Common use of FORM OF ELECTION TO PURCHASE Clause in Contracts

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Certificate.) TO:_________________ The undersigned hereby irrevocably elects to exercise _________________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock 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 insert 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 insert name and address:_________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Dated: ______________, ______ __________________________________________ Signature (Signature must conform in all respects to name of holder as specified on the fact of this Rights Certificate) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION Pursuant to Section 151 of the Delaware General Corporation Law Geoworks Corporation, a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFY:

Appears in 2 contracts

Samples: Rights Agreement (Geoworks /Ca/), Rights Agreement (Geoworks /Ca/)

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FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Certificate.) TO:_________________ The undersigned hereby irrevocably elects to exercise _________________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock 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 insert name and address:_____________________: _______________________ ________________________________________________________________________________ _________________________(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 insert print name and address:_________________________________________________ ________________________________________________________________________________ ) ________________________________________________________________________________ Dated: ________________, ______ __________________________________________ Signature (Signature must conform in all respects to name of holder as specified on the fact of this Rights Certificate) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF SECOND AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION X. X. XXXXXX COMPANY, INC. Pursuant to Section 151 of the Delaware General Corporation Law Geoworks CorporationX. X. Penney Company, Inc., a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFY:

Appears in 2 contracts

Samples: Rights Agreement (Penney J C Co Inc), Rights Agreement (Penney J C Co Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Certificate.) TO:_________________ TO:--------------------- The undersigned hereby irrevocably elects to exercise _________________ Rights --------- -----------Rights represented by this Rights Certificate to purchase the shares of Preferred Stock 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 insert print name and address:____________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ If ) --------------------------------------------------------------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 insert print name and address:_________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ) -------------------------------------------------------------------- Dated: ______________-------------------, ______ __________________________________________ ---------- -------------------------------------- Signature (Signature must conform in all respects to name of holder as specified on the fact of this Rights Certificate) Signature Guaranteed EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION MINERALS TECHNOLOGIES INC. Pursuant to Section 151 of the Delaware General Corporation Law Geoworks CorporationMINERALS TECHNOLOGIES INC., a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFY:

Appears in 2 contracts

Samples: Rights Agreement (Minerals Technologies Inc), Rights Agreement (Minerals Technologies Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires Be Executed Upon Exercise Of Warrant) The undersigned hereby irrevocably elects to exercise the Rights right, represented by this Warrant Certificate.) TO:, to receive _________ shares of Common Stock and herewith tenders payment for such shares to the order of TRICO MARINE SERVICES, INC., in the amount of $ _________ The undersigned hereby irrevocably elects to exercise _________________ Rights represented by this Rights Certificate to purchase in accordance with the shares of Preferred Stock 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 insert 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 insert name and address:_________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Dated: ______________, ______ ____________terms hereof. ______________________________ Signature Date: ______________________________ Signature Guaranteed Signatures must be guaranteed by an "eligible guarantor institution" meeting the requirements of the Warrant Agent, which requirements include membership or participation in the Security Transfer Association Medallion Program (Signature must conform "STAMP") or such other "signature guarantee program" as may be determined by the Warrant Agent in addition to, or in substitution for, STAMP, all respects to name in accordance with the Securities Exchange Act of holder 1934, as specified on amended, and the fact rules and regulations promulgated thereunder. SCHEDULE OF EXCHANGES OF INTERESTS OF GLOBAL WARRANTS The following exchanges of a part of this Rights Certificate) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS Global Warrant have been made: Amount of decrease in Amount of increase in Number of Series [A][B] in number of Series [A][B] number of Series [A][B] this Global Warrant Warrants in this Global Warrants in this Global following such decrease or Date of Exchange Warrant Warrant increase ---------------------- ----------------------- ----------------------- -------------------------- [FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION Pursuant to Section 151 of TRANSFER NOTICE] FOR VALUE RECEIVED the Delaware General Corporation Law Geoworks Corporationundersigned registered holder hereby sell(s), a company organized assign(s) and existing under the laws of the State of Delaware transfer(s) unto _______________ (the "CompanyAssignee")) (Please type or print block letters) ______________________________ (Please print or typewrite name and address including zip code of assignee) the within Warrant Certificate and all rights thereunder, DOES HEREBY CERTIFY:hereby irrevocably constituting and appointing attorney to transfer the Series [A][B] Warrant represented by this Warrant Certificate on the books of the Company with full power of substitution in the premises. Date: Seller By: ________________________

Appears in 1 contract

Samples: Warrant Agreement (Trico Marine Services Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise Rights represented by the Rights Certificate.) TO:_________________ To: MARKETSPAN CORPORATION: The undersigned hereby irrevocably elects to exercise _________________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights 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 share(s) shares be issued in the following namename of and deliverable to: ----------------------------------------------------------- (Please insert social security or other identifying number:_________________ ) ----------------------------------------------------------- (Please insert 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 insert print name and address) ------------------------------------------------------------ ------------------------------------------------------------ Dated:_________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Dated: ______________, ______ __________________________________________ ---------------------------- Signature (Signature Guaranteed: ------------------------------ Signatures must conform in all respects to name of holder as specified on be guaranteed by an "eligible guarantor institution" meeting the fact of this Rights Certificate) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION Pursuant to Section 151 requirements of the Delaware General Corporation Law Geoworks CorporationRights Agent, a company organized and existing under which requirements include membership or participation in the laws Security Transfer Agent Medallion Program ("STAMP") or such other "signature guarantee program" as may be determined by the Rights Agent in addition to, or in substitution for, STAMP, all in accordance with the Securities Exchange Act of 1934, as amended. Certificate The undersigned hereby certifies by checking the State of Delaware (the "Company"), DOES HEREBY CERTIFYappropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Marketspan Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Right Certificate.) TO:_________________ To Advanced Radio Telecom Corp. The undersigned hereby irrevocably elects to exercise _________________ Rights represented by this Rights Certificate to purchase the shares number of one one- hundredths of a share of Preferred Stock (or other securities) issuable upon the exercise of such Rights and requests that certificates for such share(s) shares be issued in the following namename of: Please insert social security or other identifying number:_________________ Please insert name and address:____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:_________________ ________________________________________number ________________________________________ ________________________________________________________________________________ (Please insert print name and address:_________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ) -------------------------------------------------------------------- Dated: ______________-----------------------, ______ __________________________________________ ---- ---------------------------- Signature (Signature must conform in all respects to name of holder as specified on the fact face of this Rights Certificate) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION Pursuant to Section 151 Signature Guaranteed:** -------------------------- ** Signature must be guaranteed by a member firm of the Delaware General Corporation Law Geoworks CorporationThe New York Stock Exchange, Inc. or a commercial bank or trust company organized and existing under the laws having an office of the State of Delaware (the "Company"), DOES HEREBY CERTIFY:correspondent in New York City.

Appears in 1 contract

Samples: Rights Agreement (Advanced Radio Telecom Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Right Certificate.) TO:_________________ To AFFINITY GAMING: The undersigned hereby irrevocably elects to exercise _________________ Rights represented by this Rights Right Certificate to purchase the shares of Preferred Stock Shares issuable upon the exercise of such Rights and requests that certificates for such share(s) Preferred Shares be issued in the following namename of: Please insert social security Social Security or other identifying number:_________________ Please insert name and address:_____________: _______________________________ ________________________________________________________________________________ __(Please print name and address) ______________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Rights Right Certificate, a new Rights Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security Social Security or other identifying number:_________________ _________________________________________________: _______________________________ ________________________________________________________________________________ (Please insert print name and address:_________________________________________________ ________________________________________________________________________________ __) ______________________________________________________________________________ Dated: ______________, ______ __________________________________________ Signature (Signature must conform in all respects to name of the holder as specified on the fact of this Rights Right Certificate) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION Pursuant Signature Guaranteed: Signatures must be guaranteed by an eligible guarantor institution (bank, stock broker or savings and loan association with membership in an approved signature medallion program). Form of Reverse Side of Right Certificate -- continued ---------------------------------------------------------------- The undersigned hereby certifies that the Rights evidenced by this Right Certificate are not beneficially owned by, were not acquired by the undersigned from and are not being assigned to an Acquiring Person or an Affiliate or Associate thereof and are not issued with respect to notional Common Shares related to a Derivative Interest described in Section 151 1.3.4 of the Delaware General Corporation Law Geoworks Corporation, a company organized and existing under definition of Beneficial Owner (as such terms are defined in the laws of the State of Delaware (the "Company"Rights Agreement), DOES HEREBY CERTIFY:.

Appears in 1 contract

Samples: Rights Agreement (Affinity Gaming)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Right Certificate.) TO:_________________ To: HILTON HOTELS CORPORATION The undersigned hereby irrevocably elects to exercise _________________ Rights represented by this Rights Right Certificate to purchase the shares of Preferred Stock Shares issuable upon the exercise of such Rights (or such other securities or property of the Company or of any other Person which may be issuable upon the exercise of the Rights) and requests that certificates for such share(s) shares be issued in the following namename of: ------------------------------------------------------------ (Please insert social security or other identifying number:_________________ Please insert print name and address:____________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ) ------------------------------------------------------------ If such number of Rights shall not be all the Rights evidenced by this Rights Right Certificate, a new Rights 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 insert print name and address:_________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ) ------------------------------------------------------------ Dated: ______________, ______ __________________________________________ ------------------------ ------------------------------- Signature (Signature Guaranteed: --------------------- Signatures must conform be guaranteed by an "eligible guarantor institution" as defined in all respects to name of holder as specified on the fact of this Rights Certificate) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION Pursuant to Section 151 of the Delaware General Corporation Law Geoworks Corporation, a company organized and existing Rule 17Ad-15 promulgated under the laws Securities Exchange Act of the State of Delaware (the "Company")1934, DOES HEREBY CERTIFYas amended. The undersigned hereby certifies that:

Appears in 1 contract

Samples: Rights Agreement (Hilton Hotels Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Right Certificate.) TO:TO _________________ _____: The undersigned hereby irrevocably elects to exercise _________________ Rights represented by this Rights Right Certificate to purchase the shares of Preferred Stock 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 insert 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 (Please print name of and delivered to: Please insert social security or other identifying number:_________________ 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 insert print name and address:_________________________________________________ ________________________________________________________________________________ ) ________________________________________________________________________________ Dated: ______________, ______ __________________________________________ -------------------------------- Signature (Signature must conform in all respects to name of holder as specified on the fact face of this Rights Right Certificate) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION THE GRAND UNION COMPANY Pursuant to Section 151 of the Delaware General Corporation Law Geoworks CorporationI, Xxxxxxx X. Xxxxxxxx, the Executive Vice President and Chief Financial Officer of The Grand Union Company, a company corporation organized and existing under the laws of the State of Delaware General Corporation Law (the "Company"), DOES in accordance with the provisions of Section 151 of such law, DO HEREBY CERTIFYCERTIFY that pursuant to the authority conferred upon the Board of Directors by the Restated Certificate of Incorporation of the Company, the Board of Directors on April 29, 1999 adopted the following resolution which creates a series of shares of Preferred Stock designated as Series A Junior Preferred Stock, as follows: RESOLVED, that pursuant to Section 151(g) of the Delaware General Corporation Law and the authority vested in the Board of Directors of the Company in accordance with the provisions of ARTICLE FOURTH of the Restated Certificate of Incorporation of the Company, a series of Preferred Stock of the Company be, and hereby is, created, and the powers, designations, preferences and relative, participating, optional or other special rights of the shares of such series, and the qualifications, limitations or restrictions thereof, be, and hereby are, as follows:

Appears in 1 contract

Samples: Corrected Version Agreement (Grand Union Co /De/)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Certificate.) TO:_________________ The undersigned hereby irrevocably elects to exercise _________________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock 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 insert 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: ________________________________ ________________________________________________________________________________ ________________________________________________________________________________ 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 insert print name and address:_________________________________________________ ________________________________________________________________________________ ) ________________________________________________________________________________ Dated: ________________, ______ __________________________________________ Signature (Signature must conform in all respects to name of holder as specified on the fact of this Rights Certificate) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION LODGIAN, INC. Pursuant to Section 151 of the Delaware General Corporation Law Geoworks CorporationI, [name] , [office] of Lodgian, Inc., a company corporation organized and existing under the laws of the State of Delaware General Corporation Law (the "CompanyCorporation"), DOES in accordance with the provisions of Section 151 of such law, DO HEREBY CERTIFYCERTIFY that pursuant to the authority conferred upon the Board of Directors by the Restated Certificate of Incorporation of the Corporation, the Board of Directors on March 26, 1999 adopted the following resolution which creates a series of [________] shares of Preferred Stock designated as Participating Preferred Stock, as follows:

Appears in 1 contract

Samples: Rights Agreement (Lodgian Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Warrant Certificate.) ). TO:_________________ : RIDE, INC. The undersigned hereby irrevocably elects to exercise ___________Warrants represented by this Warrant Certificate to purchase ______ Rights represented by this Rights Certificate to purchase the shares of Preferred Common Stock issuable upon the exercise of such Rights Warrants and requests that certificates for such share(s) shares be issued in the following namename of: (Please insert social security security, tax identification or other identifying number:_________________ ) ---------------------------------- ---------------------------------- ---------------------------------- (Please insert print name and address:____________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ) If such number of Rights Warrants shall not be all the Rights Warrants evidenced by this Rights Warrant Certificate, a new Rights Warrant Certificate for the balance remaining of such Rights Warrants shall be registered in the name of and delivered to: Please insert social security security, tax identification or other identifying number:_________________ ________________________________________________________________________________ ________________________________________________________________________________ number ---------------------------------- ---------------------------------- ---------------------------------- (Please insert print name and address:_________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ) Dated: _______________, ______ __________________________________________ ------------------------------ Signature (Signature must conform in all respects to name of holder as specified on the fact face of this Rights Warrant Certificate) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION Pursuant to Section 151 of the Delaware General Corporation Law Geoworks Corporation, a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFY:

Appears in 1 contract

Samples: Warrant Agreement (Ride Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Certificate.) TO:_________________ To Summit Technology, Inc. The undersigned hereby irrevocably elects to exercise _________________ Rights represented by this Rights Certificate to purchase the shares number of one one-thousandths of a share of Preferred Stock (or other securities) issuable upon the exercise of such Rights and requests that certificates for such share(s) shares be issued in the following namename of: Please insert social security or other identifying number:_________________ Please insert name and address:____________________________________________ ___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:_________________ ____________________________number ____________________________________________________ ________________________________________________________________________________ (Please insert print name and address:) Dated: _____________________________________________, ____ ________________________________________________________________________________ ________________________________________________________________________________ Dated: ______________, ______ __________________________________________ Signature (Signature must conform in all respects to name of holder as specified on the fact face of this Rights Certificate) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION Pursuant Signature Guaranteed:** ________________ ** Signature must be guaranteed by an "Eligible Guarantor Institution" (with membership in an approved signature guarantee medallion program) pursuant to Section 151 Rule 17Ad-15 of the Delaware General Corporation Law Geoworks Corporation, a company organized and existing under Securities Exchange Act of 1934. CERTIFICATE The undersigned hereby certifies by checking the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFYappropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Summit Technology Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder the Holder desires to exercise the Rights CertificateWarrant. TO LOGICAL DESIGN SOLUTIONS, INC.) TO:_____: The undersigned hereby irrevocably elects to exercise the Warrant evidenced by this Warrant Certificate No. ____________ The undersigned hereby irrevocably elects to exercise _____purchase ____________ Rights represented by this Rights Certificate to purchase the shares Shares of Preferred Common Stock issuable upon the exercise of such Rights Warrant and requests that certificates for such share(s) Shares be issued in the following namename of: Please insert social security or other identifying number-------------------------------------- Name -------------------------------------- Address -------------------------------------- Social Security Number -------------------------------------- Date:_________________ Please insert 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 insert name and address:_________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Dated: ______________, ______ __________________________________________ Signature (Signature must conform in all respects to name of holder as specified on the fact face of this Rights Warrant Certificate) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION Pursuant If such number of Shares shall not be all the Shares with respect to Section 151 of the Delaware General Corporation Law Geoworks Corporationwhich this Warrant is exercisable, a company organized new Warrant for the balance remaining of such Shares will be registered in the name of and existing under delivered to: -------------------------------------- Name -------------------------------------- Address -------------------------------------- Social Security Number -------------------------------------- Date:____________________ Signature (Signature must conform in all respects to name of holder as specified on the laws face of the State of Delaware (the "Company"this Warrant Certificate), DOES HEREBY CERTIFY:

Appears in 1 contract

Samples: Warrant Agreement (Logical Design Solutions Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Right Certificate.) TO:_________________ TO -------------------------: The undersigned hereby irrevocably elects to exercise _________________ ---------------- Rights represented by this Rights Right Certificate to purchase the shares of Preferred Stock 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 insert print name and address:____________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ) -------------------------------------------------------------------------------- If such number of Rights shall not be all the Rights evidenced by this Rights Right Certificate, a new Rights 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 insert print name and address:_________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ) -------------------------------------------------------------------------------- Dated: ______________-------------- -----, ______ __________________________________________ --------- ---------------------------------------- Signature (Signature must conform in all respects to name of holder as specified on the fact face of this Rights Right Certificate) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS DELPHI AUTOMOTIVE SYSTEMS CORPORATION Pursuant to Section 151 of the Delaware General Corporation Law Geoworks I, Xxxxx Xxxxxxxx, Vice President of Delphi Automotive Systems Corporation, a company corporation organized and existing under the laws of the State of Delaware General Corporation Law (the "CompanyCORPORATION"), DOES in accordance with the provisions of Section 151 of such law, DO HEREBY CERTIFY:CERTIFY that pursuant to the authority conferred upon the IPO Committee of the Board of Directors by Board of Directors and upon the Board of Directors by the Amended and Restated Certificate of Incorporation of the Corporation, the IPO Committee of the Board of Directors on February 1, 1999, adopted the following resolution which creates a series of shares of Preferred Stock designated as Series A Junior Preferred Stock, as follows: RESOLVED, that pursuant to Section 151(g) of the Delaware General Corporation Law and the authority vested in the Board of Directors of the Corporation in accordance with the provisions of ARTICLE FOURTH of the Amended and Restated Certificate of Incorporation of the Corporation and delegated to the IPO Committee by the Board of Directors, a series of Preferred Stock of the Corporation be, and hereby is, created, and the powers, designations, preferences and relative,

Appears in 1 contract

Samples: Rights Agreement (Delphi Automotive Systems Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder Holder desires to exercise the Rights Warrants evidenced by this Warrant Certificate.). TO CLEARVIEW CINEMA GROUP, INC. The undersigned hereby (1) TO:__irrevocably elects to exercise_______________ The undersigned hereby irrevocably elects Warrants represented by this Warrant Certificate to exercise purchase__________ shares of Common Stock issuable upon the exercise of such Warrants, (2) makes payment in full of the aggregate Exercise Price for such Warrants by enclosure of a bank cashier's check or money order therefor or by surrendering Warrants or shares of Common Stock for application to the aggregate Exercise Price, upon condition that new Warrants be issued for the balance of the Warrants remaining, and (3) requests that certificates for shares and Warrants be issued in the name of: (Please insert social security or other identifying number) ____________ Rights represented -------------------------------------- (Please print name and address) If such number of Warrants shall not be all the Warrants evidenced by this Rights Warrant Certificate, a new Warrant Certificate to purchase for the shares of Preferred Stock issuable upon the exercise balance remaining of such Rights and requests that certificates for such share(s) Warrants shall be issued registered in the following namename of and delivered to: Please insert social security or other identifying number:_____) ____________ -------------------------------------- (Please insert print name and address) DATED:__________________________________________, 19__ ________________________________________________________________________________ ________________________________________________________________________________ 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----------------------------------- Signature Signature Guaranteed:_________________ ________________________________________________________________________________ ________________________________________________________________________________ Please insert name and address:_________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Dated: ______________, ______ __________________________________________ Signature (Signature must conform in all respects to name of holder as specified on the fact of this Rights Certificate) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION Pursuant to Section 151 of the Delaware General Corporation Law Geoworks Corporation, a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFY:

Appears in 1 contract

Samples: Warrant Agreement (Clearview Cinema Group Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Right Certificate.) TO:_________________ To Church & Xxxxxx, Co., Inc.: The undersigned hereby irrevocably elects to exercise _________________ Rights represented by this Rights Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certificates for such share(s) shares be issued in the following namename of: Please insert social security or other identifying number:_________________ number -------------------------------------------------------------------------------- (Please insert print name and address:____________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ) -------------------------------------------------------------------------------- If such number of Rights shall not be all the Rights evidenced by this Rights Right Certificate, a new Rights 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 insert print name and address:_________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ) -------------------------------------------------------------------------------- Dated: ______________, ____19__ __________________________________________ ------------------------------------------------ Signature (Signature must conform in all respects to name of holder as specified on the fact face of this Rights Right Certificate.) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION Pursuant to Section 151 of the Delaware General Corporation Law Geoworks Corporation, a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFYSignature Guaranteed:

Appears in 1 contract

Samples: Rights Agreement (Church & Dwight Co Inc /De/)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Right Certificate pursuant to Section 11(a)(ii) of the Rights CertificateAgreement.) TO:_________________ To XXXXXX RUBBERMAID INC. The undersigned hereby irrevocably elects to exercise _________________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock 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 insert name and address:____________________________________________ _________________________________________________________________Rights represented by this Right Certificate to purchase the shares of Common Stock or other securities or property 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 identifying number _______________ ________________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new (Please print name and address) The Rights Certificate for indicating the balance remaining balance, if any, of such Rights that 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: (Please insert social security or other identifying number:_______.) (Complete only if the Rights Certificate is to be registered in a name other than the undersigned's.) (Please print name and address) Dated: __________ ________________________________________________________________________________ ________________________________________________________________________________ Please insert name and address:_________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Dated: ______________, ______ __________________________________________ Signature (Signature Guaranteed: Signatures must conform in all respects to name be guaranteed by a member firm of holder as specified on the fact of this Rights Certificate) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION Pursuant to Section 151 a registered national securities exchange, a member of the Delaware General Corporation Law Geoworks CorporationNational Association of Securities Dealers, Inc., or a commercial bank, savings association, credit union or trust company organized and existing under having an office or correspondent in the laws United States or other eligible guarantor institution which is a participant in a signature guarantee medallion program. [Form of Reverse Side of Rights Certificate -- continued] Certificate ----------- The undersigned hereby certifies that by checking the State of Delaware (the "Company"), DOES HEREBY CERTIFYappropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Newell Rubbermaid Inc)

FORM OF ELECTION TO PURCHASE. (To be executed by the registered holder if registered such holder desires to exercise any or all of the Rights represented by this Right Certificate.) TO:_________________ To SciClone Pharmaceuticals, Inc.: The undersigned hereby irrevocably elects to exercise _______________ (___ ________) of the Rights represented by this Rights Right Certificate to purchase the shares of Preferred the Common Stock of the Company, or other securities or property issuable upon the exercise of such said number of Rights and pursuant to the Rights Agreement. The undersigned hereby requests that certificates a certificate for any such share(s) securities and any such property be issued in the following namename of and delivered to: Please insert ------------------------------------------------------------------------------ ------------------------------------------------------------------------------ (Name, address and social security or other identifying numbernumber 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, address and social security or other identifying number of issuee) Dated:_________________ Please insert name and address:___, 19___________. ______________________________ ________________________________________________________________________________ ________________________________________________________________________________ If such number (Signature) Signature Guaranteed: Form of Rights shall not be all Reverse Side of Right Certificate (continued) CERTIFICATE The undersigned hereby certifies by checking 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 numberappropriate boxes that:_________________ ________________________________________________________________________________ ________________________________________________________________________________ Please insert name and address:_________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Dated: ______________, ______ __________________________________________ Signature (Signature must conform in all respects to name of holder as specified on the fact of this Rights Certificate) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION Pursuant to Section 151 of the Delaware General Corporation Law Geoworks Corporation, a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFY:

Appears in 1 contract

Samples: Rights Agreement (Sciclone Pharmaceuticals Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise Rights represented by the Rights Right Certificate.) TO:_________________ To: SOTHEBY’S The undersigned hereby irrevocably elects to exercise _________________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock 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 insert name and address:______________exercise______________________________ Rights represented by this Right Certificate to purchase the Preferred Shares issuable upon the exercise of such Rights and requests that certificates for such Preferred 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 remaining 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 remaining of such Rights shall be registered in the (Please print name of and delivered to: Please insert social security or other identifying number:address) _________________ ________________________________________________________________________________ ________________________________________________________________________________ (Please insert print name and address:_________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ) Dated: ______________, ______ __________________________________________ Signature Signature Guaranteed: Signatures must be guaranteed by a member or participant in the Medallion Signature Guarantee Program at a guarantee level acceptable to the Company’s Transfer Agent. The undersigned hereby certifies that the Rights evidenced by this Right Certificate are not Beneficially Owned by an Acquiring Person or an Affiliate or Associate thereof (Signature must conform as defined in all respects the Agreement) and are not issued with respect to name of holder as specified on the fact of this Rights CertificateNotional Common Shares related to a Derivatives Contract described in clause (iv) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION Pursuant to Section 151 of the Delaware General Corporation Law Geoworks Corporation, a company organized and existing under definition of Beneficial Owner (as such terms are defined in the laws of the State of Delaware (the "Company"Agreement), DOES HEREBY CERTIFY:. Signature

Appears in 1 contract

Samples: Rights Agreement (Sothebys)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights CertificateCertificate pursuant to Section 11(a)(ii) of the Rights Agreement.) TO:_________________ To ALLIED WASTE INDUSTRIES, INC.: The undersigned hereby irrevocably elects to exercise _________________ Rights represented by this Rights Certificate to purchase the shares of Preferred Common Stock (or such other securities of the Company) issuable upon the exercise of such the Rights and requests that certificates for such share(s) shares be issued in the following namename of: Please insert social security or other identifying number:_________________ number -------------------------------------------------------------------------------- The Rights Certificate indicating the balances, if any, of such Rights which may still be exercised pursuant to each of Section 11(a)(ii) and Section 13 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: 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: __________________________________________, 20__ ________________________________________________________________________________ ________________________________________________________________________________ If such number of Rights shall not be all ------------------------------------ Signature Signature Guaranteed: 73 Certificate The undersigned hereby certifies by checking 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 numberappropriate boxes that:_________________ ________________________________________________________________________________ ________________________________________________________________________________ Please insert name and address:_________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Dated: ______________, ______ __________________________________________ Signature (Signature must conform in all respects to name of holder as specified on the fact of this Rights Certificate) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION Pursuant to Section 151 of the Delaware General Corporation Law Geoworks Corporation, a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFY:

Appears in 1 contract

Samples: Rights Agreement (Allied Waste Industries Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires The signature to exercise the foregoing Assignment and Certificate must correspond to the name as written upon the face of this Rights Certificate.) TO:_________________ Certificate in every particular, without alteration or enlargement or any change whatsoever. To: SUIZA FOODS CORPORATION: The undersigned hereby irrevocably elects to exercise _________________ Rights represented by this Rights Certificate to purchase the shares of Preferred Common Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person that may be issuable upon the exercise of the Rights) and requests that certificates for such share(s) shares be issued in the following namename of and delivered to: Please insert social security or other identifying number:_________________ : ---------- Please insert print name and address:____________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ : -------------------------------------- ---------------------------------------------------------------------- If such number of Rights shall are not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance remaining of such Rights shall will be registered in the name of and delivered to: Please insert social security or other identifying number:_________________ ________________________________________________________________________________ ________________________________________________________________________________ : ---------- Please insert print name and address:_________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ : -------------------------------------- ---------------------------------------------------------------------- The undersigned acknowledges that this Election to Purchase is voidable by the Company if it contains any material misstatement of fact by the undersigned. Dated: ______________, ______ __________________________________________ ------------------------- ---------------------------------- Signature (Signature must conform in all respects to name of holder as specified on the fact of this Rights Certificate) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION Pursuant to Section 151 of the Delaware General Corporation Law Geoworks Corporation, a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFYGuaranteed:

Appears in 1 contract

Samples: Rights Agreement (Suiza Foods Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Certificate.) TO:_________________ TO LCA GROUP INC.: The undersigned hereby irrevocably elects to exercise _________________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certificates for such share(s) be issued in the following following: name: Please insert social security or other identifying number:_________________ Please insert name and address:____________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ (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 insert print name and address:_________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ) Dated: ______________, ______ __________________________________________ ----------------- ----- -------------------------------------- Signature (Signature must conform in all respects to name of holder as specified on the fact of this Rights Certificate) Signature Guaranteed: EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION LCA GROUP INC. Pursuant to Section 151 of the Delaware General Corporation Law Geoworks CorporationI, [name], [office] of LCA Group Inc., a company corporation organized and existing under the laws of the State of Delaware General Corporation Law (the "Company"), DOES in accordance with the provisions of Section 151 of such law, DO HEREBY CERTIFYCERTIFY that pursuant to the authority conferred upon the Board of Directors by the Certificate of Incorporation of the Company, the Board of Directors on January __, 2001 adopted the following resolution which creates a series of 150,000 shares of Preferred Stock designated as Series A Preferred Stock, as follows: RESOLVED, that pursuant to Section 151(g) of the Delaware General Corporation Law and the authority vested in the Board of Directors of the Company in accordance with the provisions of ARTICLE IV of the Amended and Restated Certificate of Incorporation of the Company, a series of Preferred Stock of the Company be, and hereby is, created, and the powers, designations, preferences and relative, participating, optional or other special rights of the shares of such series, and the qualifications, limitations or restrictions thereof, be, and hereby are, as follows:

Appears in 1 contract

Samples: Rights Agreement (Lca Corp)

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FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise Rights represented by the Rights Certificate.) TO:_________________ To: SOFTECH, INC. The undersigned hereby irrevocably elects to exercise _________________ Rights represented by this Rights Right Certificate to purchase the shares of Preferred Common Stock (or other securities or property) issuable upon the exercise of such Rights and requests that certificates for such share(sshares of Common Stock (or such other securities) be issued in the following namename of: Please insert social security or other identifying number:_________________ Please insert name and address:____________________________________________ ________________________________________________________________________________ _______(Please print name and address) _________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Rights Right Certificate, a new Rights 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 insert print name and address:_________________________________________________ ________________________________________________________________________________ _______) _________________________________________________________________________ Dated: :______________, __________ __________________________________________ Signature (Signature must conform in all respects to name of holder as specified on the fact of this Rights Right Certificate) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION Pursuant to Section 151 Signature Guaranteed: Signature must be guaranteed by a bank, trust company, broker, dealer or other eligible institution participating in a recognized signature guarantee medallion program. Form of Reverse Side of Right Certificate - continued _________________________________________________________________________ (To be completed) The undersigned certifies that the Delaware General Corporation Law Geoworks CorporationRights evidenced by this Right Certificate are not beneficially owned by, a company organized and existing under were not acquired by the laws of undersigned from, an Acquiring Person or an Affiliate or Associate thereof (as defined in the State of Delaware (the "Company"Rights Agreement), DOES HEREBY CERTIFY:. __________________________________________ Signature

Appears in 1 contract

Samples: Rights Agreement (Softech Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Right Certificate.) TO:TO _________________ _____: The undersigned hereby irrevocably elects to exercise _________________ Rights represented by this Rights Right Certificate to purchase the shares of Preferred Stock 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 insert print name and address:____________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ) If such number of Rights shall not be all the Rights evidenced by this Rights Right Certificate, a new Rights 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 insert print name and address:_________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ) Dated: ______________, ______ __________________________________________ Signature (Signature must conform in all respects to name of holder as specified on the fact face of this Rights Right Certificate) Signature Guaranteed: EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS B FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION STAGE STORES, INC. Pursuant to Section 151 of the Delaware General Corporation Law Geoworks CorporationI, ____________, ____________ of Stage Stores, Inc., a company corporation organized and existing under the laws of the State of Delaware General Corporation Law (the "Company"), DOES in accordance with the provisions of Section 151 of such law, DO HEREBY CERTIFYCERTIFY that pursuant to the authority conferred upon the Board of Directors by the Restated Certificate of Incorporation of the Company, the Board of Directors on November 11, 1998 adopted the following resolution which creates a series of shares of Preferred Stock designated as Series A Junior Preferred Stock, as follows: RESOLVED, that pursuant to Section 151(g) of the Delaware General Corporation Law and the authority vested in the Board of Directors of the Company in accordance with the provisions of ARTICLE FOURTH of the Restated Certificate of Incorporation of the Company, a series of Preferred Stock of the Company be, and hereby is, created, and the powers, designations, preferences and relative, participating, optional or other special rights of the shares of such series, and the qualifications, limitations or restrictions thereof, be, and hereby are, as follows:

Appears in 1 contract

Samples: Stage Stores Inc

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Certificate.RIGHTS CERTIFICATE) TO:_________________ To: MED/WASTE, INC. The undersigned hereby irrevocably elects to exercise _________________ ---------------- Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise exer cise of such Rights and requests that certificates for such share(s) shares be issued in the following namename of: Please insert social security or other identifying number:_________________ : -------------------- ------------------------------------------------------------------------------- (Please insert 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 insert print name and address:_________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ) ------------------------------------------------------------------------------- Dated: ______________, ______ __________________________________________ ---------- ----------------------------------- Signature (Signature must conform in all respects to name of holder as specified on the fact face of this Rights CertificateRIGHTS CERTIFICATE) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION Pursuant to Section 151 of the Delaware General Corporation Law Geoworks Corporation, a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFYSignature Guaranteed:

Appears in 1 contract

Samples: Rights Agreement (Med Waste Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Right Certificate.) TO:_________________ TO : --------------------- The undersigned hereby irrevocably elects to exercise _________________ Rights represented by this Rights Right Certificate to purchase the shares of Preferred Stock 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 insert print name and address:____________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ) ------------------------------------------------------------------------------- If such number of Rights shall not be all the Rights evidenced by this Rights Right Certificate, a new Rights 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 insert print name and address:_________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ) ------------------------------------------------------------------------------- Dated: ______________-------------, ______ __________________________________________ ---- --------------------------------------------- Signature (Signature must conform in all respects to name of holder as specified on the fact of this Rights Right Certificate) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE TERMS OF DESIGNATIONS FORM OF CERTIFICATE OF DESIGNATIONS OF THE SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION Pursuant to Section 151 of the Delaware General Corporation Law Geoworks Corporation, a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFY:STOCK

Appears in 1 contract

Samples: Rights Agreement (Usw-C Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights CertificateCertificate pursuant to Section 11(a)(ii) of the Rights Agreement.) TO:_________________ To AGOURON PHARMACEUTICALS, INC.: The undersigned hereby irrevocably elects to exercise _________________ Rights represented by this Rights Certificate to purchase the shares Common Shares (or such other securities of Preferred Stock the Company) issuable upon the exercise of such the Rights and requests that certificates for such share(s) shares be issued in the following namename of: ---------------------------------------------------------------- (Please insert social security or other identifying number:_________________ ) ---------------------------------------------------------------- (Please insert print name and address:____________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new ) ---------------------------------------------------------------- The Rights Certificate for shall be returned to the balance remaining undersigned (indicating the balance, if any, of such Rights shall which may still be exercised pursuant to Section 11(a)(ii) of the Rights Agreement) unless such Person requests that the Rights Certificate be registered in the name of and delivered to: ---------------------------------------------------------------- Please insert social security or other identifying number:_________________ ________________________________________________________________________________ ________________________________________________________________________________ number (complete only if Rights Certificate is to be registered in a name other than the undersigned) ---------------------------------------------------------------- (Please insert print name and address:_________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ) ---------------------------------------------------------------- Dated: ______________. ---------------------------------- Signature Signature Guaranteed: Signatures must be guaranteed by an Eligible Guarantor Institution, ______ __________________________________________ Signature (Signature must conform as defined in all respects to name of holder as specified on the fact of this Rights Certificate) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION Pursuant to Section 151 of the Delaware General Corporation Law Geoworks Corporation, a company organized and existing Rule 17Ad-15 under the laws Securities Exchange Act of the State of Delaware (the "Company"), DOES HEREBY CERTIFY:1934.

Appears in 1 contract

Samples: Rights Agreement (Agouron Pharmaceuticals Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires The signature to exercise the foregoing Assignment and Certificate must correspond to the name as written upon the face of this Rights Certificate.) TO:_________________ Certificate in every particular, without alteration or enlargement or any change whatsoever. To: SUIZA FOODS CORPORATION: The undersigned hereby irrevocably elects to exercise _________________ Rights represented by this Rights Certificate to purchase the shares of Preferred Common Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person that may be issuable upon the exercise of the Rights) and requests that certificates for such share(s) shares be issued in the following namename of and delivered to: Please insert social security or other identifying number:_________________ : ------------- Please insert print name and address:____________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ : ---------------------------------------- ----------------------------------------------------------------------- If such number of Rights shall are not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance remaining of such Rights shall will be registered in the name of and delivered to: Please insert social security or other identifying number:_________________ ________________________________________________________________________________ ________________________________________________________________________________ : ------------- Please insert print name and address:_________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ : ---------------------------------------- ----------------------------------------------------------------------- The undersigned acknowledges that this Election to Purchase is voidable by the Company if it contains any material misstatement of fact by the undersigned. Dated: ______________, ______ __________________________________________ ------------------------ --------------------------------------------- Signature (Signature must conform in all respects to name of holder as specified on the fact of this Rights Certificate) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION Pursuant to Section 151 of the Delaware General Corporation Law Geoworks Corporation, a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFYGuaranteed:

Appears in 1 contract

Samples: Rights Agreement (Suiza Foods Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise Rights represented by the Rights Certificate.) TO:_________________ To: DRIL-QUIP, INC. The undersigned hereby irrevocably elects to exercise _________________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person that may be issuable upon the exercise of the Rights) and requests that certificates for such share(sshares (or other securities) be issued in the following namename of and delivered to: Please insert social security or other identifying number:_________________ number ------------------------------------------------------------------------------- (Please insert 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:_________________ ________________________________________________________________________________ ________________________________________________________________________________ number ------------------------------------------------------------------------------- (Please insert print name and address:_________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ) ------------------------------------------------------------------------------- Dated: ______________, ____199__ __________________________________________ ---------------------------------- Signature (Signature Guaranteed: Signatures must conform in all respects to name be guaranteed by a member firm of holder as specified on the fact of this Rights Certificate) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION Pursuant to Section 151 a national securities exchange, a member of the Delaware General Corporation Law Geoworks CorporationNational Association of Securities Dealers, Inc., a commercial bank or trust company organized and existing having an office or correspondent in the United States or another eligible guarantor institution (as defined pursuant to Rule 17Ad-15 under the laws Securities Exchange Act of the State of Delaware (the "Company"1934, as amended), DOES HEREBY CERTIFY:.

Appears in 1 contract

Samples: Rights Agreement (Dril-Quip Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Right Certificate.) TO:_________________ TO NEW PLAN REALTY TRUST: The undersigned hereby irrevocably elects to exercise ______________________ Rights represented by this Rights Right Certificate to purchase the shares Shares of Preferred Stock Beneficial Interest 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 insert print name and address:____________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ) -------------------------------------------------------------------------------- If such number of Rights shall not be all the Rights evidenced by this Rights Right Certificate, a new Rights 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 insert print name and address:_________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ) -------------------------------------------------------------------------------- Dated: _______________, ____19__ __________________________________________ ------------------------------------ Signature (Signature must conform in all respects to name of holder as specified on the fact of this Rights Right Certificate) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION Pursuant to Section 151 of the Delaware General Corporation Law Geoworks Corporation, a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFY:

Appears in 1 contract

Samples: Rights Agreement (New Plan Realty Trust)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Right Certificate.) TO:_________________ To Equifax Inc.: The undersigned hereby irrevocably elects to exercise _________________ Rights represented by this Rights Right Certificate to purchase the shares of Preferred Stock Common Shares or other securities issuable upon the exercise of such Rights and requests that certificates for such share(s) securities be issued in the following namename of: Please insert social security or other identifying number:_________________ Please insert name and address:____________________________________________ : ________________________________________________________________________________ ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Rights Right Certificate, a new Rights 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 insert print name and address:_________________________________________________ ) ________________________________________________________________________________ _____________________________________________________________________Optional Election to Exercise without Payment of Cash: With respect to the exercise of ___________ of the Rights specified above, the undersigned hereby elects to exercise such Rights without payment of cash and to receive a number of Common Shares or other securities having a value (as determined pursuant to the Rights Agreement) equal to the difference between (i) the value of the Common Shares or other securities that would have been issuable upon the exercise thereof upon payment of the cash amount as provided in the Rights Agreement, and (ii) the amount of such cash payment. Dated: ______________, ____19__ __________________________________________ Signature (Signature must conform in all respects to name of holder as specified on Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the fact of this Rights Certificate) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION Pursuant to Section 151 of the Delaware General Corporation Law Geoworks Corporation, a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFYappropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Equifax Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights CertificateWarrant certificate.) TO:_________________ The undersigned hereby irrevocably elects to exercise _________________ Rights Warrants represented by this Rights Warrant Certificate to purchase the shares of Preferred Common Stock issuable upon the exercise of such Rights Warrants and requests that certificates for such share(s) shares be issued in the following namename of: Please insert social security or other identifying number:_________________ number -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- (Please insert print name and address:) If such number of Warrants shall not be all the Warrants evidenced by this Warrant Certificate, a new Warrant Certificate for the balance remaining of such Warrants 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__ ________________________________________________________________________________ ________________________________________________________________________________ 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 insert name and address:_________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Dated: ______________, ______ __________________________________________ ------------------------------------------- Signature (Signature must conform in all respects to name of holder as specified on the fact face of this Rights Warrant Certificate) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION Pursuant to Section 151 of the Delaware General Corporation Law Geoworks Corporation, a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFY:

Appears in 1 contract

Samples: New Century Financial Corp

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Right Certificate.) TO:_________________ TO -------------------------: The undersigned hereby irrevocably elects to exercise _________________ ---------------- Rights represented by this Rights Right Certificate to purchase the shares of Preferred Stock 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 insert print name and address:____________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ) -------------------------------------------------------------------------------- If such number of Rights shall not be all the Rights evidenced by this Rights Right Certificate, a new Rights 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 insert print name and address:_________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ) -------------------------------------------------------------------------------- Dated: __-------------- -----, --------- ---------------------------------------- Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate) FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PREFERRED STOCK OF DELPHI AUTOMOTIVE SYSTEMS CORPORATION Pursuant to Section 151 of the Delaware General Corporation Law I, ____________, ______ __________________________________________ Signature of Delphi Automotive Systems Corporation, a corporation organized and existing under the Delaware General Corporation Law (Signature must conform the "CORPORATION"), in all respects accordance with the provisions of Section 151 of such law, DO HEREBY CERTIFY that pursuant to name the authority conferred upon the IPO Committee of holder the Board of Directors by Board of Directors and upon the Board of Directors by the Amended and Restated Certificate of Incorporation of the Corporation, the IPO Committee of the Board of Directors on February __, 1999, adopted the following resolution which creates a series of shares of Preferred Stock designated as specified on the fact of this Rights Certificate) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES Series A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION Pursuant Junior Preferred Stock, as follows: RESOLVED, that pursuant to Section 151 151(g) of the Delaware General Corporation Law Geoworks Corporationand the authority vested in the Board of Directors of the Corporation in accordance with the provisions of ARTICLE FOURTH of the Amended and Restated Certificate of Incorporation of the Corporation and delegated to the IPO Committee by the Board of Directors, a company organized and existing under the laws series of Preferred Stock of the State of Delaware (Corporation be, and hereby is, created, and the "Company")powers, DOES HEREBY CERTIFY:designations, preferences and relative,

Appears in 1 contract

Samples: Rights Agreement (Delphi Automotive Systems Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise Rights represented by the Rights Certificate.) TO:_________________ To: EGL, INC. The undersigned hereby irrevocably elects to exercise _________________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person that may be issuable upon the exercise of the Rights) and requests that certificates for such share(sshares (or other securities) be issued in the following namename of and delivered to: Please insert social security or other identifying number:_________________ Please insert name and address:____________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ number -------------------------------------------------------------------------------- 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:_________________ ________________________________________________________________________________ ________________________________________________________________________________ number -------------------------------------------------------------------------------- (Please insert print name and address:_________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ) -------------------------------------------------------------------------------- Dated: ______________, ______ __________________________________________ 200 ------------ --- --------------------------------- Signature (Signature Guaranteed: Signatures must conform in all respects to name be guaranteed by a member firm of holder as specified on the fact of this Rights Certificate) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION Pursuant to Section 151 a national securities exchange, a member of the Delaware General Corporation Law Geoworks CorporationNational Association of Securities Dealers, Inc., a commercial bank or trust company organized and existing having an office or correspondent in the United States or another eligible guarantor institution (as defined pursuant to Rule 17Ad-15 under the laws Securities Exchange Act of 1934, as amended). CERTIFICATE The undersigned hereby certifies by checking the State of Delaware (the "Company"), DOES HEREBY CERTIFYappropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Egl Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise Rights represented by the Rights Certificate.) TO:_________________ To: COMPANY ------------------------ The undersigned hereby irrevocably elects to exercise _________________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person that may be issuable upon the exercise of the Rights) and requests that certificates for such share(sshares (or other securities) be issued in the following namename of and delivered to: Please insert social security or other identifying number:_________________ number -------------------------------------------------------------------------------- (Please insert 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:_________________ ________________________________________________________________________________ ________________________________________________________________________________ number -------------------------------------------------------------------------------- (Please insert print name and address:_________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ) -------------------------------------------------------------------------------- Dated: ______________, ______ __________________________________________ 199 ------------ ---------------------------------------- Signature (Signature Guaranteed: Signatures must conform in all respects to name be guaranteed by a member firm of holder as specified on the fact of this Rights Certificate) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION Pursuant to Section 151 a national securities exchange, a member of the Delaware General Corporation Law Geoworks CorporationNational Association of Securities Dealers, Inc., a commercial bank or trust company organized and existing having an office or correspondent in the United States or another eligible guarantor institution (as defined pursuant to Rule 17Ad-15 under the laws Securities Exchange Act of the State of Delaware (the "Company"1934, as amended), DOES HEREBY CERTIFY:.

Appears in 1 contract

Samples: Rights Agreement (Pennzoil Products Co)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Certificate.Warrants) TO:_______: SOMANETICS CORPORATION The undersigned hereby irrevocably elects to exercise Warrants represented by this Warrant Certificate to purchase __________ The undersigned hereby irrevocably elects to exercise _________________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock Common Shares issuable upon the exercise of such Rights Warrants and requests that certificates for such share(s) Common Shares be issued in the following namename of: Please insert social security security, tax identification or other identifying number:_________________ Please insert name and address:____________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ number ------------------------------------- ------------------------------------- ------------------------------------- If such number of Rights shall Warrants is not be all the Rights Warrants evidenced by this Rights Warrant Certificate, a new Rights Warrant Certificate for the balance remaining of such Rights Warrants shall be registered in the name of and delivered to: Please insert social security security, tax identification or other identifying number:_________________ ________________________________________________________________________________ ________________________________________________________________________________ number ------------------------------------- ------------------------------------- ------------------------------------- (Please insert print name and address:_________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ) Dated: ______________, ______ __________________________________________ -------------------------------------- ----------------------------------- Signature (Signature must conform in all respects to name of holder as specified on the fact face of this Rights Warrant Certificate) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION Pursuant to Section 151 of the Delaware General Corporation Law Geoworks Corporation, a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFYSignature Guaranteed:

Appears in 1 contract

Samples: Warrant Agreement (Somanetics Corp)

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