INFORMATION IN RESPONSE TO THIS. SECTION WILL BE KEPT STRICTLY CONFIDENTIAL OMNIBUS SIGNATURE PAGE TO THE SUBSCRIPTION AGREEMENT TO PURCHASE SAFETY QUICK LIGHTING & FAN CORP.’S COMMON STOCK DOLLAR AMOUNT INVESTED: US $ NUMBER OF SHARES SUBSCRIBED FOR: AMOUNT INVESTED TO BE SENT VIA: [ ] Check (enclosed) [ ] Wire NAME IN WHICH THE SECURITIES SHOULD BE ISSUED:
INFORMATION IN RESPONSE TO THIS. SECTION WILL BE KEPT STRICTLY CONFIDENTIAL DOLLAR AMOUNT INVESTED $_____________________________ AND/OR $____________________________ Face Amount of Note: ___% Interest and ___% Warrant ___% Interest and ____% Warrant AMOUNT INVESTED TO BE SENT VIA: □ Check (enclosed) □ Wire Name in Which Note and Warrants Should Be Issued: ______________________________________________________________________________________________ Address Information: For individual subscribers this address should be the Subscriber’s primary legal residence. For entities other than individual subscribers, please provide address information for the entities primary place of business. Information regarding a joint subscriber should be included in the column at right. ________________________________________________ Legal Address ________________________________________________ Legal Address _________________________________________ City, State, and Zip Code _________________________________________ City, State, and Zip Code Alternate Address Information: Subscribers who wish to receive correspondence at an address other than the address listed above should complete the Alternate Address section below. _________________________________________ Alternate Address for Correspondence _________________________________________ Alternate Address for Correspondence _________________________________________ City, State and Zip Code _________________________________________ City, State and Zip Code _________________________________________ Telephone _________________________________________ Telephone _________________________________________ Tax ID # or Social Security # _________________________________________ Tax ID # or Social Security # AGREED AND SUBSCRIBED This ___ day of ___________, _____ By:_________________________________ Name:_______________________________ Title (if any): _________________________ ACCEPTED This ___ day of ___________, _____ By:_________________________________ Name: Xxxxx X. Hills Title: President & CEO CERTIFICATE OF SIGNATORY (To be completed if the Securities are being subscribed for by an entity) I, ___________________________________________, am the_______________________________ of _____________________________________________ (the “Entity”). I certify that I am empowered and duly authorized by the Entity to execute and carry out the terms of the Securities Purchase Agreement and to purchase and hold the Notes and Warrants, and certify further that the Securities...
INFORMATION IN RESPONSE TO THIS. SECTION WILL BE KEPT STRICTLY CONFIDENTIAL DOLLAR AMOUNT INVESTED $_____________________________ AMOUNT INVESTED TO BE SENT VIA: ☐ Check (enclosed) ☐ Wire Name in Which Note and Warrants Should Be Issued: Address Information: For individual subscribers this address should be the Subscriber’s primary legal residence. For entities other than individual subscribers, please provide address information for the entities primary place of business. Information regarding a joint subscriber should be included in the column at right Legal Address Legal Address City, State, and Zip Code City, State, and Zip Code AGREED AND SUBSCRIBED ACCEPTED This ___ day of _________, 2017 This ___ day of _______, 2017 By: By: Name: Name: Xxxxxx Xxxxxxx Title (if any): Title: Chief Executive Officer CERTIFICATE OF SIGNATORY (To be completed if the Securities are being subscribed for by an entity) I, ,am the _______________________________ of _____________________________________________ (the “Entity”). I certify that I am empowered and duly authorized by the Entity to execute and carry out the terms of the Securities Purchase Agreement and to purchase and hold the Notes and Warrants, and certify further that the Securities Purchase Agreement has been duly and validly executed on behalf of the Entity and constitutes a legal and binding obligation of the Entity.
INFORMATION IN RESPONSE TO THIS. SECTION WILL BE KEPT STRICTLY CONFIDENTIAL OMNIBUS SIGNATURE PAGE TO THE SUBSCRIPTION AGREEMENT TO PURCHASE SAFETY QUICK LIGHTING & FAN CORP.’S COMMON STOCK DOLLAR AMOUNT INVESTED: US $ __________________________________ NUMBER OF SHARES SUBSCRIBED FOR: ____________________________ AMOUNT INVESTED TO BE SENT VIA: [ ] Check (enclosed) [ ]Wire NAME IN WHICH THE SECURITIES SHOULD BE ISSUED: _________________________________________________________________
INFORMATION IN RESPONSE TO THIS. SECTION WILL BE KEPT STRICTLY CONFIDENTIAL OMNIBUS SIGNATURE PAGE TO THE SUBSCRIPTION AGREEMENT TO PURCHASE SQL TECHNOLOGIES CORP.’S COMMON STOCK DOLLAR AMOUNT INVESTED: US $ NUMBER OF SHARES SUBSCRIBED FOR: AMOUNT INVESTED TO BE SENT VIA: ☐ Check (enclosed) ☐ Wire NAME IN WHICH THE SECURITIES SHOULD BE ISSUED: SUBSCRIBER ADDRESS INFORMATION: For individual subscribers this address should be the Subscriber’s primary legal residence. For entities other than individual subscribers, please provide address information for the entities primary place of business. Information regarding a joint subscriber should be included in the column at right. Legal Address Legal Address City, State and Zip Code City, State and Zip Code Tax ID (EIN, SSN, OR ITIN) Tax ID (EIN, SSN, OR ITIN) Telephone Number / Facsimile Number Telephone Number / Facsimile Number Email Address Email Address ALTERNATE ADDRESS INFORMATION: Please enter an alternate address if you wish to receive correspondence at an address other than the address listed above. Alternative Address for Correspondence Alternative Address for Correspondence City, State and Zip Code City, State and Zip Code Other (telephone, fax, email) Other (telephone, fax, email) AGREED AND SUBSCRIBED AGREED AND SUBSCRIBED This ___ day of __________, 2020 This ___ day of __________, 2020 Subscriber: SQL TECHNOLOGIES CORP. By: By: Name: Jxxx X. Xxxxx Title: Chief Executive Officer
