FORM OF SUBSCRIPTION. (To be signed only upon exercise of Warrant)
FORM OF SUBSCRIPTION. (To be signed only upon exercise of Option)
FORM OF SUBSCRIPTION. TO: Nexaira Wireless Inc. 1404 – 000 Xxxx Xxxxxxxx Xxxxxx Xxxxxxxxx, Xxxxxxx Xxxxxxxx Xxxxxx X0X 0X0 The undersigned Holder of the within Warrants hereby subscribes for ____________ common shares (the “Shares”) of Nexaira Wireless Inc. (the “Company”) pursuant to the within Warrants at US$1.50 per Share on the terms specified in the said Warrants. This subscription is accompanied by a certified cheque or bank draft payable to or to the order of the Company for the whole amount of the purchase price of the Shares. The undersigned represents that, at the time of the exercise of these Warrants, all of the representations and warranties contained in Section 6 of the Subscription Agreement between the Company and the undersigned pursuant to which these Warrants were issued are true and accurate. The undersigned hereby directs that the Shares be registered as follows: TOTAL: (Please print full name in which share certificates are to be issued, stating whether Mr., Mrs. or Miss is applicable). DATED this ________ day of __________________, ______. In the presence of: Signature of Witness Signature of Warrant Holder
FORM OF SUBSCRIPTION. [To be executed only upon exercise of Warrant] To Simmxxx Xxxdings, Inc.: The undersigned registered holder of the within Warrant hereby irrevocably exercises such Warrant for, and purchases thereunder, __________ (1) shares of the Common Stock and herewith makes payment of $___________ therefor, and requests that the certificates for such shares be issued in the name of, and deliver to _____________, whose address is Dated: ---------------------------- (Signature must conform in all respects to name of holder as specified on the face of Warrant) --------------------------------- (Street Address) --------------------------------- (City) (State) (Zip Code)
FORM OF SUBSCRIPTION. (To be executed only upon exercise of Warrant) To _________________ The undersigned registered holder of the within Warrant hereby irrevocably exercises such Warrant for, and purchases thereunder, ________ shares of Common Stock of PERMA-FIX ENVIRONMENTAL SERVICES, INC., a Delaware corporation, and herewith makes payment of $________ therefor [by application pursuant to section 1.5 of such Warrant of $________ aggregate principal amount of Notes (as defined in such Warrant) plus $________ accrued interest thereon] [by cashless exercise pursuant to section 1.6 of such Warrant], and requests that the certificates for such shares be issued in the name of, and delivered to ________ whose address is ________. [The undersigned hereby instructs you to credit the principal amount of each Note so applied against the installments of principal remaining unpaid on such Note in the ________ order of their maturity dates.] Dated: ______________ ________________________ (Signature must conform in all respects to name of holder as specified on the face of this Warrant) [insert address] _______________________________ 1Insert here the number of shares called for on the face of this Warrant (or, the case of a partial exercise, the portion thereof as to which thgis Warrant is being exercised), in either case without making any adjustment for (i) additional Common Stock or any other stock or other securities or property or cash which, pursuant to the adjustment provisions of this Warrant, may be delivered upon exercise of (ii) a payment effected by cashless exercise pursuant to section 1.6 of this Warrant. In the case of a partial exercise, a new warrant or Warrants will be issued and delivered, representing the unexercised portion of this Warrant, to the holder surrendering the same. 2Delete inapplicable language in brackets.
FORM OF SUBSCRIPTION. TO: Colorado Goldfields Inc. 00000 X. Xxxxxxx Xxxxxx, Xxxxx 000 Xxxxxxxx, Xxxxxxxx, XXX 00000 The undersigned Holder of the within Warrants hereby subscribes for ____________ common shares (the "Shares") of Colorado Goldfields Inc. (the "Company") pursuant to the within Warrants at US$1.00 per Share on the terms specified in the said Warrants. This subscription is accompanied by a certified cheque or bank draft payable to or to the order of the Company for the whole amount of the purchase price of the Shares. The undersigned represents that, at the time of the exercise of these Warrants, all of the representations and warranties contained in Section 6 of the Subscription Agreement between the Company and the undersigned pursuant to which these Warrants were issued are true and accurate. The undersigned hereby directs that the Shares be registered as follows: TOTAL: (Please print full name in which share certificates are to be issued, stating whether Mr., Mrs. or Miss is applicable). DATED this __________ day of __________________, _______. In the presence of: __________________________________________ __________________________________________ Signature of Witness Signature of Warrant Holder Name (Mr./Mrs./Miss) _________________________________________________________ Address _________________________________________________________ _________________________________________________________
FORM OF SUBSCRIPTION. TO: Pan American Gold Corporation Suite 605 – 000 Xxxx Xxxxxx Vancouver, BC V6C 2B3 The undersigned Holder of the within Warrants hereby subscribes for __________ common shares (the “Shares”) of Pan American Gold Corporation (the “Company) pursuant to the within Warrants at US$0.80 per Share on the terms specified in the said Warrants. This subscription is accompanied by a certified cheque or bank draft payable to or to the order of the Company for the whole amount of the purchase price of the Shares. The undersigned Holder hereby certifies that the undersigned is not a U.S. person and is not subscribing for the Shares on behalf of a U.S. person. The undersigned hereby directs that the Shares be registered as follows:
FORM OF SUBSCRIPTION. (To be signed only upon exercise of Warrant) To River Oaks Furniture, Inc. The undersigned, the Holder of the within Warrant, hereby irrevocably elects to exercise the purchase right represented by such Warrant for, and to purchase thereunder, ________(1) shares of Common Stock of River Oaks Furniture, Inc. and herewith makes payment of $______ therefor, and requests that the certificate or certificates for such shares be issued in the name of and delivered to the undersigned. Dated ------------------------------------------ (Signature must conform in all respects to name of Holder as specified on the face of the Warrants) ------------------------------------------ (Address) --------
(1) Insert here the maximum number of shares or, in the case of a partial exercise, the portion thereof as to which the Warrant is being exercised.
FORM OF SUBSCRIPTION. [To be executed only upon exercise of Warrant]
FORM OF SUBSCRIPTION. TO: Eden Energy Corp. 1925 – 000 Xxxxxxx Xxxxxx Xxxxxxxxx, XX X0X 0X0 The undersigned Holder of the within Warrants hereby subscribes for ____________ common shares (the “Shares”) of Eden Energy Corp. (the “Company) pursuant to the within Warrants at [US$3.25 or US$5.25] per Share on the terms specified in the said Warrants. This subscription is accompanied by a certified cheque or bank draft payable to or to the order of the Company for the whole amount of the purchase price of the Shares. The undersigned hereby directs that the Shares be registered as follows: TOTAL: (Please print full name in which share certificates are to be issued, stating whether Mr., Mrs. or Miss is applicable). DATED this ________ day of __________________, 2006. In the presence of: Signature of Witness Signature of Warrant Holder
