement (Uni Marts Inc)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Rights represented by Certificate other than pursuant to Section 11(a)(ii) of the Right CertificateRights Agreement.) ToTo PHARMOS CORPORATION: CD Radio Inc. The undersigned hereby irrevocably elects to exercise ______________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) issuable upon the exercise shares of such Rights Preferred Stock (or such other securities of the Company or of any other entity that may be Person) issuable upon the exercise of the Rights) Rights and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying number: ________________________________________________________________________________ (Please insert social security or other identifying number) ________________________________________________________________________________ (Please print name and address) The Rights Certificate indicating the balance, if any, of such Rights which may still be exercised pursuant to Section 11(a)(ii) of the Rights Agreement shall be returned to the undersigned unless such Person requests that the Rights Certificate be registered in the name of and delivered to: (Complete only if Rights Certificate is to be registered in a name other than the undersigned.) ________________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number _____________________________________ ___________________________________________________________________ (Please print name and address) Dated:______________, 20____________________________. _________________________ ____________________________ Signature Signature Signature(s) Guaranteed: ________________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
Samples: Rights Agreement (Pharmos Corp)
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. XXXXXX TIRE & RUBBER COMPANY The undersigned hereby irrevocably elects to exercise __________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) Units of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person or other property which may be issuable upon the exercise of the Rights) and requests that certificates for such shares Units be issued in the name ofof and delivered to: Please insert social security or other identifying number: ___________________________________ ___________________________________________________________________ (Please print name and address) ______________________________________________ Please insert social security or other identifying number:______________________ If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ______________________________________ Please insert social security or other identifying number: ____________________ Dated:_________________ __, 199_ ______________________ ___________________________________________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:Signature
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. OLD KENT FINANCIAL CORPORATION The undersigned hereby irrevocably elects to exercise ___________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Please insert social security or other identifying number: ___________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________________ ___________________________________________________________________________ Dated: :_________________ __, 19__ ________________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. REALOGY CORPORATION The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Please insert social security or other identifying number: number ___________________________________ ____________________________________________________________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: ____________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ______________________________________________________________________________________________________________________________________________ (Please print name and address) ______________________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE Certificate The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
Samples: Rights Agreement (Realogy Corp)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Certificate.) ToTo T CELL SCIENCES, INC.: CD Radio Inc. The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying taxpayer number: ____________ ________________________ ___________________________________________________________________ (Please print name and address) ________________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right CertificateCertificate or if the Rights are being exercised pursuant to Section 11(a)(ii) of the Rights Agreement, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying taxpayer number: ____________ __________________________ ___________________________________________________________________ (Please print name and address) ________________________________________________________________________________ ________________________________________________________________________________ Dated: ___________ ________, 19__ ___________________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:____________
Appears in 1 contract
Samples: Shareholder Rights Agreement (Avant Immunotherapeutics Inc)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Certificate.) ToTo Synagro Technologies, Inc.: CD Radio Inc. The undersigned hereby irrevocably elects to exercise ____________ Rights represented by this Right Certificate to purchase the Series B Shares (or fractions thereof) Preferred Stock issuable upon the exercise of such the Rights (or such other securities or property of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Please insert social security or other identifying number: _______________:____________________ ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ________________________________________________________________________________ Please insert social security or other identifying number:_____________________ ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ Dated: :__________________, 19__ ________________________________________ Signature Signature Guaranteed: CERTIFICATE NOTICE The undersigned hereby certifies by checking signatures to the appropriate boxes that:foregoing Form of Election To Purchase must correspond to the name as written upon the face of this Right Certificate in every particular, without alteration or enlargement or any change whatsoever.
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. _______________ The undersigned hereby irrevocably elects to exercise ___exercise______ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying numberof and delivered to: ___________________________________ ___________________________________________________________________ (Please print name and address) ________________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: ______________________ If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: ________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ _____________________________________________Please insert social security or other identifying number: ______________________ Dated: ____________, ____ ___, 19__ _________________________ Signature Signature Guaranteed: 60 CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
Samples: Rights Agreement (Cybercash Inc)
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. SAGE, INC. The undersigned hereby irrevocably elects to exercise ____________________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) Units of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person or other property which may be issuable upon the exercise of the Rights) and requests that certificates for such shares Units be issued in the name ofof and delivered to: Please insert social security or other identifying number: ___________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ________________________________________________________________________ Dated(Please print name and address) _______________________________ (Please insert social security or other identifying number). If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: __________________, 19_________ __________________________________________________________ (Please print name and address) ______________________________________________ (Please insert social security or other identifying number). Dated ____________________________ __________________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
Samples: Rights Agreement (Sage Inc/Ca)
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. ELECTROGLAS, INC. The undersigned hereby irrevocably elects to exercise ____________________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) Units of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person or other property which may be issuable upon the exercise of the Rights) and requests that certificates for such shares Units be issued in the name ofof and delivered to: Please insert social security or other identifying number: ___________________________________ ________________________________________________________________________ (Please print name and address) _______________________________ (Please insert social security or other identifying number). If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: __________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Please insert social security or other identifying number: ___________). Dated __________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE Certificate ----------- The undersigned hereby certifies by checking the appropriate boxes in (1) and (2) that:
Appears in 1 contract
Samples: Rights Agreement (Electroglas Inc)
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. OCTEL CORP. The undersigned hereby irrevocably elects to exercise __________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Please insert social security or other identifying number: ___________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ (Please print social security or other identifying number) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ____________________________________________ (Please print social security or other identifying number) Dated:_______________, _____ ________________ Signature Signature Guaranteed:___________________________________________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
Samples: Rights Agreement (Octel Corp)
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) ToTo CBL & Associates Properties, Inc.: CD Radio Inc. The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying numberof and delivered to: ___________________________________ ___________________________________________________________________ (Please print name and address) _______________________________________________________________________________ Please insert social security or other identifying number: If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) _______________________________________________________________________________ Please insert social security or other identifying number: Dated: _________, ____ ___________________________________________________________________ Dated: __________________, 19__ _________________________ Signature [Signature] Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. COVENTRY HEALTH CARE, INC. The undersigned hereby irrevocably elects to exercise __________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Common Stock, issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Please insert social security or other identifying number: ___________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ________________________________________________________________________________ DatedPlease insert social security or other identifying number: __________________, 19___ If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Please print name and address) ________________________________________________________________________________ ________________________________________________________________________________ Please insert social security or other identifying number: _____________________ Dated:_________________________, [____]. ____________________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:_______________________________________________________________________________ 52
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Certificate.) To: CD Radio Inc. Xxxxxx Oil Corporation The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares securities be issued in the name ofof and delivered to: Please insert social security or other identifying number: number ___________________________________ ___________________________________________________________________ (Please print name and address) ____________________________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ Dated: __________________, 19__ _________________________ 19 Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. L. X. Xxxxxx Company: The undersigned hereby irrevocably elects to exercise ____________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Common Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity person that may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: ______________________________ Please insert social security or other identifying number: _____number ______________________________ ______________________________________ ______________________________ (Please print name and address) _____________________________________If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: ______________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _______number ______________________________ ______________________________________ ______________________________ (Please print name and address) Dated:_____________ __________________________________________________, _____ ___________________________________________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that::
Appears in 1 contract
Samples: Rights Agreement (Foster L B Co)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Certificate.) To: CD Radio Inc. PACIFIC GATEWAY EXCHANGE, INC. The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Certificate to purchase the Series B Preferred Shares (or fractions thereof) issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying number: ___________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ _____________________________________________________________________________ (Please print name and address) Date: ________________ ________________________________________________, ____ ___________________________________________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE ----------- The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. RAWLINGS SPORTING GOODS COMPANY, INC.: The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that Person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Please insert social security or other identifying taxpayer identification number: _______________________________________________ ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying taxpayer identification number: _______________________________________________ ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ Dated: ______________, ____ ___________________________________________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. _____________CORPORATION: The undersigned hereby irrevocably elects to exercise __________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Please insert social security or other identifying number: number ___________________________________ ___________________________________________________________________ (Please print name and address) ________________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number _____________________________________ ___________________________________________________________________ (Please print name and address) ________________________________________________________________________________ Dated: _______________, _____ ___________________________________________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE Certificate ----------- The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
Samples: Rights Agreement (HSB Group Inc)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. COACHMEN INDUSTRIES, INC. The undersigned hereby irrevocably elects to exercise _______________ Rights represented by this Right Rights Certificate to purchase the Series B Common Shares (or fractions thereof) issuable upon the exercise of such Rights (or such other securities of the Company or of any other entity that may be issuable upon the exercise of the Rights) Rights and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying number: ___________________________________ ________________________number ___________________________________________ ------------------------------------------------------------------------------ (Please print name and address) ________________________------------------------------------------------------------------------------ ------------------------------------------------------------------------------ If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ___________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate------------------------------------------------------------------------------ (Please print name and address) ------------------------------------------------------------------------------ ------------------------------------------------------------------------------ Dated ___________________, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number_____ ------------------------- Signature Signature Guaranteed: _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. ___________________________ The undersigned hereby irrevocably elects to exercise ___________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Please insert social security or other identifying number: number __________________________________________________ _______________________________________________________________________________ (Please print name and address) _______________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number __________________________________________________ _______________________________________________________________________________ (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ Dated: __________________, 19__ _________________________ --------------------------------- Signature Signature Guaranteed: CERTIFICATE Reverse Side of Rights Certificate Certificate The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Interface, Inc. The undersigned hereby irrevocably elects to exercise ______________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that Person which may be issuable upon the exercise of the Rights) and requests that certificates (or registrations in uncertificated book-entry form on the books of the Company) for such shares securities be issued in the name ofof and delivered to: Please insert social security or other identifying number: number ___________________________________ ________________________________________________________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _______________________________________________________________________ ______________________If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number _____________________________________________ (Please print name and address) _____________________________________________ Dated: ____________________, _______ ___________________________________________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:Exhibit C
Appears in 1 contract
Samples: Rights Agreement (Interface Inc)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right CertificateTO BE EXECUTED IF HOLDER DESIRES TO EXERCISE THE RIGHT CERTIFICATE.) ToTo IROBOT CORPORATION: CD Radio Inc. The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying taxpayer number: ___________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ________________________________________________________________________________ Dated________________________________________________________________________________ (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Certificate or if the Rights are being exercised pursuant to Section 11(a)(ii) of the Rights Agreement, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying taxpayer number: __________________, 19______________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ (Please print name and address) Dated: _________, _____ ___________________________________ ___________________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:__________________________________________________________
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Certificate.) To: CD Radio Stratus Properties Inc. The undersigned hereby irrevocably elects to exercise ____________ Rights represented by this Right Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares securities be issued in the name ofof and delivered to: Please insert social security or other identifying number: number ___________________________________ ___________________________________________________________________ (Please print name and address) _____________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number _____________________________________ ___________________________________________________________________ (Please print name and address) _____________________________________________________________________ Dated: ________________, 20__ ___________________________________________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies Signature must be guaranteed by checking a participant in a Medallion Signature Guarantee Program at a guarantee level acceptable to the appropriate boxes that:Company's Rights Agent.
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. BALLY ENTERTAINMENT CORPORATION The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company Corporation or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying numberof and delivered to: ___________________________________ ___________________________________________________________________ (Please print name and address) _______________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: :______________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: _______________________________________________________________________________ (Please print name and address) ___________________________________________________________________ ______________ Please insert social security or other identifying number:______________________________________________________ Dated: ___:_______________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE . Certificate ___________ The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Rights represented by Certificate pursuant to Section 11(a)(ii) of the Right CertificateRights Agreement.) To: CD Radio Inc. MEDICINOVA, INC. The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) issuable upon the exercise shares of such Rights Common Stock (or such other securities of the Company or of any other entity that may be Company) issuable upon the exercise of the Rights) Rights and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying number: _______________________________________________________________________________________________________________ (Please insert social security or other identifying number) _______________________________________________________________________________________________________________ (Please print name and address) ___________________________________________________________________________________________________________ If such number of The Rights shall not be all Certificate indicating the Rights evidenced by this Right Certificatebalance, a new Right Certificate for the balance if any, of such Rights which may still be exercised pursuant to Section 11(a)(ii) of the Rights Agreement shall be returned to the undersigned unless the undersigned requests that the Rights Certificate be registered in the name of and delivered to: Please insert social security or other identifying number: _______________________________________________________________________________________________________________ Please insert social security or other identifying number (complete only if Rights Certificate is to be registered in a name other than the undersigned) _______________________________________________________________________________________________________________ (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:20 .
Appears in 1 contract
Samples: Rights Agreement (Medicinova Inc)
FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights represented by the Right Certificate.) ToTO ZymeTx, Inc.: CD Radio Inc. The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Certificate to purchase the Series B Shares (or fractions thereof) issuable upon the exercise of such Rights (or such other securities of the Company or of any other entity that may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying number: ___________________________________ ________________Rights represented by this Rights Certificate to purchase the shares of Preferred Stock (or other securities) issuable upon the exercise of such Rights and requests that certificates for such share(s) be issued in the following name: Please insert social security or other identifying number: --------------------------------------------------- ------------------------------------------------------------------------------- (Please print name and address) ------------------------------------------------------------------------------- If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number:___________________________________________________ ------------------------------------------------------------------------------- (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be -------------------------------------------------------------------------------- Dated: ------------------- --------------------------------------------- Signature (Signature must conform in all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the respects to name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and addressholder as specified on the face of this Rights Certificate) ___________________________________________________________________ ___________________________________________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
Samples: Rights Agreement (Zymetx Inc)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. American Stock Transfer & Trust Company The undersigned hereby irrevocably elects to exercise ___________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Common Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Please insert social security or other identifying number: number __________________________________________________ _______________________________________________________________________________ (Please print name and address) _______________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number __________________________________________________ _______________________________________________________________________________ (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ Dated: ________________ ___, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE Reverse Side of Rights Certificate Certificate The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
Samples: Rights Agreement (American Superconductor Corp /De/)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Certificate.) To: CD Radio Inc. OMEGA WORLDWIDE, INC. The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Certificate to purchase the Series B Preferred Shares (or fractions thereof) issuable upon the exercise of such the Rights (or such other securities of the Company Corporation or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying number: ___________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ____________________________:_______________________________________ ______________________________________________________________ (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number:_______________________________________ Dated: ______________________________________________________________ (Please print name and address) Date:_______________________________, 19__ __________________________ Signature Signature Guaranteed: CERTIFICATE Certificate The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Series B Rights represented by the Right Certificate.) To: CD Radio Inc. FRUIT OF THE LOOM, INC. The undersigned hereby irrevocably elects to exercise _____________ Series B Rights represented by this Right Series B Rights Certificate to purchase the Series B Preferred Shares (or fractions thereof) issuable upon the exercise of such Series B Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares Preferred Shares be issued in the name of: Please insert social security or other identifying number: ________________________________________________________________________________ ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ (Please insert social security or other identifying number) If such number of Series B Rights shall not be all the Series B Rights evidenced by this Right Series B Rights Certificate, a new Right Series B Rights Certificate for the balance remaining of such Series B Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: ________________________________________________________________________________ ________________________________________________________________________________ (Please print name and address) ___________________________________________________________________ ______________ (Please insert social security or other identifying number) Dated: _________________________, 19__ Signature Guaranteed: __________________________________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies Signatures must be guaranteed by checking the appropriate boxes that:an Eligible Guarantor Institution as defined by SEC Rule 17Ad-15 (17 C.F.R. 240.17-Ad-15).
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Certificate.) To: CD Radio Inc. McMoRan Exploration Co. The undersigned hereby irrevocably elects to exercise ____________ Rights represented by this Right Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares securities be issued in the name ofof and delivered to: Please insert social security or other identifying number: number _______________________________________________________________ (Please print name and address) _______________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number _________________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ Dated: __________________, 19__ ___________________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if the holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. CUTCO INDUSTRIES, INC. The undersigned hereby irrevocably elects to exercise ______________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Common Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying numberof and delivered to: ___________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________ Please insert social security or other identifying number:_________________________ If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: _______________________________________________________________________________ (Please print name and address) _______________________________________________________________________________ Please insert social security or other identifying number:_________________________ Dated:_________________ ________________________________ Signature Signature Guaranteed: ___________________________________________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Rights represented by the Right Certificate.) ToTO: CD Radio Inc. HARVEST NATURAL RESOURCES, INC. The undersigned hereby irrevocably elects to exercise ____________________ Rights represented by this Right Rights Certificate to purchase the Series B Preferred Shares (or fractions thereofsuch other securities of the Company) issuable upon the exercise of such Rights and requests that certificate for such Preferred Shares (or such other securities of the Company or of any other entity that may be issuable upon the exercise of the RightsCompany) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying number: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ (Please insert social security or other identifying number) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ (Please insert social security or other identifying number) Dated: ____________________________ ___________________________________ _________________________________________ Signature Signature Signature(s) Guaranteed: ___________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:39
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right CertificateTO BE EXECUTED IF HOLDER DESIRES TO EXERCISE RIGHTS REPRESENTED BY THE RIGHTS CERTIFICATE.) To: CD Radio Inc. Mellon Investor Services LLC The undersigned hereby irrevocably elects to exercise __________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity person that may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Please insert social security or other identifying number: _____________number ______________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ________________________________________________________________________________ Dated(Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number __________________, 19____ ________________________________________________________________________________ ________________________________________________________________________________ (Please print name and address) Dated: ______________ _________________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:Certificate
Appears in 1 contract
Samples: Rights Agreement (Centene Corp)
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Certificate.) To: CD Radio Inc. Deltic Timber Corporation The undersigned hereby irrevocably elects to exercise ___________ Rights represented by this Right Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares securities be issued in the name ofof and delivered to: Please insert social security or other identifying number: number ___________________________________ ___________________________________________________________________ (Please print name and address) ______________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ Dated: __________________, 19__ ______________________________ Signature Signature Guaranteed: CERTIFICATE Certificate ----------- The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Certificate.) To: CD Radio Xxxxxx Industries, Inc. The undersigned hereby irrevocably elects to exercise ____________ Rights represented by this Right Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares securities be issued in the name ofof and delivered to: Please insert social security or other identifying number: number ___________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number _____________________________________ ___________________________________________________________________ (Please print name and address) Dated: ________________________________________________________________, 20___ ___________________________________________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. SOUTHWEST BANCORP, INC.: The undersigned hereby irrevocably elects to exercise ____________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity person that may be issuable upon the exercise of the Rights) and requests that certificates for such shares (or other securities) be issued in the name ofof and delivered to: Please insert social security or other identifying number: number ___________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ________________________________________________________________________________ Dated(Please print name and address) Date: _______________, ___, 19_ __ __________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. THE CHEFS’ WAREHOUSE, INC. The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) Units of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity person or other property that may be issuable upon the exercise of the Rights) and requests that certificates for such shares Units be issued in the name ofof and delivered to: Please insert social security or other identifying number: ___________________________________ ___________________________________________________________________ (Please print name and address) ____________________________________________________ ____________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ _______________If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: ____________________________________________________ (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ DatedPlease insert social security or other identifying number: __________________, 19__ _________________________ Dated: _____ __, 202_ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. UNITED DOMINION REALTY TRUST, INC.: The undersigned hereby irrevocably elects to exercise ____________ Rights represented by this Right Rights Certificate to purchase the shares of Series B Shares (or fractions thereof) C Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity person that may be issuable upon the exercise of the Rights) and requests that certificates for such shares (or other securities) be issued in the name ofof and delivered to: Please insert social security or other identifying number: number ___________________________________ ___________________________________________________________________ (Please print name and address) ______________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ Dated(Please print name and address) 1 Date: __________________, 19__ _________________________ -------------------------------- Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
Samples: Rights Agreement (United Dominion Realty Trust Inc)
FORM OF ELECTION TO PURCHASE. (To be executed by the registered holder if such holder desires to exercise the Rights represented evidenced by the Right this Rights Certificate.) To: CD Radio Inc. DUKE REALTY INVESTMENTS, INC. The undersigned hereby irrevocably elects to exercise ________________ Rights represented evidenced by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) Units issuable upon the exercise of such the Rights (or such other securities securities, cash or property of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares Units (or such other securities which may be issuable upon the exercise of the Rights) be issued in the name ofof and delivered to: Please insert social security or other identifying number: _______________:____________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and addressname) ___________________________________________________________________________ ___________________________________________________________________________ Dated(Please print address) If such number of Rights shall not be all of the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number:__________________, 19__ ___________________________________________________________________________ (Please print name) ___________________________________________________________________________ ___________________________________________________________________________ (Please print address) Dated: ____________, ____ Signature:_____________________________________________ (Sign exactly as your name appears on the other side of this Rights Certificate) Signature Signature Guaranteed: Guarantee:____________________ CERTIFICATE ----------- The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed by the registered holder if such holder desires to exercise the Rights represented by the Right Certificate.) ToTo Hastings Manufacturing Company: CD Radio Inc. The undersigned hereby irrevocably elects to exercise ____________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) issuable upon the exercise of such Rights Preferred Stock (or such other securities of the Company or of any other entity person that may be issuable upon the exercise of the Rights) issuable upon the exercise of such Rights and requests that certificates for such shares be issued in the name of: Please insert social security or other tax identifying number: ___________________________________ ___________________________________________________________________ (Please print name and address) _______________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such remaining Rights shall be registered in the name of and delivered to: Please insert social security or other tax identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ Dated: __________________, 19__ ____________________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Rights represented by the Right Certificate.) ToTO: CD Radio Inc. BENTON OIL AND GAS COMPANY The undersigned hereby irrevocably ixxxxxxably elects to exercise _________ Rights represented by this Right Certificate to purchase the Series B Shares (or fractions thereof) issuable upon the exercise of such Rights (or such other securities of the Company or of any other entity that may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying number: ___________________________________ ___________________________________________________________________ Rights represented by this Rights Certificate to purchase the Preferred Shares (or such other securities of the Company) issuable upon the exercise of such Rights and requests that certificate for such Preferred Shares (or other securities of the Company) be issued in the name of: -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- (Please print name and address) ___________________________________________________________________ -------------------------------------------------------------------------------- (Please insert social security or other identifying number) If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- (Please print name and address) -------------------------------------------------------------------------------- (Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ Dated: __________________, 19__ _________________________ --------------------------- --------------------------------- --------------------------------- Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:Signature
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. CENDANT CORPORATION The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Please insert social security or other identifying number: number ___________________________________ __________________________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: __________________________________________ If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ____________________________________________________________________________________________________________ (Please print name and address) ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE Certificate The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
Samples: Rights Agreement (Cendant Corp)
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. UNIPHASE CORPORATION The undersigned hereby irrevocably elects to exercise ____________________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) Units of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person or other property which may be issuable upon the exercise of the Rights) and requests that certificates for such shares Units be issued in the name of: Please insert social security or other identifying numberof and delivered to: _____________________ _______________________________ (Please print name and address) ________________ _______________ (Please insert social security or other identifying number). If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: _________________________ __________________________________________________________ (Please print name and address) ______________________________________________ (Please insert social security or other identifying number). Dated ___________________, 199___ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ Dated: __________________, 19__ _________________________ --------------------------------- Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. ALLTRISTA CORPORATION The undersigned hereby irrevocably elects to exercise __________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Please insert social security or other identifying number: ________________:___________________ _____________________________________________________________________________ (Please print name and address) _____________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: ___________________ ___________________ ___________________________________________________________________ (Please print name and address) ______________________________________________________________________________ Dated: ____________, 19__ ___________________________________________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE Certificate The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
Samples: Rights Agreement (Alltrista Corp)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Certificate.) ToTo CORE, INC.: CD Radio Inc. The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying taxpayer number: ___________________________________ ___________________________________________________________________ ---------------------------- ------------------------------------------------------------------------------- (Please print name Print Name and addressAddress) ___________________________________________________________________ ------------------------------------------------------------------------------- ------------------------------------------------------------------------------- If such number of Rights shall not be all the Rights evidenced by this Right CertificateCertificate or if the Rights are being exercised pursuant to Section 11(a)(ii) of the Rights Agreement, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying taxpayer number: _____________________________________ ___________________________________________________________________ ---------------------------- ------------------------------------------------------------------------------- (Please print name Print Name and addressAddress) ___________________________________________________________________ ___________________________________________________________________ ------------------------------------------------------------------------------- ------------------------------------------------------------------------------- Dated: __________________, 19__ _________________________ Signature Signature: ------------------------- --------------------------- Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:----------------------------------
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. SYBRON DENTAL SPECIALTIES, INC.: The undersigned hereby irrevocably elects to exercise __________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Please insert social security or other identifying number: number ___________________________________ ___________________________________________________________________ (Please print name and address) _______________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number _____________________________________ ___________________________________________________________________ (Please print name and address) _______________________________________________________________________________ _______________________________________________________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:---------------------------------- Signature
Appears in 1 contract
Samples: Rights Agreement (SDS Holding Co)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. MATRIA HOLDING COMPANY, INC: The undersigned hereby irrevocably elects to exercise __________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Common Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Please insert social security or other identifying number: number ___________________________________ ___________________________________________________________________ (Please print name and address) _______________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be be, registered in the name of and delivered to: Please insert social security or other identifying number: number _____________________________________ ___________________________________________________________________ (Please print name and address) _______________________________________________________________________________ Dated:____________________, 20_____ ___________________________________________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE Certificate The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. XXXX XX INDUSTRIES, INC. The undersigned hereby irrevocably elects to exercise __________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Please insert social security or other identifying number: number ___________________________________ ___________________________________________________________________ (Please print name and address) __________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number _____________________________________ ___________________________________________________________________ (Please print name and address) __________________________________________________________________________ __________________________________________________________________________ Dated: __________________, 19__ ______________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:Signature
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right this Rights Certificate.) To: CD Radio Inc. BE AEROSPACE, INC. The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) Units of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares Units be issued in the name of: Please insert social security or other identifying numberof and delivered to: ___________________________________ ___________________________________________________________________ (Please print name and address) ________________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: ________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: ________________________________________________________________________________ (Please print name and address) Please insert social security or other identifying number: ___________________________________________________________________ ___________________________________________________________________ Dated: ___________ __, ________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
Samples: Rights Agreement (Be Aerospace Inc)
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Certificate.) To: CD Radio Horizon Offshore, Inc. The undersigned hereby irrevocably elects to exercise ____________ Rights represented by this Right Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares securities be issued in the name ofof and delivered to: Please insert social security or other identifying number: number ___________________________________ ___________________________________________________________________ (Please print name and address) __________________________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number _____________________________________ ___________________________________________________________________ (Please print name and address) __________________________________________________________________________________________ Dated: _____________________, 20___ ___________________________________________________________________ Dated: __________________, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Certificate.) To: CD Radio Inc. CPI CORP. The undersigned hereby irrevocably elects to exercise ____________ Rights represented by this Right Certificate to purchase the shares of Series B A Shares (or fractions thereof) issuable upon the exercise of such the Rights (or Common Shares or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying number: ________________ ____________________ ___________________________________________________________________ (Please print name and address) ________________________________________________________________________________ ________________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: ________________ Please insert social security or other identifying number: ________________ ______________________ ___________________________________________________________________ (Please print name and address) ________________________________________________________________________________ ________________________________________________________________________________ Dated: _______________, 200_ ___, 19__ __________________________ Signature Signature Guaranteed: CERTIFICATE Certificate The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
Samples: Rights Agreement (Cpi Corp)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. NTL EUROPE, INC. The undersigned hereby irrevocably elects to exercise __________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Please insert social security or other identifying number: ___________________________________ ___________________________________________________________________ (Please print name and address) _______________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) _______________________________________________________________________________ _______________________________________________________________________________ Dated: _______________, ___, 19__ _________________________ Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
Samples: Rights Agreement (NTL Inc/De/)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. AngioDynamics, Inc.: The undersigned hereby irrevocably elects to exercise __________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Please insert social security or other identifying number: number _______________________________________________________________________________ (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number _______________________________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ Dated: __________________, 19,__ _________________________ -------------------------- Signature Signature Guaranteed: CERTIFICATE Certificate The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
Samples: Rights Agreement (Angiodynamics Inc)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. CODORUS VALLEY BANCORP, INC. The undersigned hereby irrevocably elects to exercise ____________________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Common Stock issuable upon the exercise of such the Rights (or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Please insert social security or other identifying number: ___________________________________ ___________number ________________________________________________________ (Please print name Print Name and addressAddress) ___________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _____________________________________ ___________number ________________________________________________________ (Please print name Print Name and addressAddress) ___________________________________________________________________ ___________________________________________________________________ Dated: __________________, 19__ _________________________ ------------------------------ ---------------------------------------- Signature Signature Medallion Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
FORM OF ELECTION TO PURCHASE. (To be executed by the registered holder if such holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. LOJACK CORPORATION The undersigned hereby irrevocably elects to exercise __________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or Common Stock or such other securities of the Company or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Please insert social security or other identifying number: ________________number ___________________ ____________________________________________________________________________ (Please print name and address) ____________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: __________________number ___________________ ____________________________________________________________________________ (Please print name and address) ____________________________________________________________________________ ____________________________________________________________________________ Dated: __________________, 19__ _________________________ ----------------------------- Signature Signature Guaranteed: CERTIFICATE Certificate The undersigned hereby certifies by checking the appropriate boxes that:
Appears in 1 contract
Samples: Rights Agreement (Lojack Corp)
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To: CD Radio Inc. TRINITY INDUSTRIES, INC. The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Right Rights Certificate to purchase the Series B Shares (or fractions thereof) shares of Preferred Stock issuable upon the exercise of such the Rights (or such other securities of the Company Corporation or of any other entity that person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Please insert social security or other identifying number: number ___________________________________ ___________________________________________________________________ (Please print name and addressPLEASE PRINT NAME AND ADDRESS) ________________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: number _____________________________________ ___________________________________________________________________ (Please print name and addressPLEASE PRINT NAME AND ADDRESS) ___________________________________________________________________ ___________________________________________________________________ Dated: __________________, 19__ _________________________ -------------------------- ------------------------------------- Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:72
Appears in 1 contract
