Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified or official bank check, in each case payable to the Company, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder must provide the information required below and deliver this Warrant Certificate to the Company at the address set forth below. The Warrant Certificate and this Election to Purchase must be received by the Company by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), Warrants, evidenced by this Warrant Certificate, to purchase, of the shares of Common Stock (each a “Share”) of Homeowners Choice, Inc., a Florida corporation (the “Company”), and represents that, on or before the Exercise Date, such holder has tendered payment for such Shares by certified or official bank check to the order of the Company, in the amount of $ in accordance with the terms hereof. The undersigned requests that said number of Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Shares is less than all of the Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: , Name: (Please Print) (Insert Social Security or Other Identifying Number of Holder) Address:
Appears in 3 contracts
Samples: Warrant Agreement (Homeowners Choice, Inc.), Warrant Agreement (Homeowners Choice, Inc.), Warrant Agreement (Homeowners Choice, Inc.)
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder Holder must, by 5:00 P.M.p.m., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a bank wire transfer in immediately available funds, in each case payable to the Company, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder Holder must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M.p.m., New York City time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on __________, ____ (the “Exercise Date”), __________ Warrants, evidenced by this Warrant Certificate, to purchase, of __________ shares (the shares of Common Stock (each a “ShareWarrant Shares”) of Homeowners ChoiceCommon Stock, par value of $0.001 per share (the “Common Stock”) of WaferGen Bio-systems, Inc., a Florida Nevada corporation (the “Company”), and represents that, that on or before the Exercise Date, : o such holder Holder has tendered payment for such Warrant Shares by certified or official bank check payable to the order of the CompanyCompany c/o Continental Stock Transfer & Trust Co., 00 Xxxxxxx Xxxxx, 0xx Xxxxx, Xxx Xxxx, Xxx Xxxx 00000, or by bank wire transfer in immediately available funds payable to the Company at Account No. [ ], in each case in the amount of $ $_______ in accordance with the terms hereof, or o [if permitted] the cancellation of such number of Warrant Shares as is necessary, in accordance with the formula set forth in subsection 3.3.9 of the Warrant Agreement, to exercise this Warrant with respect to the maximum number of Warrant Shares purchasable pursuant to the cashless exercise procedure set forth in subsection 3.3.9. The undersigned requests that said number of Warrant Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Warrant Shares is less than all of the Warrant Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder Holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: ________ __, ____ Name: _________________________________________ (Please Printplease print) / / / / - / / / - / / / / / (Insert Social Security or Other Identifying Number of Holder) Address ___________________________________________________ ___________________________________________________ Signature __________________________ This Warrant may only be exercised by presentation to the Warrant Agent at one of the following locations: By hand at: Continental Stock Transfer & Trust Co. 00 Xxxxxxx Xxxxx, 0xx Xxxxx Xxx Xxxx, Xxx Xxxx 00000 By mail at: Continental Stock Transfer & Trust Co. 00 Xxxxxxx Xxxxx, 0xx Xxxxx Xxx Xxxx, Xxx Xxxx 00000 The method of delivery of this Warrant Certificate is at the option and risk of the exercising Holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to ensure timely delivery. Instructions as to form and delivery of Warrant Shares and/or Warrant Certificates Name in which Warrant Shares are to be registered if other than in the name of the Holder of this Warrant Certificate: _________________________________________ (Name) Address to which Warrant Shares are to be mailed if other than to the address of the Holder of this Warrant Certificate as shown on the books of the Warrant Agent: _________________________________________ (Street Address:) _________________________________________ (City and State)(Zip Code) Name in which Warrant Certificate evidencing unexercised Warrants, if any, is to be registered if other than in the name of the Holder of this Warrant Certificate: _________________________________________ (Name) Address to which certificate representing unexercised Warrants, if any, is to be mailed if other than to the address of the Holder of this Warrant Certificate as shown on the books of the Warrant Agent: _________________________________________ (Street Address) _________________________________________ (City and State)(Zip Code) Dated: _________________________________________ Signature: _________________________________________ Signature must conform in all respects to the name of the Holder as specified on the face of this Warrant Certificate. If Warrant Shares, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the Holder hereof or are to be delivered to an address other than the address of such Holder as shown on the books of the Warrant Agent, the above signature must be guaranteed by an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm Address Tel: Authorized Signature Name Title Dated: ________________, 20___ ASSIGNMENT (FORM OF ASSIGNMENT TO BE EXECUTED IF WARRANT HOLDER DESIRES TO TRANSFER WARRANTS EVIDENCED HEREBY) FOR VALUE RECEIVED, ____________ HEREBY SELL(S), ASSIGN(S) AND TRANSFER(S) UNTO: ______________________________________________ (Name of Assignee) ______________________________________________ (Xxxxxx Xxxxxxx) ______________________________________________ (City and State)(Zip Code) ______________________________________________ (Social Security or Other Identifying Number of Assignee) the rights represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint ___________________ Attorney to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. Dated: _________________________________________ Signature: _______________________________________ Signature must conform in all respects to the name of the Holder as specified on the face of this Warrant Certificate. If Warrant Shares, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the Holder hereof or are to be delivered to an address other than the address of such Holder as shown on the books of the Warrant Agent, the above signature must be guaranteed by a an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm Address Tel: Authorized Signature Name Title Dated: ________________, 20___
Appears in 2 contracts
Samples: Warrant Agreement (WaferGen Bio-Systems, Inc.), Warrant Agreement (WaferGen Bio-Systems, Inc.)
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder must, must pay [in United States dollars][in applicable currency] [in cash] [by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck or by bank wire transfer, in each case payable to case] [by bank wire transfer] [in immediately available funds], the Company, in an amount equal to the Exercise Warrant Price in full for Warrants exercised to [insert of name of Warrant Agent] [corporate trust department] [insert address of Warrant Agent], Attention: ______________________ [or ________________], which [payment] [wire transfer] must specify the name of the Holder and the number of Warrants exercisedexercised by such Holder. In addition, the Warrant holder Holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth below. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified [payment] [wire transfer]. To be Executed Upon Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY of Warrant The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise __________ Warrants, evidenced by this Warrant Certificate, to purchase, purchase ________ shares of the shares [Title of Common Stock Warrant Securities] (each a “Share”the "Warrant Securities") of Homeowners Choice, Inc., a Florida corporation (the “Company”), Company and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Securities [in United States dollars] [in applicable currency] [in cash] [by certified check or official bank check or by bank wire transfer, in each case] [by bank wire transfer] [in immediately available funds] to the order of the CompanyCredit Suisse First Boston (USA), Inc., c/o [insert name and address of Warrant Agent], in the amount of $ ___________ in accordance with the terms hereof. The undersigned requests that said number principal amount of Shares Warrant Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. [If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing representing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated.] Date: , ___________________ Name: (Please Print) :_________________ Address_______________ _________________________ ______________________ (Insert Social Security or Other Identifying Number of Holder) Address:Signature Guaranteed Signature -------------------------- --------------------------------------- (Signature must conform in all respects to name of holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a bank, trust company or member broker of the New York, Midwest or Pacific Stock Exchange) The Warrants evidenced hereby may be exercised at the following addresses: By hand at ---------------------------------------------------------------------- ---------------------------------------------------------------------- ---------------------------------------------------------------------- By mail at ---------------------------------------------------------------------- ---------------------------------------------------------------------- ---------------------------------------------------------------------- [Instructions as to form and delivery of Warrant Securities and, if applicable, Warrant Certificates evidencing unexercised Warrants - complete as appropriate.]
Appears in 2 contracts
Samples: Debt Warrant Agreement (Credit Suisse First Boston Usa Inc), Debt Warrant Agreement (Credit Suisse First Boston Usa Inc)
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder or Participant must, by 5:00 P.M.p.m., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a wire transfer in immediately available funds, in each case payable to the Company, in an amount equal to the Exercise Price in full for the Warrants exercisedexercised (unless the holder has elected a Cashless Exercise, in which case no such payment must be made). In addition, the The Warrant holder or Participant must also provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M.p.m., New York City time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), Warrants, evidenced by this Warrant Certificate, to purchase, of the shares of Common Stock (each a “Share”) of Homeowners ChoiceLM Funding America, Inc., a Florida Delaware corporation (the “Company”), and represents that: this exercise is intended to be a Cash Exercise and that such holder has, on or before the Exercise Date, such holder has tendered payment for such Shares by certified or official bank check or bank wire transfer in immediately available funds to the order of the Company c/o American Stock Transfer & Trust Company, LLC, in the amount of $ in accordance with the terms hereof; or this exercise is intended to be a Cashless Exercise. The undersigned requests that said number of Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Shares is less than all of the Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: , Name: (Please Print) (Insert Social Security or Other Identifying Number of Holder) Address: Signature: This Warrant may only be exercised by presentation to the Warrant Agent. The method of delivery of this Warrant Certificate is at the option and risk of the exercising holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to assure timely delivery. (Instructions as to form and delivery of Shares and/or Warrant Certificates) Name in which Shares are to be registered if other than in the name of the registered holder of this Warrant Certificate: Address to which Shares are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address) (City and State) (Zip Code) Name in which Warrant Certificate evidencing unexercised Warrants, if any, are to be registered if other than in the name of the registered holder of this Warrant Certificate: Address to which certificate representing unexercised Warrants, if any, are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address) (City and State) (Zip Code) Dated: Signature Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate. If Shares, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the registered holder hereof or are to be delivered to an address other than the address of such holder as shown on the books of the Warrant Agent, the above signature must be guaranteed by an Eligible Guarantor Institution (Banks, Stockbrokers, Savings and Loan Associations and Credit Unions with membership in an approved Signature Guarantee Medallion Program), pursuant to S.E.C. Rule 17Ad-15. SIGNATURE GUARANTEE Name of Firm: Address: Area Code and Number: Authorized Signature: Name: Title: Dated: ASSIGNMENT (FORM OF ASSIGNMENT TO BE EXECUTED IF WARRANT HOLDER DESIRES TO TRANSFER WARRANTS EVIDENCED HEREBY) FOR VALUE RECEIVED, HEREBY SELL(S), ASSIGN(S) AND TRANSFER(S) UNTO: (Please print name and address (Please insert social security or including zip code of assignee) other identifying number of assignee) the rights represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint Attorney to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. Dated: Signature (Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by an Eligible Guarantor Institution (Banks, Stockbrokers, Savings and Loan Associations and Credit Unions with membership in an approved Signature Guarantee Medallion Program), pursuant to S.E.C. Rule 17Ad-15. SIGNATURE GUARANTEE Name of Firm: Address: Area Code and Number: Authorized Signature: Name: Title:
Appears in 2 contracts
Samples: Warrant Agreement (Lm Funding America, Inc.), Warrant Agreement (Lm Funding America, Inc.)
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder or Participant must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a bank wire transfer in immediately available funds, in each case payable to the CompanyWarrant Agent at Account No. ____, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder or Participant must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on __________, ____ (the “Exercise Date”), _____________ Warrants, evidenced by this Warrant Certificate, to purchase, of _________________ shares (the shares of Common Stock (each a “ShareWarrant Shares”) of Homeowners ChoiceCommon Stock, par value of $0.001 per share (the “Common Stock”) of Enerpulse Technologies, Inc., a Florida Nevada corporation (the “Company”), and represents that, that on or before the Exercise Date, Date £ such holder has tendered payment for such Warrant Shares by certified or official bank check or bank wire transfer in immediately available funds to the order of the CompanyCompany c/o Securities Transfer Corporation, 2000 Xxxxxx Xxxxxxx, Xxxxx 000, Xxxxxx, XX 00000, in the amount of $ $_____________ in accordance with the terms hereof, or £ [if permitted] the cancellation of such number of Warrant Shares as is necessary, in accordance with the formula set forth in subsection 3.3.7 of the Warrant Agreement, to exercise this Warrant with respect to the maximum number of Warrant Shares purchasable pursuant to the cashless exercise procedure set forth in subsection 3.3.7. The undersigned requests that said number of Warrant Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Warrant Shares is less than all of the Warrant Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: ______________ __, Name: ____ Name (Please Print) / / / / - / / /- / / / / / (Insert Social Security or Other Identifying Number of Holder) Address:
Appears in 2 contracts
Samples: Warrant Agency Agreement (Enerpulse Technologies, Inc.), Warrant Agency Agreement (Enerpulse Technologies, Inc.)
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder or Participant must, by 5:00 P.M.p.m., New York City Philadelphia time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a wire transfer in immediately available funds, in each case payable to the Company, in an amount equal to the Exercise Price in full for the Warrants exercisedexercised (unless the holder has elected a Cashless Exercise, in which case no such payment must be made). In addition, the The Warrant holder or Participant must also provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M.p.m., New York Philadelphia time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), Warrants, evidenced by this Warrant Certificate, to purchase, of the shares of Common Stock Ordinary Shares (each a “Share”) of Homeowners Choice, Inc.Oxbridge Re Holdings Limited, a Florida corporation Cayman Islands exempted company (the “Company”), and represents that: this exercise is intended to be a Cash Exercise and that such holder has, on or before the Exercise Date, such holder has tendered payment for such Shares by certified or official bank check or bank wire transfer in immediately available funds to the order of the CompanyCompany c/o Broadridge Corporate Issuer Solutions, Inc., in the amount of $ in accordance with the terms hereof; or this exercise is intended to be a Cashless Exercise. The undersigned requests that said number of Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Shares is less than all of the Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: , Name: (Please Print) (Insert Social Security or Other Identifying Number of Holder) Address: Signature: This Warrant may only be exercised by presentation to the Warrant Agent. The method of delivery of this Warrant Certificate is at the option and risk of the exercising holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to assure timely delivery. (Instructions as to form and delivery of Shares and/or Warrant Certificates) Name in which Shares are to be registered if other than in the name of the registered holder of this Warrant Certificate: Address to which Shares are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address) (City and State) (Zip Code) Name in which Warrant Certificate evidencing unexercised Warrants, if any, are to be registered if other than in the name of the registered holder of this Warrant Certificate: Address to which certificate representing unexercised Warrants, if any, are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address) (City and State) (Zip Code) Dated: Signature Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate. If Shares, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the registered holder hereof or are to be delivered to an address other than the address of such holder as shown on the books of the Warrant Agent, the above signature must be guaranteed by an Eligible Guarantor Institution (Banks, Stockbrokers, Savings and Loan Associations and Credit Unions with membership in an approved Signature Guarantee Medallion Program), pursuant to S.E.C. Rule 17Ad-15. SIGNATURE GUARANTEE Name of Firm: Address: Area Code and Number: Authorized Signature: Name: Title: Dated: ASSIGNMENT (FORM OF ASSIGNMENT TO BE EXECUTED IF WARRANT HOLDER DESIRES TO TRANSFER WARRANTS EVIDENCED HEREBY) FOR VALUE RECEIVED, HEREBY SELL(S), ASSIGN(S) AND TRANSFER(S) UNTO: (Please print name and address including zip code of assignee) (Please insert social security or other identifying number of assignee) the rights represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint Attorney to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. Dated: Signature (Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by an Eligible Guarantor Institution (Banks, Stockbrokers, Savings and Loan Associations and Credit Unions with membership in an approved Signature Guarantee Medallion Program), pursuant to S.E.C. Rule 17Ad-15. SIGNATURE GUARANTEE Name of Firm: Address: Area Code and Number: Authorized Signature: Name: Title:
Appears in 2 contracts
Samples: Warrant Agreement (OXBRIDGE RE HOLDINGS LTD), Warrant Agreement (OXBRIDGE RE HOLDINGS LTD)
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder Holder must, by 5:00 P.M._______, New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a bank wire transfer in immediately available funds, in each case payable to the Company, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder Holder must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M.p.m., New York City time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), Warrants, evidenced by this Warrant Certificate, to purchase, of purchase shares (the shares of Common Stock (each a “ShareWarrant Shares”) of Homeowners Choicecommon voting shares, par value of $0.001 per share (the “ Common Stock ”) of Nxt-ID, Inc., a Florida Delaware corporation (the “Company”), and represents that, that on or before the Exercise Date, : ¨ such holder Holder has tendered payment for such Warrant Shares by certified or official bank check payable to the order of the CompanyCompany c/o ______________, __________________________, or by bank wire transfer in immediately available funds payable to the Company at Account No. , in each case in the amount of $ in accordance with the terms hereof. , or The undersigned requests that said number of Warrant Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Warrant Shares is less than all of the Warrant Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder Holder of the Warrant Certificate Certificate, unless otherwise specified in the instructions below. Dated: , Name: (Please Print) - - (Insert Social Security or Other Identifying Number of Holder) Address Signature This Warrant may only be exercised by presentation to the Warrant Agent at one of the following locations: By hand at: [TA] [TA Address] By mail at: [TA] [TA Address] The method of delivery of this Warrant Certificate is at the option and risk of the exercising Holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to insure timely delivery. (Instructions as to form and delivery of Warrant Shares and/or Warrant Certificates) Name in which Warrant Shares are to be registered if other than in the name of the Holder of this Warrant Certificate: Address to which Warrant Shares are to be mailed if other than to the address of the Holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address) (City and State) (Zip Code) Name in which Warrant Certificate evidencing unexercised Warrants, if any, is to be registered if other than in the name of the Holder of this Warrant Certificate: Address to which certificate representing unexercised Warrants, if any, is to be mailed if other than to the address of the Holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address) (City and State) (Zip Code) Dated: Signature Signature must conform in all respects to the name of the Holder as specified on the face of this Warrant Certificate. If Warrant Shares, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the Holder hereof or are to be delivered to an address other than the address of such Holder as shown on the books of the Warrant Agent, the above signature must be guaranteed by a an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm Address Area Code & Number Authorized Signature Name Title Dated: , 201 ASSIGNMENT (FORM OF ASSIGNMENT TO BE EXECUTED IF WARRANT HOLDER DESIRES TO TRANSFER WARRANTS EVIDENCED HEREBY) FOR VALUE RECEIVED, (Please print name and address including zip code of assignee) HEREBY SELL(S), ASSIGN(S) AND TRANSFER(S) UNTO (Please insert social security or including zip code of assignee) the rights represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint Attorney to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. Dated:
Appears in 2 contracts
Samples: Warrant Agreement (NXT-Id, Inc.), Warrant Agreement (NXT-Id, Inc.)
Instructions for Exercise of Warrant. To exercise the any Warrants evidenced herebyhereby for Warrant Debt Securities (as hereinafter defined), the holder mustHolder must pay, in lawful money of the United States of America, [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck in New York Clearing House funds] [by bank wire transfer in immediately available funds], in each case payable to the Company, in an amount equal to the Exercise Warrant Price in full for the Warrants exercised, to [Warrant Agent] [address of Warrant Agent], Attn: [●], which payment must specify the name of the Holder and the number of Warrants exercised by such Holder. In addition, the Warrant holder Holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth belowabove. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified Exercise Datepayment. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY (To be executed upon exercise of Warrants) The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise Warrants, evidenced represented by this Warrant Certificate, to purchase, purchase $[●] principal amount of the shares [Title of Common Stock Warrant Debt Securities] (each a the “ShareWarrant Debt Securities”) of Homeowners Choice, Inc., a Florida corporation (the “Company”), Dynatronics Corporation and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Debt Securities, in lawful money of the United States of America, [in cash or by certified check or official bank check in New York Clearing House funds] [by bank wire transfer in immediately available funds], to the order of the CompanyDynatronics Corporation, c/o [insert name and address of Warrant Agent], in the amount of $ $[●] in accordance with the terms hereof. The undersigned requests that said number principal amount of Shares Warrant Debt Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing the Warrants for the aggregate principal amount of Warrant Debt Securities remaining balance of the Warrants evidenced hereby unexercised be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated: , Name: (Dated ________________________________________ Name ________________________________________ Please Print) : ___________________________________ Address: ______________________________________ (Insert Social Security or Other Identifying Number of Holder) Address:___________________________________ Signature Guaranteed ____________________________________________________________________ Signature ______________________________________________________________________________ (Signature must conform in all respects to name of holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a FINRA member firm). This Warrant may be exercised at the following addresses: By hand at __________________________________________________________________________ By mail at ___________________________________________________________________________ [Instructions as to form and delivery of Warrant Debt Securities and, if applicable, Warrant Certificates evidencing Warrants for the number of Warrant Debt Securities remaining unexercised — complete as appropriate.]
Appears in 1 contract
Samples: Debt Securities Warrant Agreement (Dynatronics Corp)
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder must, must pay [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck or by bank wire transfer] [by bank wire transfer], in each case payable to immediately available funds, the Company, in an amount equal to the Exercise Warrant Price in full for Warrants exercised to [insert name of Warrant Agent] Corporate Trust Department [insert address of Warrant Agent], Attn: [or ], which [payment] [wire transfer] must specify the name of the holder and the number of Warrants exercisedexercised by such holder. In addition, the Warrant holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (registered mail is recommended) to the Company Warrant Agent at the address addresses set forth below. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified [payment] [wire transfer]. To Be Executed Upon Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY of Warrant The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), Warrants, exercise Warrants evidenced by this Warrant Certificate, to purchase, purchase _______________ [Title of Warrant Securities] (the shares of Common Stock (each a “Share”"Warrant Securities") of Homeowners ChoicePattxxxxx Xxxrgy, Inc., a Florida corporation (the “Company”), Inc. and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Securities [in cash or by certified check or official bank check or by bank wire transfer, in each case] [by bank wire transfer], in immediately available funds, to the order of the CompanyPattxxxxx Xxxrgy, Inc., c/o [insert name and address of Warrant Agent], in the amount of $ [$]______________ [if applicable -- insert relevant amounts in applicable foreign currency, currency unit or composite currency] in accordance with the terms hereof]. The undersigned requests that said number principal amount of Shares Warrant Securities be in fully registered formform and in the authorized denominations, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing representing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated: , Name: Dated Name ------------------------------------- ------------------------ (Please Print) (Insert ------------------------------------------- Address ------------------------------------------- Social Security or Other Identifying Number of HolderHolder ------------------------------------------- Signature The Warrants evidenced hereby may be exercised at the following addresses: By hand at -------------------------------------------- -------------------------------------------- By mail at -------------------------------------------- -------------------------------------------- [Instructions as to form and delivery of Warrant Securities and, if applicable, Warrant Certificates evidencing unexercised Warrants--complete as appropriate.] Assignment (Form of Assignment to be Executed if Holder Desires to Transfer Warrants Evidenced Hereby) Address:For value received ____________________________ hereby sells, assigns and transfers unto ____________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ (Please print name and address, including zip code of assignee, and Social Security Number or other identifying number) the Warrants represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint Attorney, to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. Dated -------------------------------- ------------------------------ Signature
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the any Warrants evidenced herebyhereby for Warrant Securities (as hereinafter defined), the holder mustHolder must pay, in lawful money of the United States of America, [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck in New York Clearing House funds] [by bank wire transfer in immediately available funds], in each case payable to the Company, in an amount equal to the Exercise Warrant Price in full for the Warrants exercised, to [●] [address of Warrant Agent], Attention: [●], which payment must specify the name of the Holder and the number of Warrants exercised by such Holder. In addition, the Warrant holder Holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth belowabove. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified Exercise Datepayment. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY (To be executed upon exercise of Warrants) The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise [●] Warrants, evidenced by this Warrant Certificate, to purchasepurchase [●] shares of the [Title of Warrant Securities] (the "Warrant Securities"), of the shares of Common Stock (each a “Share”) of Homeowners ChoiceAutoWeb, Inc., a Florida corporation (the “Company”), Inc. and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Securities, in lawful money of the United States of America, [in cash or by certified check or official bank check in New York Clearing House funds] [by bank wire transfer in immediately available funds], to the order of the CompanyAutoWeb, Inc., c/o [insert name and address of Warrant Agent], in the amount of $ $[●] in accordance with the terms hereof. The undersigned requests that said number of Shares Warrant Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing the Warrants for the number of Warrant Securities remaining balance of the Warrants evidenced hereby unexercised be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated: , ____________________________ Name: (____________________________ Please Print) Print Address: ___________________________________________________ (Insert Social Security or Other Identifying Number of Holder) Address:Signature Guaranteed: ________________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a FINRA member firm). This Warrant may be exercised at the following addresses: By hand at: By mail at: [Instructions as to form and delivery of Warrant Securities and, if applicable, Warrant Certificates evidencing Warrants for the number of Warrant Securities remaining unexercised—complete as appropriate.] ASSIGNMENT [Form of assignment to be executed if Warrant Holder desires to transfer Warrant] FOR VALUE RECEIVED, [●] hereby sells, assigns and transfers unto: _______________________________ (Please print name and address including zip code) _______________________________ Please print Social Security or other identifying number the right represented by the within Warrant to purchase [●] shares of [Title of Warrant Securities] of AutoWeb, Inc. to which the within Warrant relates and appoints [●] attorney to transfer such right on the books of the Warrant Agent with full power of substitution in the premises. Dated: ____________________________ Name: _______________________________ Please Print (Signature must conform in all respects to name of holder as specified on the face of the Warrant) Signature Guaranteed ________________________________ Signature
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the any Warrants evidenced herebyhereby for Warrant Securities (as hereinafter defined), the holder mustHolder must pay, in lawful money of the United States of America, [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck in New York Clearing House funds] [by bank wire transfer in immediately available funds], in each case payable to the Company, in an amount equal to the Exercise Warrant Price in full for the Warrants exercised, to [•] [address of Warrant Agent], Attention: [•], which payment must specify the name of the Holder and the number of Warrants exercised by such Holder. In addition, the Warrant holder Holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth belowabove. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified Exercise Datepayment. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY (To be executed upon exercise of Warrants) The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise [•] Warrants, evidenced by this Warrant Certificate, to purchase, purchase [•] shares of the shares of Common Stock (each a “Share”) of Homeowners ChoiceStock, Inc., a Florida corporation par value $0.001 per share (the “CompanyWarrant Securities”), of AcelRx Pharmaceuticals, Inc. and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Securities, in lawful money of the United States of America, [in cash or by certified check or official bank check in New York Clearing House funds] [by bank wire transfer in immediately available funds], to the order of the CompanyAcelRx Pharmaceuticals, Inc., c/o [insert name and address of Warrant Agent], in the amount of $ $[•] in accordance with the terms hereof. The undersigned requests that said number of Shares Warrant Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing the Warrants for the number of Warrant Securities remaining balance of the Warrants evidenced hereby unexercised be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated: , Name: (Please Print) Print Address: (Insert Social Security or Other Identifying Number of Holder) Address:Signature Guaranteed: Signature (Signature must conform in all respects to name of holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a FINRA member firm). This Warrant may be exercised at the following addresses: By hand at: By mail at: [Instructions as to form and delivery of Warrant Securities and, if applicable, Warrant Certificates evidencing Warrants for the number of Warrant Securities remaining unexercised — complete as appropriate.]
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder or Participant must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at the office of the Warrant Agent, or at the office of its successor as Warrant Agent, in the Borough of Manhattan, City of New York cash, a certified or official bank checkcheck or a wire transfer in immediately available funds, in each case payable to the CompanyWarrant Agent at Account No. ____, in an amount equal to the Exercise Price in full for the Warrants exercised[; provided, however, that the holder of this Warrant Certificate may, in lieu of payment of the Exercise Price for the Warrants, surrender its Warrants for that number of shares of Common Stock equal to the quotient obtained by dividing (x) the product of the number of shares of Common Stock underlying the surrendered Warrants, multiplied by the difference between the Fair Market Value and the Exercise Price by (y) the Fair Market Value]4. In addition, the Warrant holder or Participant must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth below. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on __________, ____ (the “Exercise Date”), _____________ Warrants, evidenced by this Warrant Certificate, to purchase, _________________ of the shares of Common Stock (each a “Share”) of Homeowners Choice, Inc.NRDC Acquisition Corp., a Florida Delaware corporation (the “Company”), and represents that, on or before the Exercise Date, such holder has tendered payment for such Shares by cash, certified or official bank check or bank wire transfer in immediately available funds to the order of the Company c/o Continental Stock Transfer & Trust Company, 00 Xxxxxxx Xxxxx, Xxx Xxxx, Xxx Xxxx 00000, in the amount of $ $_____________ in accordance with the terms hereof[ or, at the election of the holder, so long as such holder is the original purchaser of such Warrants or its permitted transferees, the holder (in lieu of payment of the Exercise Price for the Warrants) has surrendered Warrants for that number of shares of Common Stock equal to the quotient obtained by dividing (x) the product of the number of shares of Common Stock underlying the surrendered Warrants, multiplied by the difference between the Fair Market Value and the Exercise Price by (y) the Fair Market Value in accordance with the terms hereof]5. The undersigned requests that said number of Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Shares is less than all of the Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: , Name: (Please Print) (Insert Social Security or Other Identifying Number of Holder) Address:.
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder or Participant must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a bank wire transfer in immediately available funds, in each case payable to the CompanyWarrant Agent at Account No. ____, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder or Participant must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on __________, ____ (the “Exercise Date”), _____________ Warrants, evidenced by this Warrant Certificate, to purchase, of _________________ shares (the shares of Common Stock (each a “ShareWarrant Shares”) of Homeowners ChoiceCommon Stock, par value of $0.001 per share (the “Common Stock”) of Enerpulse Technologies, Inc., a Florida Nevada corporation (the “Company”), and represents that, that on or before the Exercise Date, Date ¨ such holder has tendered payment for such Warrant Shares by certified or official bank check or bank wire transfer in immediately available funds to the order of the CompanyCompany c/o Securities Transfer Corporation, 2000 Xxxxxx Xxxxxxx, Xxxxx 000, Xxxxxx, XX 00000, in the amount of $ $_____________ in accordance with the terms hereof, or ¨ [if permitted] the cancellation of such number of Warrant Shares as is necessary, in accordance with the formula set forth in subsection 3.3.7 of the Warrant Agreement, to exercise this Warrant with respect to the maximum number of Warrant Shares purchasable pursuant to the cashless exercise procedure set forth in subsection 3.3.7. The undersigned requests that said number of Warrant Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Warrant Shares is less than all of the Warrant Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: ______________ __, Name: ____ Name (Please Print) / / / / - / / /- / / / / / (Insert Social Security or Other Identifying Number of Holder) Address:
Appears in 1 contract
Samples: Warrant Agency Agreement (Enerpulse Technologies, Inc.)
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder or Participant must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank check, wire transfer in each case immediately available funds payable to the CompanyWarrant Agent at Account No. , in an amount equal to the Exercise Warrant Price in full for the Warrants exercised. In addition, the Warrant holder or Participant must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New City York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), Warrants, evidenced by this Warrant Certificate, to purchase, of shares (the shares of Common Stock (each a “ShareWarrant Shares”) of Homeowners ChoiceCommon Stock, par value of $0.00001 per share (the “Common Stock”) of Red Mountain Resources, Inc., a Florida Texas corporation (the “Company”), and represents that, that on or before the Exercise Date, Date ☐ such holder has tendered payment for such Warrant Shares by certified or official bank check wire transfer in immediately available funds to the order of the CompanyCompany c/o Broadridge Corporate Issuer Solutions, Inc., 1000 Xxxx Xx., Xxxxx 0000, Xxxxxxxxxxxx, XX 00000, in the amount of $ in accordance with the terms hereof, or ☐ [if permitted] the cancellation of such number of Warrant Shares as is necessary, in accordance with the formula set forth in subsection 3.3.3 of the Warrant Agreement, to exercise this Warrant with respect to the maximum number of whole Warrant Shares purchasable pursuant to the cashless exercise procedure set forth in subsection 3.3.3. The undersigned requests that said number of Warrant Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Warrant Shares is less than all of the Warrant Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: , Name: Name (Please Print) / / / / - / / /- / / / / / (Insert Social Security or Other Identifying Number of Holder) Address:
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder Holder must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a bank wire transfer in immediately available funds, in each case payable to the Company, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder Holder must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York City time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on __________, ____ (the “Exercise Date”), __________ Warrants, evidenced by this Warrant Certificate, to purchase, of __________ shares (the shares of Common Stock (each a “ShareWarrant Shares”) of Homeowners ChoiceCommon Stock, par value of $0.001 per share (the “Common Stock”) of Rennova Health, Inc., a Florida Delaware corporation (the “Company”), and represents that, that on or before the Exercise Date, : o such holder Holder has tendered payment for such Warrant Shares by certified or official bank check payable to the order of the CompanyCompany c/o [_________________], [ ], or by bank wire transfer in immediately available funds payable to the Company at Account No. [ ], in each case in the amount of $ $_______ in accordance with the terms hereof, or o [if permitted] the cancellation of such number of Warrant Shares as is necessary, in accordance with the formula set forth in subsection 3.3.7 of the Warrant Agreement, to exercise this Warrant with respect to the maximum number of Warrant Shares purchasable pursuant to the cashless exercise procedure set forth in subsection 3.3.7. The undersigned requests that said number of Warrant Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Warrant Shares is less than all of the Warrant Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder Holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: ________ __, Name: ____ Name (Please Print) / / / / - / / / - / / / / / (Insert Social Security or Other Identifying Number of Holder) Address __________________________ __________________________ Signature __________________________ This Warrant may only be exercised by presentation to the Warrant Agent at one of the following locations: By hand at: _________________________ By mail at: _________________________ The method of delivery of this Warrant Certificate is at the option and risk of the exercising Holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to ensure timely delivery. (Instructions as to form and delivery of Warrant Shares and/or Warrant Certificates) Name in which Warrant Shares are to be registered if other than in the name of the Holder of this Warrant Certificate: Address to which Warrant Shares are to be mailed if other than to the address of the Holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address) (City and State) (Zip Code) Name in which Warrant Certificate evidencing unexercised Warrants, if any, is to be registered if other than in the name of the Holder of this Warrant Certificate: Address to which certificate representing unexercised Warrants, if any, is to be mailed if other than to the address of the Holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address) (City and State) (Zip Code) Dated:
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the any Warrants evidenced herebyhereby for Warrant Securities (as hereinafter defined), the holder mustHolder must pay, in lawful money of the United States of America, [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck in New York Clearing House funds] [by bank wire transfer in immediately available funds], in each case payable to the Company, in an amount equal to the Exercise Warrant Price in full for the Warrants exercised, to [●] [address of Warrant Agent], Attention: [●], which payment must specify the name of the Holder and the number of Warrants exercised by such Holder. In addition, the Warrant holder Holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth belowabove. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified Exercise Datepayment. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY (To be executed upon exercise of Warrants) The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise [●] Warrants, evidenced by this Warrant Certificate, to purchase, purchase [●] shares of the shares [Title of Common Stock (each a “Share”) of Homeowners Choice, Inc., a Florida corporation Warrant Securities] (the “CompanyWarrant Securities”), of Cytokinetics, Incorporated and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Securities, in lawful money of the United States of America, [in cash or by certified check or official bank check in New York Clearing House funds] [by bank wire transfer in immediately available funds], to the order of the CompanyCytokinetics, Incorporated, c/o [insert name and address of Warrant Agent], in the amount of $ $[●] in accordance with the terms hereof. The undersigned requests that said number of Shares Warrant Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing the Warrants for the number of Warrant Securities remaining balance of the Warrants evidenced hereby unexercised be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated: , Name: (Please Print) Print Address: (Insert Social Security or Other Identifying Number of Holder) Address:Signature Guaranteed: Signature (Signature must conform in all respects to name of holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a FINRA member firm). This Warrant may be exercised at the following addresses: By hand at: By mail at: [Instructions as to form and delivery of Warrant Securities and, if applicable, Warrant Certificates evidencing Warrants for the number of Warrant Securities remaining unexercised — complete as appropriate.]
Appears in 1 contract
Samples: Warrant Agreement (Cytokinetics Inc)
Instructions for Exercise of Warrant. To exercise the any Warrants evidenced herebyhereby for Warrant Securities (as hereinafter defined), the holder mustHolder must pay, in lawful money of the United States of America, [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck in New York Clearing House funds] [by bank wire transfer in immediately available funds], in each case payable to the Company, in an amount equal to the Exercise Warrant Price in full for the Warrants exercised, to [Warrant Agent] [address of Warrant Agent], Attn: , which payment must specify the name of the Holder and the number of Warrants exercised by such Holder. In addition, the Warrant holder Holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth belowabove. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified Exercise Datepayment. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY (To be executed upon exercise of Warrants) The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise Warrants, evidenced by this Warrant Certificate, to purchase, purchase shares of the shares of Common Stock (each a “Share”) of Homeowners ChoiceStock, Inc., a Florida corporation par value $0.001 per share (the “CompanyWarrant Securities”), of Chimerix, Inc. and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Securities, in lawful money of the United States of America, [in cash or by certified check or official bank check in New York Clearing House funds] [by bank wire transfer in immediately available funds], to the order of the CompanyChimerix, Inc., c/o [insert name and address of Warrant Agent], in the amount of $ in accordance with the terms hereof. The undersigned requests that said number of Shares Warrant Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing the Warrants for the number of Warrant Securities remaining balance of the Warrants evidenced hereby unexercised be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. DatedDated Name Please Print Address: , Name: (Please Print) (Insert Social Security or Other Identifying Number of Holder) Address:Signature Guaranteed Signature (Signature must conform in all respects to name of holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a FINRA member firm). This Warrant may be exercised at the following addresses: By hand at By mail at [Instructions as to form and delivery of Warrant Securities and, if applicable, Warrant Certificates evidencing Warrants for the number of Warrant Securities remaining unexercised—complete as appropriate.]
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder must, must pay in Dollars [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank check, check or by bank wire transfer] [by bank wire transfer] [in each case payable to immediately available funds] the Company, in an amount equal to the Exercise Warrant Price in full for Warrants exercised to [Warrant Agent], [corporate trust department] [insert address of Warrant Agent], Attn. [or ], which [payment] [wire transfer] must specify the name of the holder and the number of Warrants exercisedexercised by such holder. In addition, the Warrant holder must provide complete the information required below below, including any applicable certifications if the Warrant Securities are issuable in bearer form, and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth below. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified [payment] [wire transfer]. To Be Executed Upon Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY of Warrant The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise Warrants, evidenced by this Warrant Certificate, to purchase, purchase [Common Stock] [Preferred Stock] of the shares of Common Stock (each a “Share”) of Homeowners Choice, Inc., a Florida corporation American Express Company (the “Company”), "Warrant Securities") and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Securities in Dollars [in cash or by certified check or official bank check or by bank wire transfer, in each case] [by bank wire transfer] in immediately available funds to the order of the CompanyTriton Energy Limited, c/o [insert name and address of Warrant Agent], in the amount of $ in accordance with the terms hereof. The undersigned requests that said number principal amount of Shares Warrant Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing representing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated: , ____________________ Name: (Please Print) __________________________ ______________________________ Address_______________________ (Insert Social Security or Other Identifying Number of Holder) Address:________________________ Signature Guaranteed Signature_____________________ _____________________________ (Signature must conform in all respects to name of holder as specified on face of this Warrant Certificate and must bear a signature guarantee by a bank, trust company or member broker of the New York, Midwest or Pacific Stock Exchanges) The Warrants evidenced hereby may be exercised at the following addresses: By hand at ___________________________________ ___________________________________ ___________________________________ By mail at ___________________________________ ___________________________________ ___________________________________ [Instructions as to form and delivery of Warrant Securities and, if applicable, Warrant Certificates evidencing unexercised Warrants -- complete as appropriate.]
Appears in 1 contract
Samples: Warrant Agreement (Emcor Group Inc)
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder must, must pay [in United States dollars][in applicable currency] [in cash] [by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck or by bank wire transfer, in each case payable to case] [by bank wire transfer] [in immediately available funds], the Company, in an amount equal to the Exercise Warrant Price in full for Warrants exercised to [insert of name of Warrant Agent] [corporate trust department] [insert address of Warrant Agent], Attn. ______________________ [or ________________], which [payment] [wire transfer] must specify the name of the Holder and the number of Warrants exercisedexercised by such Holder. In addition, the Warrant holder Holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth below. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified [payment] [wire transfer]. To be Executed Upon Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY of Warrant The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise __________ Warrants, evidenced by this Warrant Certificate, to purchase, purchase ________ shares of the shares [Title of Common Stock Warrant Securities] (each a “Share”the "Warrant Securities") of Homeowners Choice, Inc., a Florida corporation (the “Company”), Company and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Securities [in United States dollars] [in applicable currency] [in cash] [by certified check or official bank check or by bank wire transfer, in each case] [by bank wire transfer] [in immediately available funds] to the order of the CompanyXxxxxxxxx, Xxxxxx & Xxxxxxxx, Inc., c/o [insert name and address of Warrant Agent], in the amount of $ ___________ in accordance with the terms hereof. The undersigned requests that said number principal amount of Shares Warrant Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. [If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing representing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated: , .] Date:_____________________ Name: (Please Print) ___________________________________ __________________________ Address________________________________ (Insert Social Security or Other Identifying Number of Holder) Address:________________________________ Signature Guaranteed __________________________ Signature______________________________ (Signature must conform in all respects to name of holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a bank, trust company or member broker of the New York, Midwest or Pacific Stock Exchange) The Warrants evidenced hereby may be exercised at the following addresses: By hand at ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ By mail at ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ [Instructions as to form and delivery of Warrant Securities and, if applicable, Warrant Certificates evidencing unexercised Warrants -- complete as appropriate.]
Appears in 1 contract
Samples: Debt Warrant Agreement (Donaldson Lufkin & Jenrette Inc /Ny/)
Instructions for Exercise of Warrant. To exercise the any Warrants evidenced herebyhereby for Warrant Debt Securities (as hereinafter defined), the holder mustHolder must pay, in lawful money of the United States of America, [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck in New York Clearing House funds] [by bank wire transfer in immediately available funds], in each case payable to the Company, in an amount equal to the Exercise Warrant Price in full for the Warrants exercised, to [Warrant Agent] [address of Warrant Agent], Attn: , which payment must specify the name of the Holder and the number of Warrants exercised by such Holder. In addition, the Warrant holder Holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth belowabove. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified Exercise Datepayment. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY (To be executed upon exercise of Warrants) The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise Warrants, evidenced represented by this Warrant Certificate, to purchase, purchase $ principal amount of the shares [Title of Common Stock Warrant Debt Securities] (each a the “ShareWarrant Debt Securities”) of Homeowners ChoiceBiocept, Inc., a Florida corporation (the “Company”), Inc. and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Debt Securities, in lawful money of the United States of America, [in cash or by certified check or official bank check in New York Clearing House funds] [by bank wire transfer in immediately available funds], to the order of the CompanyBiocept, Inc., c/o [insert name and address of Warrant Agent], in the amount of $ in accordance with the terms hereof. The undersigned requests that said number principal amount of Shares Warrant Debt Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing the Warrants for the aggregate principal amount of Warrant Debt Securities remaining balance of the Warrants evidenced hereby unexercised be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. DatedDated Name Please Print Address: , Name: (Please Print) (Insert Social Security or Other Identifying Number of Holder) Address:Signature Guaranteed Signature (Signature must conform in all respects to name of holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a FINRA member firm). This Warrant may be exercised at the following addresses: By hand at By mail at [Instructions as to form and delivery of Warrant Debt Securities and, if applicable, Warrant Certificates evidencing Warrants for the number of Warrant Debt Securities remaining unexercised—complete as appropriate.]
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder or Participant must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a bank wire transfer in immediately available funds, in each case payable to the CompanyWarrant Agent at Account No. ____, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder or Participant must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on __________, ____ (the “Exercise Date”), _____________ Warrants, evidenced by this Warrant Certificate, to purchase, of _________________ shares (the shares of Common Stock (each a “ShareWarrant Shares”) of Homeowners ChoiceCommon Stock, par value of $0.001 per share (the “Common Stock”) of Enerpulse Technologies, Inc., a Florida Nevada corporation (the “Company”), and represents that, that on or before the Exercise Date, Date £ such holder has tendered payment for such Warrant Shares by certified or official bank check or bank wire transfer in immediately available funds to the order of the CompanyCompany c/o Securities Transfer Corporation, 0000 Xxxxxx Xxxxxxx, Xxxxx 000, Xxxxxx, XX 00000, in the amount of $ $_____________ in accordance with the terms hereof, or £ [if permitted] the cancellation of such number of Warrant Shares as is necessary, in accordance with the formula set forth in subsection 3.3.7 of the Warrant Agreement, to exercise this Warrant with respect to the maximum number of Warrant Shares purchasable pursuant to the cashless exercise procedure set forth in subsection 3.3.7. The undersigned requests that said number of Warrant Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Warrant Shares is less than all of the Warrant Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: ______________ __, Name: ____ Name (Please Print) / / / / - / / /- / / / / / (Insert Social Security or Other Identifying Number of Holder) Address:
Appears in 1 contract
Samples: Enerpulse Technologies, Inc. Warrant Agency Agreement (Enerpulse Technologies, Inc.)
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder or Participant must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a bank wire transfer in immediately available funds, in each case payable to the CompanyWarrant Agent at Account No. , in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder or Participant must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), Warrants, evidenced by this Warrant Certificate, to purchase, of shares (the shares of Common Stock (each a “ShareWarrant Shares”) of Homeowners ChoiceCommon Stock, par value of $0.0001 per share (the “Common Stock”) of Synergy Pharmaceuticals, Inc., a Florida corporation (the “Company”), and represents that, that on or before the Exercise Date, Date [ ] such holder has tendered payment for such Warrant Shares by certified or official bank check or bank wire transfer in immediately available funds to the order of the CompanyCompany c/o Broadridge Corporate Issuer Solutions, Inc., 0000 Xxxx Xx., Xxxxx 0000, Xxxxxxxxxxxx, XX 00000, in the amount of $ in accordance with the terms hereof, or [ ] [if permitted] the cancellation of such number of Warrant Shares as is necessary, in accordance with the formula set forth in subsection 3.3.7 of the Warrant Agreement, to exercise this Warrant with respect to the maximum number of Warrant Shares purchasable pursuant to the cashless exercise procedure set forth in subsection 3.3.7. The undersigned requests that said number of Warrant Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Warrant Shares is less than all of the Warrant Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: , Name: Name (Please Print) / / / / - / / /- / / / / / (Insert Social Security or Other Identifying Number of Holder) Address:
Appears in 1 contract
Samples: Warrant Agency Agreement (Synergy Pharmaceuticals, Inc.)
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder or Participant must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a wire transfer in immediately available funds, in each case payable to the CompanyWarrant Agent at Account No. , in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder or Participant must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), Warrants, evidenced by this Warrant Certificate, to purchase, of the shares of Common Stock (each a “Share”) of Homeowners Choice, Inc., a Florida corporation (the “Company”), and represents that, on or before the Exercise Date, such holder has tendered payment for such Shares by certified or official bank check or bank wire transfer in immediately available funds to the order of the Company c/o American Stock Transfer & Trust Company, 6200 00xx Xxxxxx, Xxxxxxxx, Xxx Xxxx 00000, in the amount of $ in accordance with the terms hereof. The undersigned requests that said number of Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Shares is less than all of the Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: , Name: (Please Print) (Insert Social Security or Other Identifying Number of Holder) Address:
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder must, must pay in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank check, in each case payable to check or by bank wire transfer the Company, in an amount equal to the Exercise Warrant Price in full for Warrants exercised to Xxxxxxxx Brands International, Inc., c/o Securities Transfer Company, One East Fourth Street, 12th Floor, Room 1201, Xxxxxxxxxx, Xxxx 00000, which payment and/or wire transfer in immediately available funds must specify the name of the holder and the number of Warrants exercisedexercised by such holder. In addition, the Warrant holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth below. The To Be Executed Upon Exercise of Warrant Certificate and this Election to Purchase must be received by the Company by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise [____________] Warrants, evidenced by this Warrant Certificate, to purchase, purchase [____________] shares of the shares of Common Stock (each a “Share”the "Warrant Shares") of Homeowners ChoiceXxxxxxxx Brands International, Inc., a Florida corporation (the “Company”), Inc. and represents that, on that he or before the Exercise Date, such holder it has tendered payment for such Warrant Shares in cash or by certified check or official bank check or by bank wire transfer, in each case in immediately available funds to the order of the Xxxxxxxx Brands International, Inc. c/o Securities Transfer Company, One East Fourth Street, 12th Floor, Room 1201, Xxxxxxxxxx, Xxxx 00000, Attn., in the amount of $ $[____________] in accordance with the terms hereof. The undersigned requests that said number of Warrant Shares be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing representing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated: , Name: (Please Print) Name -------------------- ------------------------ Address --------------------------- --------------------- (Insert Social Security or Other Identifying Number of Holder) Address:Signature Guaranteed Signature ------------------------- ------------------------ (Signature must conform in all respects to name of holder as specified on face of this Warrant Certificate and must bear a signature guarantee by a bank, trust company or member broker of the New York, Midwest or Pacific Stock Exchange) The Warrants evidenced hereby may be exercised by hand or mail at the following address: Xxxxxxxx Brands International, Inc. c/o Securities Transfer Company One East Fourth Street, 12th Floor Room 1201 Xxxxxxxxxx, XX 00000
Appears in 1 contract
Samples: Warrant Agreement (Chiquita Brands International Inc)
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder Holder must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a bank wire transfer in immediately available funds, in each case payable to the Company, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder Holder must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York City time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on __________, ____ (the “Exercise Date”), __________ Warrants, evidenced by this Warrant Certificate, to purchase, of __________ shares (the shares of Common Stock (each a “ShareWarrant Shares”) of Homeowners ChoiceCommon Stock, par value of $0.01 per share (the “Common Stock”) of Eyegate Pharmaceuticals, Inc., a Florida Delaware corporation (the “Company”), and represents that, that on or before the Exercise Date, : o such holder Holder has tendered payment for such Warrant Shares by certified or official bank check payable to the order of the CompanyCompany c/o VStock Transfer, LLC, 00 Xxxxxxxxx Xxxxx, Xxxxxxxx, XX 00000, or by bank wire transfer in immediately available funds payable to the Company at Account No. [●], in each case in the amount of $ $[●] in accordance with the terms hereof, or o [if permitted solely upon the occurrence of a Restrictive Legend Event as set forth in the Warrant Agreement] the cancellation of such number of Warrant Shares as is necessary, in accordance with the formula set forth in subsection 3.3.7 of the Warrant Agreement, to exercise this Warrant with respect to the maximum number of Warrant Shares purchasable pursuant to the cashless exercise procedure set forth in subsection 3.3.7. The undersigned requests that said number of Warrant Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Warrant Shares is less than all of the Warrant Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder Holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: ________ __, Name: ____ Name (Please Print) / / / / - / / / - / / / / / (Insert Social Security or Other Identifying Number of Holder) Address:Address Signature This Warrant may only be exercised by presentation to the Warrant Agent at one of the following locations: By hand at: VStock Transfer, LLC 00 Xxxxxxxxx Xxxxx Xxxxxxxx, XX 00000 By mail at: VStock Transfer LLC
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder or Participant must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a wire transfer in immediately available funds, in each case payable to the CompanyWarrant Agent at Account No. , in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder or Participant must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), Warrants, evidenced by this Warrant Certificate, to purchase, of the shares of Common Stock (each each, a “Share”) of Homeowners Choice, Inc.TAC Acquisition Corp., a Florida Delaware corporation (the “Company”), and represents that, that on or before the Exercise Date, Date such holder has tendered payment for such Shares by certified or official bank check or bank wire transfer in immediately available funds to the order of the CompanyCompany x/x Xxx Xxxx xx Xxx Xxxx, 000 Xxxxxxx Xxxxxx (11E), New York, NY 10286, in the amount of $ in accordance with the terms hereof. The undersigned requests that said number of Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Shares is less than all of the Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: , Name: Name (Please Print) / / / / - / / /- / / / / / (Insert Social Security or Other Identifying Number of Holder) Address Signature This Warrant may only be exercised by presentation to the Warrant Agent at one of the following locations: By hand at: By mail at: The method of delivery of this Warrant Certificate is at the option and risk of the exercising holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to assure timely delivery. (Instructions as to form and delivery of Shares and/or Warrant Certificates) Name in which Shares are to be registered if other than in the name of the registered holder of this Warrant Certificate: Address to which Shares are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address:) (City and State) (Zip Code) Name in which Warrant Certificate evidencing unexercised Warrants, if any, are to be registered if other than in the name of the registered holder of this Warrant Certificate: Address to which certificate representing unexercised Warrants, if any, are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address) (City and State) (Zip Code) Dated: Signature Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate. If Shares, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the registered holder hereof or are to be delivered to an address other than the address of such holder as shown on the books of the Warrant Agent, the above signature must be guaranteed by a an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Name Title Dated: , 200 ASSIGNMENT (FORM OF ASSIGNMENT TO BE EXECUTED IF WARRANT HOLDER DESIRES TO TRANSFER WARRANTS EVIDENCED HEREBY) FOR VALUE RECEIVED, HEREBY SELL(S), ASSIGN(S) AND TRANSFER(S) UNTO (Please print name and address (Please insert social security or including zip code of assignee) other identifying number of assignee) the rights represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint Attorney to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. Dated: Signature (Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Name Title Dated: , 200
Appears in 1 contract
Samples: Common Stock Warrant Agreement (TAC Acquisition Corp.)
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder Holder must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a bank wire transfer in immediately available funds, in each case payable to the Company, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder Holder must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York City time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on __________, ____ (the “Exercise Date”), __________ Warrants, evidenced by this Warrant Certificate, to purchase, of __________ shares (the shares of Common Stock (each a “ShareWarrant Shares”) of Homeowners ChoiceCommon Stock, par value of $0.01 per share (the “Common Stock”) of Eyegate Pharmaceuticals, Inc., a Florida Delaware corporation (the “Company”), and represents that, that on or before the Exercise Date, : o such holder Holder has tendered payment for such Warrant Shares by certified or official bank check payable to the order of the CompanyCompany c/o VStock Transfer, LLC, 10 Xxxxxxxxx Xxxxx, Xxxxxxxx, XX 00000, or by bank wire transfer in immediately available funds payable to the Company at Account No. [●], in each case in the amount of $ $[●] in accordance with the terms hereof, or o [if permitted solely upon the occurrence of a Restrictive Legend Event as set forth in the Warrant Agreement] the cancellation of such number of Warrant Shares as is necessary, in accordance with the formula set forth in subsection 3.3.7 of the Warrant Agreement, to exercise this Warrant with respect to the maximum number of Warrant Shares purchasable pursuant to the cashless exercise procedure set forth in subsection 3.3.7. The undersigned requests that said number of Warrant Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Warrant Shares is less than all of the Warrant Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder Holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: ________ __, Name: ____ Name (Please Print) / / / / - / / / - / / / / / (Insert Social Security or Other Identifying Number of Holder) Address Signature This Warrant may only be exercised by presentation to the Warrant Agent at one of the following locations: By hand at: VStock Transfer, LLC 10 Xxxxxxxxx Xxxxx Xxxxxxxx, XX 00000 By mail at: VStock Transfer LLC 10 Xxxxxxxxx Xxxxx Xxxxxxxx, XX 00000 The method of delivery of this Warrant Certificate is at the option and risk of the exercising Holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to ensure timely delivery. (Instructions as to form and delivery of Warrant Shares and/or Warrant Certificates) Name in which Warrant Shares are to be registered if other than in the name of the Holder of this Warrant Certificate: Address to which Warrant Shares are to be mailed if other than to the address of the Holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address) (City and State) (Zip Code) Name in which Warrant Certificate evidencing unexercised Warrants, if any, is to be registered if other than in the name of the Holder of this Warrant Certificate: Address to which certificate representing unexercised Warrants, if any, is to be mailed if other than to the address of the Holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address) (City and State) (Zip Code) Dated:
Appears in 1 contract
Samples: Warrant Agency Agreement (Eyegate Pharmaceuticals Inc)
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder or Participant must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a bank wire transfer in immediately available funds, in each case payable to the CompanyWarrant Agent at Account No. ____, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder or Participant must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on __________, ____ (the “Exercise Date”), _____________ Warrants, evidenced by this Warrant Certificate, to purchase, of _________________ shares (the shares of Common Stock (each a “ShareWarrant Shares”) of Homeowners ChoiceCommon Stock, Inc.par value of $0.0001 per share (the “Common Stock”) of Medovex Corp., a Florida Nevada corporation (the “Company”), and represents that, that on or before the Exercise Date, : [ ] such holder has tendered payment for such Warrant Shares by certified or official bank check or bank wire transfer in immediately available funds to the order of the Company c/o InterWest Transfer Company, Inc., 0000 Xxxxxx Xxxxxxxx Road, Suite 100, Salt Lake City, UT 84117, in the amount of $ $_____________ in accordance with the terms hereof, or [ ] [if permitted] the cancellation of such number of Warrant Shares as is necessary, in accordance with the formula set forth in subsection 3.3.7 of the Warrant Agreement, to exercise this Warrant with respect to the maximum number of Warrant Shares purchasable pursuant to the cashless exercise procedure set forth in subsection 3.3.7. The undersigned requests that said number of Warrant Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Warrant Shares is less than all of the Warrant Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: ______________ __, Name: ____ Name __________________________ (Please Print) / / / / - / / /- / / / / / (Insert Social Security or Other Identifying Number of Holder) Address ________________________ ________________________ Signature _______________________ This Warrant may only be exercised by presentation to the Warrant Agent at one of the following locations: By hand at: By mail at: The method of delivery of this Warrant Certificate is at the option and risk of the exercising holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to assure timely delivery. (Instructions as to form and delivery of Warrant Shares and/or Warrant Certificates) Name in which Warrant Shares are to be registered if other than in the name of the registered holder of this Warrant Certificate: _____________________________ Address to which Warrant Shares are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: _____________________________ (Street Address:) _____________________________ (City and State) (Zip Code) Name in which Warrant Certificate evidencing unexercised Warrants, if any, are to be registered if other than in the name of the registered holder of this Warrant Certificate: _____________________________ Address to which certificate representing unexercised Warrants, if any, are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: _____________________________ (Street Address) _____________________________ (City and State) (Zip Code) Dated: _____________________________ Signature Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate. If Warrant Shares, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the registered holder hereof or are to be delivered to an address other than the address of such holder as shown on the books of the Warrant Agent, the above signature must be guaranteed by a an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Name Title Dated: __________________________, 201___ ASSIGNMENT (FORM OF ASSIGNMENT TO BE EXECUTED IF WARRANT HOLDER DESIRES TO TRANSFER WARRANTS EVIDENCED HEREBY) FOR VALUE RECEIVED, _________________ HEREBY SELL(S), ASSIGN(S) AND TRANSFER(S) UNTO ________________________________________________________ __________________________________ _______________________________________ (Please print name and address (Please insert social security or including zip code of assignee) other identifying number of assignee) the rights represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint ____________ Attorney to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. Dated: _____________________________________________ Signature (Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Name Title
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the any Warrants evidenced herebyhereby for Warrant Securities (as hereinafter defined), the holder mustHolder must pay, in lawful money of the United States of America, [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck in New York Clearing House funds] [by bank wire transfer in immediately available funds], in each case payable to the Company, in an amount equal to the Exercise Warrant Price in full for the Warrants exercised, to [Warrant Agent] [address of Warrant Agent], Attn: , which payment must specify the name of the Holder and the number of Warrants exercised by such Holder. In addition, the Warrant holder Holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth belowabove. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified Exercise Datepayment. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY (To be executed upon exercise of Warrants) The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise Warrants, evidenced by this Warrant Certificate, to purchase, purchase shares of the shares of Common Stock (each a “Share”) of Homeowners ChoiceStock, Inc., a Florida corporation par value $0.001 per share (the “CompanyWarrant Securities”), of Chimerix, Inc. and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Securities, in lawful money of the United States of America, [in cash or by certified check or official bank check in New York Clearing House funds] [by bank wire transfer in immediately available funds], to the order of the CompanyChimerix, Inc., c/o [insert name and address of Warrant Agent], in the amount of $ in accordance with the terms hereof. The undersigned requests that said number of Shares Warrant Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing the Warrants for the number of Warrant Securities remaining balance of the Warrants evidenced hereby unexercised be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. DatedDated Name Please Print Address: , Name: (Please Print) (Insert Social Security or Other Identifying Number of Holder) Address:Signature Guaranteed Signature (Signature must conform in all respects to name of holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a FINRA member firm). This Warrant may be exercised at the following addresses: By hand at By mail at [Instructions as to form and delivery of Warrant Securities and, if applicable, Warrant Certificates evidencing Warrants for the number of Warrant Securities remaining unexercised—complete as appropriate.] ASSIGNMENT [Form of assignment to be executed if Warrant Holder desires to transfer Warrant] FOR VALUE RECEIVED, hereby sells, assigns and transfers unto: (Please print name and address including zip code) Please print Social Security or other identifying number the right represented by the within Warrant to purchase shares of [Title of Warrant Securities] of Chimerix, Inc. to which the within Warrant relates and appoints attorney to transfer such right on the books of the Warrant Agent with full power of substitution in the premises. Dated Signature (Signature must conform in all respects to name of holder as specified on the face of the Warrant) Signature Guaranteed
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder or Participant must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a bank wire transfer in immediately available funds, in each case payable to the CompanyWarrant Agent at Account No. , in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder or Participant must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), Warrants, evidenced by this Warrant Certificate, to purchase, of shares (the shares of Common Stock (each a “ShareWarrant Shares”) of Homeowners ChoiceCommon Stock, par value of $0.0001 per share (the “Common Stock”) of Trovagene, Inc., a Florida Delaware corporation (the “Company”), and represents that, that on or before the Exercise Date, Date [ ] such holder has tendered payment for such Warrant Shares by certified or official bank check or bank wire transfer in immediately available funds to the order of the CompanyCompany c/o Broadridge Corporate Issuer Solutions, Inc., 0000 Xxxx Xx., Xxxxx 0000, Xxxxxxxxxxxx, XX 00000, in the amount of $ in accordance with the terms hereof, or [ ] [if permitted] the cancellation of such number of Warrant Shares as is necessary, in accordance with the formula set forth in subsection 3.3.7 of the Warrant Agreement, to exercise this Warrant with respect to the maximum number of Warrant Shares purchasable pursuant to the cashless exercise procedure set forth in subsection 3.3.7. The undersigned requests that said number of Warrant Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Warrant Shares is less than all of the Warrant Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: , Name: Name (Please Print) / / / / - / / /- / / / / / (Insert Social Security or Other Identifying Number of Holder) Address:
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder [For Global Warrant Certificate: or Participant] must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its corporate trust department, a certified or official bank checkcheck or a wire transfer in immediately available funds, in each case payable to the CompanyWarrant Agent at Account No. ____, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder [For Global Warrant Certificates: or Participant] must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow [For Global Warrant Certificates: and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose]. The This Warrant Certificate and this the Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on __________, ___ (the “"Exercise Date”'), _____________ Warrants, evidenced by this Warrant Certificate, to purchase, [$_____________ principal amount] [__________________] of the shares [title of Common Stock Securities purchasable upon exercise of Warrants] [If Warrants for Depositary Shares are to be offered: , each representing a 1/___th interest in a share of [title of securities represented by the Depositary Shares]] (each a “Share”the "Warrant Securities") of Homeowners ChoiceFIFTH THIRD BANCORP, Inc., a Florida an Ohio corporation (the “"Company”"), and represents that, that on or before the Exercise Date, Date such holder has tendered payment for such Shares Warrant Securities by certified or official bank check or bank wire transfer in immediately available funds to the order of the CompanyCompany c/o [Name and address of Warrant Agent], in the amount of $ $_____________ in accordance with the terms hereof. The undersigned requests that said [principal amount of] [number of Shares of] Warrant Securities be in fully registered form, in the authorized denominations, registered in such names and delivered, all as specified in accordance with the instructions set forth below. [Unless Warrants may be exercised on only one date: If said number [principal amount] [number] of Shares Warrant Securities is less than all of the Shares Warrant Securities purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. .] Dated: ____________ __, Name: ____ Name __________________________ ------------------------ (Please Print) / / / /- / / /- / / / / / (Insert Social Security or Other Identifying Number of Holder) Address:_______________________ ------------------------ Signature________________________ This Warrant may only be exercised by presentation to the Warrant Agent at one of the following locations: By hand at By mail at The method of delivery of this Warrant Certificate is at the option and risk of the exercising holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to assure timely delivery. (Instructions as to form and delivery of Warrant Securities and/or Warrant Certificates) Name in which Warrant Securities are to be registered if other than in the name of the registered holder of this Warrant Certificate: Address to which Warrant Securities are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: ---------------------------------------- (Street Address) ---------------------------------------- (City and State) (Zip Code) [Except for Global Warrant Certificate:] Name in which Warrant Certificate evidencing unexercised Warrants, if any, are to be registered if other than in the name of the registered holder of this Warrant Certificate: ---------------------------------------- Address to which certificate representing unexercised Warrants, if any, are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: ---------------------------------------- (Street Address) ---------------------------------------- (City and State) (Zip Code)] Date: ---------------------------------------- Signature ([Except for Global Warrant Certificate: Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate.] If Warrant Securities, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the registered holder hereof or are to be delivered to an address other than the address of such holder as shown on the books of the Warrant Agent, the above signature must be guaranteed by a member firm of a registered national stock exchange, a member of the National Association of Securities Dealers, Inc., a participant in the Security Transfer Agents Medallion Program or the Stock Exchange Medallion Program, or by a commercial bank or trust company having an office or correspondent in the United States.) SIGNATURE GUARANTEE Name of Firm_____________________ Address__________________________ Area Code and Number_______________________ Authorized Signature _________________________ Name ____________________________ Title _____________________________ Dated: ______________________, ____ ASSIGNMENT (FORM OF ASSIGNMENT TO BE EXECUTED IF WARRANT HOLDER DESIRES TO TRANSFER WARRANTS EVIDENCED HEREBY) FOR VALUE RECEIVED_________________ hereby sells, assigns and transfers unto ______________________________________. ___________________________________ ____________________________________ (Please print name and address (Please insert social security or including zip code) other identifying number) the rights represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint _____________ Attorney, to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. Dated: ---------------------------------------- Signature (Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a member firm of a registered national securities exchange, a member of the National Association of Securities Dealers, Inc., a participant in the Security Transfer Agents Medallion Program or the Stock Exchange Medallion Program, or by a commercial bank or trust company having an office or correspondent in the United States) SIGNATURE GUARANTEE Name of Form_____________________ Address__________________________ Area Code and Number_______________________ Authorized Signature _________________________ Name ____________________________ Title _____________________________ Date: _______________________, ____
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder or Participant must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a wire transfer in immediately available funds, in each case payable to the CompanyWarrant Agent at Account No. 530-061686, in an amount equal to the Exercise Price in full for the Warrants exercisedexercised or inform the Warrant Agent that it is exercising the Warrants on a cashless basis. In addition, the Warrant holder or Participant must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), Warrants, evidenced by this Warrant Certificate, to purchase, of the shares of Class A Common Stock (each a “Share”) of Homeowners ChoiceWestway Group, Inc., a Florida Delaware corporation (the “Company”), and represents that, on or before the Exercise Date, such holder has tendered payment for such Shares by certified or official bank check or bank wire transfer in immediately available funds to the order of the Company c/o Continental Stock Transfer & Trust Company, 00 Xxxxxxx Xxxxx, Xxx Xxxx, Xxx Xxxx 00000, in the amount of $ or has informed the Warrant Agent that it is exercising the Warrants on a cashless basis in accordance with the terms hereof. The undersigned requests that said number of Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Shares is less than all of the Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. ¨ Check Box if Exercising on Cashless Basis Dated: , Name: (Please Print) (Insert Social Security or Other Identifying Number of Holder) Signature Name (Please Print) Address This Warrant may only be exercised by presentation to the Warrant Agent at one of the following locations: By hand at: Continental Stock Transfer & Trust Company, 00 Xxxxxxx Xxxxx, XX, XX 00000 By mail at: Continental Stock Transfer & Trust Company, 00 Xxxxxxx Xxxxx, XX, XX 00000 The method of delivery of this Warrant Certificate is at the option and risk of the exercising holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to assure timely delivery. (Instructions as to form and delivery of Shares and/or Warrant Certificates) Name in which Shares are to be registered if other than in the name of the registered holder of this Warrant Certificate: Name in which Warrant Certificate evidencing unexercised Warrants, if any, are to be registered if other than in the name of the registered holder of this Warrant Certificate: Dated: , 20 Address to which Shares are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address:) (City and State) (Zip Code) Address to which certificate representing unexercised Warrants, if any, are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address) (City and State) (Zip Code) SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Signature Name Title Dated: , 20 Signature Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate. If Shares, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the registered holder hereof or are to be delivered to an address other than the address of such holder as shown on the books of the Warrant Agent, the above signature must be guaranteed by an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). ASSIGNMENT (FORM OF ASSIGNMENT TO BE EXECUTED IF WARRANT HOLDER DESIRES TO TRANSFER WARRANTS EVIDENCED HEREBY) FOR VALUE RECEIVED, HEREBY SELL(S), ASSIGN(S) AND TRANSFER(S) UNTO (Please Print Name and Address Including Zip Code of Assignee) (Please Insert Social Security or Other Identifying Number of Assignee) the rights represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint Attorney to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. Dated: , 20 SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Signature Name Title Dated: , 20 Signature Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). Exhibit C FOUNDER WARRANT CERTIFICATE EXERCISABLE ONLY IF COUNTERSIGNED BY THE WARRANT AGENT AS PROVIDED HEREIN. Warrant Certificate evidencing Warrants to Purchase Class A Common Stock, par value $.0001, as described herein. Westway Group, Inc. No. [ ] VOID AFTER 5:00 P.M., NEW YORK CITY TIME, ON MAY 24, 2014, OR UPON EARLIER REDEMPTION This certifies that [ ], or its registered assigns, is the registered holder of [ ] warrants to purchase certain securities (each a “Warrant”). Each Warrant entitles the holder thereof, subject to the provisions contained herein and in the Warrant Agreement (as defined below), to purchase from Westway Group, Inc., a Delaware corporation (the “Company”), one share of the Company’s Class A Common Stock (each a “Share”), at the Exercise Price set forth below. The exercise price of each Warrant (the “Exercise Price”) shall be $5.00 initially, subject to adjustments as set forth in the Warrant Agreement (as defined below).
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder or Participant must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a wire transfer in immediately available funds, in each case payable to the CompanyWarrant Agent at Account No. _______, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder or Participant must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on _______, _______ (the “Exercise Date”), _______ Warrants, evidenced by this Warrant Certificate, to purchase, _______ of the shares of Common Stock (each each, a “Share”) of Homeowners Choice, Inc.Global Logistics Acquisition Corporation, a Florida Delaware corporation (the “Company”), and represents that, that on or before the Exercise Date, Date such holder has tendered payment for such Shares by certified or official bank check or bank wire transfer in immediately available funds to the order of the CompanyCompany c/x Xxx Xxxx xx Xxx Xxxx, 100 Xxxxxxx Xxxxxx (11E), New York, NY 10286, in the amount of $ $_______ in accordance with the terms hereof. The undersigned requests that said number of Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Shares is less than all of the Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: , Name: Name (Please Print) / / / / — / / / — / / / / / (Insert Social Security or Other Identifying Number of Holder) Address Signature This Warrant may only be exercised by presentation to the Warrant Agent at one of the following locations: By hand at: By mail at: The method of delivery of this Warrant Certificate is at the option and risk of the exercising holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to assure timely delivery. (Instructions as to form and delivery of Shares and/or Warrant Certificates) Name in which Shares are to be registered if other than in the name of the registered holder of this Warrant Certificate: Address to which Shares are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address:) (City and State) (Zip Code) Name in which Warrant Certificate evidencing unexercised Warrants, if any, are to be registered if other than in the name of the registered holder of this Warrant Certificate: Address to which certificate representing unexercised Warrants, if any, are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address) (City and State) (Zip Code) Dated: Signature Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate. If Shares, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the registered holder hereof or are to be delivered to an address other than the address of such holder as shown on the books of the Warrant Agent, the above signature must be guaranteed by a an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Name Title Dated: , 200 19 ASSIGNMENT (FORM OF ASSIGNMENT TO BE EXECUTED IF WARRANT HOLDER DESIRES TO TRANSFER WARRANTS EVIDENCED HEREBY) FOR VALUE RECEIVED, HEREBY SELL(S), ASSIGN(S) AND TRANSFER(S) UNTO (Please print name and address (Please insert social security or including zip code of assignee) other identifying number of assignee) the rights represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint Attorney to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. Dated: Signature (Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Name Title Dated: , 200
Appears in 1 contract
Samples: Common Stock Warrant Agreement (Global Logistics Acquisition CORP)
Instructions for Exercise of Warrant. To exercise the any Warrants evidenced herebyhereby for Warrant Securities (as hereinafter defined), the holder mustHolder must pay, in lawful money of the United States of America, [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck in New York Clearing House funds] [by bank wire transfer in immediately available funds], in each case payable to the Company, in an amount equal to the Exercise Warrant Price in full for the Warrants exercised, to [●] [address of Warrant Agent], Attention: [●], which payment must specify the name of the Holder and the number of Warrants exercised by such Holder. In addition, the Warrant holder Holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth belowabove. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified Exercise Datepayment. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY (To be executed upon exercise of Warrants) The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise [●] Warrants, evidenced by this Warrant Certificate, to purchase, purchase [●] shares of the shares of Common Stock (each a “Share”) of Homeowners ChoiceStock, Inc., a Florida corporation par value $0.0001 per share (the “CompanyWarrant Securities”), of SI-BONE, Inc. and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Securities, in lawful money of the United States of America, [in cash or by certified check or official bank check in New York Clearing House funds] [by bank wire transfer in immediately available funds], to the order of the CompanySI-BONE, Inc., c/o [insert name and address of Warrant Agent], in the amount of $ $[●] in accordance with the terms hereof. The undersigned requests that said number of Shares Warrant Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing the Warrants for the number of Warrant Securities remaining balance of the Warrants evidenced hereby unexercised be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated: , Name: (Please Print) Print Address: (Insert Social Security or Other Identifying Number of Holder) Address:Signature Guaranteed: Signature (Signature must conform in all respects to name of holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a FINRA member firm). This Warrant may be exercised at the following addresses: By hand at: By mail at: [Instructions as to form and delivery of Warrant Securities and, if applicable, Warrant Certificates evidencing Warrants for the number of Warrant Securities remaining unexercised—complete as appropriate.]
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Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder Holder must, by 5:00 P.M.p.m., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a bank wire transfer in immediately available funds, in each case payable to the Company, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder Holder must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M.p.m., New York City time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on , ____________ (the “Exercise Date”), _____________ Warrants, evidenced by this Warrant Certificate, to purchase, of purchase _________ shares (the shares of Common Stock (each a “ShareWarrant Shares”) of Homeowners Choicecommon stock, par value of $0.0001 per share (the “Common Stock”), of GenSpera, Inc., a Florida Delaware corporation (the “Company”), and represents that, that on or before the Exercise Date, : [ ] such holder Holder has tendered payment for such Warrant Shares by certified or official bank check payable to the order of the Company c/o American Stock Transfer & Trust Company, LLC, 6000 00xx Xxxxxx, Xxxxxxxx, XX 00000, or by bank wire transfer in immediately available funds payable to the Company at [ ], Account No. [ ], in each case in the amount of $ $_____________ in accordance with the terms hereof, or [ ] [if permitted] the cancellation of such number of Warrant Shares as is necessary, in accordance with the formula set forth in subsection 3.3.7 of the Warrant Agreement, to exercise this Warrant with respect to the maximum number of Warrant Shares purchasable pursuant to the cashless exercise procedure set forth in subsection 3.3.7. The undersigned requests that said number of Warrant Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Warrant Shares is less than all of the Warrant Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder Holder of the Warrant Certificate Certificate, unless otherwise specified in the instructions below. Dated: ________________, Name: _______ Name (Please Print) _____-___-_______ (Insert Social Security or Other Identifying Number of Holder) Address:
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the any Warrants evidenced herebyhereby for Warrant Securities (as hereinafter defined), the holder mustHolder must pay, in lawful money of the United States of America, [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck in New York Clearing House funds] [by bank wire transfer in immediately available funds], in each case payable to the Company, in an amount equal to the Exercise Warrant Price in full for the Warrants exercised, to [Warrant Agent] [address of Warrant Agent], Attn: , which payment must specify the name of the Holder and the number of Warrants exercised by such Holder. In addition, the Warrant holder Holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth belowabove. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified Exercise Datepayment. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY (To be executed upon exercise of Warrants) The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise Warrants, evidenced by this Warrant Certificate, to purchase, purchase shares of the shares of Common Stock (each a “Share”) of Homeowners ChoiceStock, Inc., a Florida corporation par value $0.0001 per share (the “CompanyWarrant Securities”), of Biocept, Inc. and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Securities, in lawful money of the United States of America, [in cash or by certified check or official bank check in New York Clearing House funds] [by bank wire transfer in immediately available funds], to the order of the CompanyBiocept, Inc., c/o [insert name and address of Warrant Agent], in the amount of $ in accordance with the terms hereof. The undersigned requests that said number of Shares Warrant Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing the Warrants for the number of Warrant Securities remaining balance of the Warrants evidenced hereby unexercised be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. DatedDated Name Please Print Address: , Name: (Please Print) (Insert Social Security or Other Identifying Number of Holder) Address:Signature Guaranteed Signature (Signature must conform in all respects to name of holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a FINRA member firm). This Warrant may be exercised at the following addresses: By hand at By mail at [Instructions as to form and delivery of Warrant Securities and, if applicable, Warrant Certificates evidencing Warrants for the number of Warrant Securities remaining unexercised—complete as appropriate.]
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the any Warrants evidenced herebyhereby for Warrant Debt Securities (as hereinafter defined), the holder mustHolder must pay, in lawful money of the United States of America, [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck in New York Clearing House funds] [by bank wire transfer in immediately available funds], in each case payable to the Company, in an amount equal to the Exercise Warrant Price in full for the Warrants exercised, to [Warrant Agent] [address of Warrant Agent], Attn: , which payment must specify the name of the Holder and the number of Warrants exercised by such Holder. In addition, the Warrant holder Holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth belowabove. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified Exercise Datepayment. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY (To be executed upon exercise of Warrants) The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise Warrants, evidenced represented by this Warrant Certificate, to purchase, purchase $ principal amount of the shares [Title of Common Stock Warrant Debt Securities] (each a the “ShareWarrant Debt Securities”) of Homeowners ChoiceChimerix, Inc., a Florida corporation (the “Company”), Inc. and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Debt Securities, in lawful money of the United States of America, [in cash or by certified check or official bank check in New York Clearing House funds] [by bank wire transfer in immediately available funds], to the order of the CompanyChimerix, Inc., c/o [insert name and address of Warrant Agent], in the amount of $ in accordance with the terms hereof. The undersigned requests that said number principal amount of Shares Warrant Debt Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing the Warrants for the aggregate principal amount of Warrant Debt Securities remaining balance of the Warrants evidenced hereby unexercised be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. DatedDated Name Please Print Address: , Name: (Please Print) (Insert Social Security or Other Identifying Number of Holder) Address:Signature Guaranteed Signature (Signature must conform in all respects to name of holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a FINRA member firm). This Warrant may be exercised at the following addresses: By hand at By mail at [Instructions as to form and delivery of Warrant Debt Securities and, if applicable, Warrant Certificates evidencing Warrants for the number of Warrant Debt Securities remaining unexercised—complete as appropriate.] ASSIGNMENT [Form of assignment to be executed if Warrant Holder desires to transfer Warrant] FOR VALUE RECEIVED, hereby sells, assigns and transfers unto: (Please print name and address including zip code) Please print Social Security or other identifying number the right represented by the within Warrant to purchase $ aggregate principal amount of [Title of Warrant Debt Securities] of Chimerix, Inc. to which the within Warrant relates and appoints attorney to transfer such right on the books of the Warrant Agent with full power of substitution in the premises. Dated Signature (Signature must conform in all respects to name of holder as specified on the face of the Warrant) Signature Guaranteed
Appears in 1 contract
Samples: Warrant Agreement (Chimerix Inc)
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder or Participant must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a wire transfer in immediately available funds, in each case payable to the CompanyWarrant Agent at Account No. ________, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder or Participant must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), Warrants, evidenced by this Warrant Certificate, to purchase, of the shares of Common Stock (each each, a “Share”) of Homeowners Choice, Inc.Healthcare Acquisition Partners Corp., a Florida Delaware corporation (the “Company”), and represents that, that on or before the Exercise Date, Date such holder has tendered payment for such Shares by certified or official bank check or bank wire transfer in immediately available funds to the order of the CompanyCompany c/o Mellon Investor Services LLC, [address], in the amount of $ in accordance with the terms hereof. The undersigned requests that said number of Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Shares is less than all of the Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: , Name: Name (Please Print) / / / / - / / / - / / / / / (Insert Social Security or Other Identifying Number of Holder) Address Signature This Warrant may only be exercised by presentation to the Warrant Agent at one of the following locations: By hand at: By mail at: The method of delivery of this Warrant Certificate is at the option and risk of the exercising holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to assure timely delivery. (Instructions as to form and delivery of Shares and/or Warrant Certificates) Name in which Shares are to be registered if other than in the name of the registered holder of this Warrant Certificate: Address to which Shares are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address) (City and State) (Zip Code) Dated: Signature Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate. If Shares, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the registered holder hereof or are to be delivered to an address other than the address of such holder as shown on the books of the Warrant Agent, the above signature must be guaranteed by a an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm ________________________ Address _____________________________ Area Code and Number _________________ Authorized Signature ___________________ Name _______________________________ Title ________________________________ Dated: , 200 ASSIGNMENT (FORM OF ASSIGNMENT TO BE EXECUTED IF WARRANT HOLDER DESIRES TO TRANSFER WARRANTS EVIDENCED HEREBY) FOR VALUE RECEIVED, HEREBY SELL(S), ASSIGN(S) AND TRANSFER(S) UNTO (Please print name and address including zip code of assignee) (Please insert social security or other identifying number of assignee) the rights represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint Attorney to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. Dated:
Appears in 1 contract
Samples: Common Stock Warrant Agreement (Healthcare Acquisition Partners Corp.)
Instructions for Exercise of Warrant. To exercise the any Warrants evidenced herebyhereby for Warrant Securities (as hereinafter defined), the holder mustHolder must pay, in lawful money of the United States of America, [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck in New York Clearing House funds] [by bank wire transfer in immediately available funds], in each case payable to the Company, in an amount equal to the Exercise Warrant Price in full for the Warrants exercised, to [●] [address of Warrant Agent], Attention: [●], which payment must specify the name of the Holder and the number of Warrants exercised by such Holder. In addition, the Warrant holder Holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth belowabove. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified Exercise Datepayment. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY (To be executed upon exercise of Warrants) The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise [●] Warrants, evidenced by this Warrant Certificate, to purchase, purchase [●] shares of the shares [Title of Common Stock (each a “Share”) of Homeowners Choice, Inc., a Florida corporation Warrant Securities] (the “CompanyWarrant Securities”), of Dynatronics Corporation and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Securities, in lawful money of the United States of America, [in cash or by certified check or official bank check in New York Clearing House funds] [by bank wire transfer in immediately available funds], to the order of the CompanyDynatronics Corporation, c/o [insert name and address of Warrant Agent], in the amount of $ $[●] in accordance with the terms hereof. The undersigned requests that said number of Shares Warrant Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing the Warrants for the number of Warrant Securities remaining balance of the Warrants evidenced hereby unexercised be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated: , Name: (Please Print) Print Address: (Insert Social Security or Other Identifying Number of Holder) Address:Signature Guaranteed: Signature (Signature must conform in all respects to name of holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a FINRA member firm). This Warrant may be exercised at the following addresses: By hand at: By mail at: [Instructions as to form and delivery of Warrant Securities and, if applicable, Warrant Certificates evidencing Warrants for the number of Warrant Securities remaining unexercised — complete as appropriate.]
Appears in 1 contract
Samples: Preferred Stock Warrant Agreement (Dynatronics Corp)
Instructions for Exercise of Warrant. To exercise the any Warrants evidenced herebyhereby for Warrant Securities (as hereinafter defined), the holder mustHolder must pay, in lawful money of the United States of America, [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck in New York Clearing House funds] [by bank wire transfer in immediately available funds], in each case payable to the Company, in an amount equal to the Exercise Warrant Price in full for the Warrants exercised, to [●] [address of Warrant Agent], Attention: [●], which payment must specify the name of the Holder and the number of Warrants exercised by such Holder. In addition, the Warrant holder Holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth belowabove. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified Exercise Datepayment. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY (To be executed upon exercise of Warrants) The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise [●] Warrants, evidenced by this Warrant Certificate, to purchasepurchase [●] shares of the Common Stock, par value $0.001 per share (the "Warrant Securities"), of the shares of Common Stock (each a “Share”) of Homeowners ChoiceAutoWeb, Inc., a Florida corporation (the “Company”), Inc. and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Securities, in lawful money of the United States of America, [in cash or by certified check or official bank check in New York Clearing House funds] [by bank wire transfer in immediately available funds], to the order of the CompanyAutoWeb, Inc., c/o [insert name and address of Warrant Agent], in the amount of $ $[●] in accordance with the terms hereof. The undersigned requests that said number of Shares Warrant Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing the Warrants for the number of Warrant Securities remaining balance of the Warrants evidenced hereby unexercised be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated: , ____________________________ Name: (____________________________ Please Print) Print Address: ______________________________________________ (Insert Social Security or Other Identifying Number of Holder) Address:Signature Guaranteed: ___________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a FINRA member firm). This Warrant may be exercised at the following addresses: By hand at: By mail at: [Instructions as to form and delivery of Warrant Securities and, if applicable, Warrant Certificates evidencing Warrants for the number of Warrant Securities remaining unexercised- complete as appropriate.]
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder or Participant must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a bank wire transfer in immediately available funds, in each case payable to the CompanyWarrant Agent at Account No. ____, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder or Participant must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on __________, ____ (the “Exercise Date”), _____________ Warrants, evidenced by this Warrant Certificate, to purchase, of _________________ shares (the shares of Common Stock (each a “ShareWarrant Shares”) of Homeowners ChoiceCommon Stock, par value of $0.0001 per share (the “Common Stock”) of Auddia Inc., a Florida Delaware corporation (the “Company”), and represents that, that on or before the Exercise Date, Date [ ] such holder has tendered payment for such Warrant Shares by certified or official bank check or bank wire transfer in immediately available funds to the order of the Company c/o VStock Transfer Company, Inc., 00 Xxxxxxxxx Xxxxx, Xxxxxxxx, XX 00000, in the amount of $ $_____________ in accordance with the terms hereof, or [ ] the cancellation of such number of Warrant Shares as is necessary, in accordance with the formula set forth in subsection 3.3.7 of the Agreement, to exercise this Warrant with respect to the maximum number of Warrant Shares purchasable pursuant to the cashless exercise procedure set forth in subsection 3.3.7. The undersigned requests that said number of Warrant Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Warrant Shares is less than all of the Warrant Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: ______________ __, Name: ____ Name __________________________ (Please Print) / / / / - / / /- / / / / / (Insert Social Security or Other Identifying Number of Holder) Address:________________________ ________________________
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder must, must pay in Dollars [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank check, check or by bank wire transfer] [by bank wire transfer] [in each case payable to immediately available funds] the Company, in an amount equal to the Exercise Warrant Price in full for Warrants exercised to [Warrant Agent], [corporate trust department] [insert address of Warrant Agent], Attn. __________________ [or ______________], which [payment] [wire transfer] must specify the name of the holder and the number of Warrants exercisedexercised by such holder. In addition, the Warrant holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth below. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified [payment] [wire transfer]. To Be Executed Upon Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY of Warrant The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise _________ Warrants, evidenced by this Warrant Certificate, to purchase, purchase __________ shares of the shares [Title of Common Stock Warrant Securities] (each a “Share”the "Warrant Securities") of Homeowners Choice, Inc., a Florida corporation (the “Company”), J.P. Morgan Chase & Co. and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares xxx xxxx Xxrxxxx Securities in Dollars [in cash or by certified check or official bank check or by bank wire transfer, in each case] [by bank wire transfer] in immediately available funds to the order of the CompanyJ.P. Morgan Chase & Co., in the c/o [insert name and address of Warrant Agexx], xx xxx amount of $ _______________ in accordance with the terms hereof. The undersigned requests that said number principal amount of Shares Warrant Securities be in fully registered formthe authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing representing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated: , Name: (Please Print) Name ------------------- ---------------------------- -------------------------- Address ------------------------- (Insert Social Security or Other other Identifying Number ------------------------- of Holder) Address:Signature Guaranteed Signature ----------------------- ------------------------- (Signature must conform in all respects to name of holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a bank, trust company or member broker of the New York, Midwest or Pacific Stock Exchanges) The Warrants evidenced hereby may be exercised at the following addresses: By hand at ------------------------------------------------ ------------------------------------------------ ------------------------------------------------ ------------------------------------------------ ------------------------------------------------ By mail at ------------------------------------------------ ------------------------------------------------ ------------------------------------------------ ------------------------------------------------ ------------------------------------------------ [Instructions as to form and delivery of Warrant Securities and, if applicable, Warrant Certificate evidencing unexercised Warrants - complete as appropriate.]
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder must, must pay [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck or by bank wire transfer] [by bank wire transfer], in each case payable to immediately available funds, the Company, in an amount equal to the Exercise Warrant Price in full for Warrants exercised to [insert name of Warrant Agent] Corporate Trust Department [insert address of Warrant Agent], Attn: [or ], which [payment] [wire transfer] must specify the name of the holder and the number of Warrants exercisedexercised by such holder. In addition, the Warrant holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (registered mail is recommended) to the Company Warrant Agent at the address addresses set forth below. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified [payment] [wire transfer]. To Be Executed Upon Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY of Warrant The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), Warrants, exercise Warrants evidenced by this Warrant Certificate, to purchase, purchase ______________ [Title of Warrant Securities] (the shares of Common Stock (each a “Share”"Warrant Securities") of Homeowners ChoiceNaboxx Xxxustries, Inc., a Florida corporation (the “Company”), Inc. and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Securities [in cash or by certified check or official bank check or by bank wire transfer, in each case] [by bank wire transfer], in immediately available funds, to the order of the CompanyNaboxx Xxxustries, Inc., c/o [insert name and address of Warrant Agent], in the amount of $ [$]______________ [if applicable, express Warrant exercise price in applicable foreign currency, currency unit or composite currency] in accordance with the terms hereof. The undersigned requests that said number principal amount of Shares Warrant Securities be in fully registered formform and in the authorized denominations, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing representing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated: , Name: Name ----------------------------------- (Please Print) (Insert ----------------------------------- Address ----------------------------------- Social Security or Other Identifying Number of Holder) Address----------------------------------- Signature The Warrants evidenced hereby may be exercised at the following addresses:
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Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder Holder must, by 5:00 P.M._______, New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a bank wire transfer in immediately available funds, in each case payable to the Company, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder Holder must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M.p.m., New York City time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), Warrants, evidenced by this Warrant Certificate, to purchase, of purchase shares (the shares of Common Stock (each a “ShareWarrant Shares”) of Homeowners Choicecommon voting shares, par value of $0.001 per share (the “ Common Stock ”) of CNS Response, Inc., a Florida Delaware corporation (the “Company”), and represents that, that on or before the Exercise Date, : ¨ such holder Holder has tendered payment for such Warrant Shares by certified or official bank check payable to the order of the CompanyCompany c/o ______________, __________________________, or by bank wire transfer in immediately available funds payable to the Company at Account No. , in each case in the amount of $ in accordance with the terms hereof, or ¨ [if permitted] the cancellation of such number of Warrant Shares as is necessary, in accordance with the formula set forth in subsection 3.3.7 of the Warrant Agreement, to exercise this Warrant with respect to the maximum number of Warrant Shares purchasable pursuant to the cashless exercise procedure set forth in subsection 3.3.7. The undersigned requests that said number of Warrant Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Warrant Shares is less than all of the Warrant Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder Holder of the Warrant Certificate Certificate, unless otherwise specified in the instructions below. Dated: , Name: Name (Please Print) - - (Insert Social Security or Other Identifying Number of Holder) Address:
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Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder [For Global Warrant Certificate: or Participant] must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its corporate trust department, a certified or official bank checkcheck or a wire transfer in immediately available funds, in each case payable to the CompanyWarrant Agent at Account No. ____, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder [For Global Warrant Certificates: or Participant] must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow [For Global Warrant Certificates: and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose]. The This Warrant Certificate and this the Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on __________, ____ (the “"Exercise Date”"), _____________ Warrants, evidenced by this Warrant Certificate, to purchase, [$_____________ principal amount] [_________________] of the shares [title of Common Stock Securities purchasable upon exercise of Warrants] [If Warrants for Depositary Shares are to be offered: , each representing a 1/__th interest in a share of [title of securities represented by the Depositary Shares]] (each a “Share”the "Warrant Securities") of Homeowners Choice, Inc.First Union Corporation, a Florida North Carolina corporation (the “"Company”"), and represents that, that on or before the Exercise Date, Date such holder has tendered payment for such Shares Warrant Securities by certified or official bank check or bank wire transfer in immediately available funds to the order of the CompanyCompany c/o [Name and address of Warrant Agent], in the amount of $ $_____________ in accordance with the terms hereof. The undersigned requests that said [principal amount of] [number of Shares of] Warrant Securities be in fully registered form, in the authorized denominations, registered in such names and delivered, all as specified in accordance with the instructions set forth below. [Unless Warrants may be exercised on only one date: If said number [principal amount] [number] of Shares Warrant Securities is less than all of the Shares Warrant Securities purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. .] Dated: ______________ __, ____ Name: __________________________ ________________ (Please Print) / / / /- / / /- / / / / / (Insert Social Security or Other Identifying Number of Holder) Address:_______________________ __________________________ This Warrant may only be exercised by presentation to the Warrant Agent at one of the following locations: By hand at By mail at The method of delivery of this Warrant Certificate is at the option and risk of the exercising holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to assure timely delivery. (Instructions as to form and delivery of Warrant Securities and/or Warrant Certificates) Name in which Warrant Securities are to be registered if other than in the name of the registered holder of this Warrant Certificate: ------------------------------ Address to which Warrant Securities are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: ------------------------------ (Street Address) ------------------------------ (City and State) (Zip Code) [Except for Global Warrant Certificate: Name in which Warrant Certificate evidencing unexercised Warrants, if any, are to be registered if other than in the name of the registered holder of this Warrant Certificate: ----------------------------- Address to which certificate representing unexercised Warrants, if any, are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: ------------------------------ (Street Address) ------------------------------ (City and State) (Zip Code)] Dated: ------------------------------ Signature ([Except for Global Warrant Certificate: Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate.] If Warrant Securities, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the registered holder hereof or are to be delivered to an address other than the address of such holder as shown on the books of the Warrant Agent, the above signature must be guaranteed by a member firm of a registered national stock exchange, a member of the National Association of Securities Dealers, Inc., a participant in the Security Transfer Agents Medallion Program or the Stock Exchange Medallion Program, or by a commercial bank or trust company having an office or correspondent in the United States.) SIGNATURE GUARANTEE Name of Firm _________________ Address ______________________ Area Code and Number ___________________ Authorized Signature ____________________ Name _________________________ Title ________________________ Dated: ________________, 19__ ASSIGNMENT (FORM OF ASSIGNMENT TO BE EXECUTED IF WARRANT HOLDER DESIRES TO TRANSFER WARRANTS EVIDENCED HEREBY) FOR VALUE RECEIVED _________________ hereby sells, assigns and transfers unto ________________________________ ---------------------------------- ----------------------- (Please print name and address (Please insert social including zip code) security or other identifying number) the rights represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint ____________ Attorney, to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises.
Appears in 1 contract
Samples: Warrant Agreement (First Union Corp)
Instructions for Exercise of Warrant. PRIOR TO MAKING A DECISION TO EXERCISE ANY WARRANTS EVIDENCED HEREBY, THE HOLDER OF THE WARRANTS SHOULD CAREFULLY READ THE PROSPECTUS RELATING TO THE COMMON STOCK UNDERLYING SUCH WARRANTS. A COPY OF SUCH PROSPECTUS IS AVAILABLE FREE OF CHARGE BY CONTACTING MARATHON ACQUISITION CORP. AT ITS PRINCIPAL EXECUTIVE OFFICES. THE SECURITIES AND EXCHANGE COMMISSION ALSO MAINTAINS A WEBSITE AT XXX.XXX.XXX THAT CONTAINS SUCH INFORMATION. To exercise the Warrants evidenced hereby, the holder or Participant must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a wire transfer in immediately available funds, in each case payable to the CompanyWarrant Agent at such an account number as the Warrant Agent may designate from time to time, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder or Participant must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), Warrants, evidenced by this Warrant Certificate, to purchase, of the shares of Common Stock (each each, a “Share”) of Homeowners Choice, Inc.Marathon Acquisition Corp., a Florida Delaware corporation (the “Company”), and represents that, that on or before the Exercise Date, Date such holder has tendered payment for such Shares by certified or official bank check or bank wire transfer in immediately available funds to the order of the CompanyCompany x/x Xxx Xxxx xx Xxx Xxxx, 000 Xxxxxxx Xxxxxx (11E), New York, NY 10286, in the amount of $ in accordance with the terms hereof. The undersigned requests that said number of Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Shares is less than all of the Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: , Name: Name (Please Print) / / / / - / / / - / / / / / (Insert Social Security or Other Identifying Number of Holder) Address Signature This Warrant may only be exercised by presentation to the Warrant Agent at one of the following locations: By hand at: By mail at: The method of delivery of this Warrant Certificate is at the option and risk of the exercising holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to assure timely delivery. (Instructions as to form and delivery of Shares and/or Warrant Certificates) Name in which Shares are to be registered if other than in the name of the registered holder of this Warrant Certificate: Address to which Shares are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address:) (City and State) (Zip Code) Name in which Warrant Certificate evidencing unexercised Warrants, if any, are to be registered if other than in the name of the registered holder of this Warrant Certificate: Address to which certificate representing unexercised Warrants, if any, are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address) (City and State) (Zip Code) Dated: Signature Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate. If Shares, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the registered holder hereof or are to be delivered to an address other than the address of such holder as shown on the books of the Warrant Agent, the above signature must be guaranteed by a an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Name Title Dated: , 200 ASSIGNMENT (FORM OF ASSIGNMENT TO BE EXECUTED IF WARRANT HOLDER DESIRES TO TRANSFER WARRANTS EVIDENCED HEREBY) FOR VALUE RECEIVED, HEREBY SELL(S), ASSIGN(S) AND TRANSFER(S) UNTO ____________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________ (Please print name and address (Please insert social security or including zip code of assignee) other identifying number of assignee) the rights represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint Attorney to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. Dated: Signature (Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Name Title
Appears in 1 contract
Samples: Common Stock Warrant Agreement (Marathon Acquisition Corp.)
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder must, must pay in [Dollars] [applicable currency] [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank check, check or by bank wire transfer] [by bank wire transfer] [in each case payable to immediately available funds] the Company, in an amount equal to the Exercise Warrant Price in full for Warrants exercised to [__________], [corporate trust department] [insert address of Warrant Agent], Attn. __________ [or ____________], which [payment] [wire transfer] must specify the name of the holder and the number of Warrants exercisedexercised by such holder. In addition, the Warrant holder must provide complete the information required below below, including any applicable certifications if the Warrant Securities are issuable in bearer form, and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth below. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified [payment] [wire transfer]. To Be Executed Upon Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY of Warrant The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise ____________ Warrants, evidenced by this Warrant Certificate, to purchase, purchase ____________ shares of the shares of [Common Stock Stock] (each a “Share”the "Warrant Securities") of Homeowners Choice, Inc., a Florida corporation (the “Company”), Union Planters Corporation and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Securities in [Dollars] [applicable currency] [in cash or by certified check or official bank check or by bank wire transfer, in each case] [by bank wire transfer] in immediately available funds to the order of the CompanyUnion Planters Corporation, c/o [insert name and address of Warrant Agent], in the amount of $ ____________ in accordance with the terms hereof. The undersigned requests that said number principal amount of Shares Warrant Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing representing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated: , ________________________ Name: (Please Print) ___________________________ ________________________________ Address: ________________________ (Insert Social Security or Other other Identifying Number of Holder) Address:)
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder Holder must, by 5:00 P.M.p.m., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a bank wire transfer in immediately available funds, in each case payable to the Company, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder Holder must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M.p.m., New York City time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), Warrants, evidenced by this Warrant Certificate, to purchase, of purchase shares (the shares of Common Stock (each a “ShareWarrant Shares”) of Homeowners Choicecommon voting shares, par value of $0.001 per share (the “Common Stock”) of Galectin Therapeutics Inc., a Florida Nevada corporation (the “Company”), and represents that, that on or before the Exercise Date, : ¨ such holder Holder has tendered payment for such Warrant Shares by certified or official bank check payable to the order of the CompanyCompany c/o Continental Stock Transfer & Trust Co., 00 Xxxxxxx Xxxxx, 0xx Xxxxx, Xxx Xxxx, Xxx Xxxx 00000, or by bank wire transfer in immediately available funds payable to the Company at Account No. , in each case in the amount of $ in accordance with the terms hereof, or ¨ [if permitted] the cancellation of such number of Warrant Shares as is necessary, in accordance with the formula set forth in subsection 3.3.7 of the Warrant Agreement, to exercise this Warrant with respect to the maximum number of Warrant Shares purchasable pursuant to the cashless exercise procedure set forth in subsection 3.3.7. The undersigned requests that said number of Warrant Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Warrant Shares is less than all of the Warrant Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder Holder of the Warrant Certificate Certificate, unless otherwise specified in the instructions below. Dated: , Name: Name (Please Print) - - (Insert Social Security or Other Identifying Number of Holder) Address Signature This Warrant may only be exercised by presentation to the Warrant Agent at one of the following locations: By hand at: Continental Stock Transfer & Trust Co. 00 Xxxxxxx Xxxxx, 0xx Xxxxx Xxx Xxxx, Xxx Xxxx 00000 By mail at: Continental Stock Transfer & Trust Co. 00 Xxxxxxx Xxxxx, 0xx Xxxxx Xxx Xxxx, Xxx Xxxx 00000 The method of delivery of this Warrant Certificate is at the option and risk of the exercising Holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to insure timely delivery. (Instructions as to form and delivery of Warrant Shares and/or Warrant Certificates) Name in which Warrant Shares are to be registered if other than in the name of the Holder of this Warrant Certificate: Address to which Warrant Shares are to be mailed if other than to the address of the Holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address:) (City and State) (Zip Code) Name in which Warrant Certificate evidencing unexercised Warrants, if any, is to be registered if other than in the name of the Holder of this Warrant Certificate: Address to which certificate representing unexercised Warrants, if any, is to be mailed if other than to the address of the Holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address) (City and State) (Zip Code) Dated: Signature Signature must conform in all respects to the name of the Holder as specified on the face of this Warrant Certificate. If Warrant Shares, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the Holder hereof or are to be delivered to an address other than the address of such Holder as shown on the books of the Warrant Agent, the above signature must be guaranteed by a an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Name Title Dated: , 201 ASSIGNMENT (FORM OF ASSIGNMENT TO BE EXECUTED IF WARRANT HOLDER DESIRES TO TRANSFER WARRANTS EVIDENCED HEREBY) FOR VALUE RECEIVED, (Please print name and address including zip code of assignee) HEREBY SELL(S), ASSIGN(S) AND TRANSFER(S) UNTO (Please insert social security or including zip code of assignee) the rights represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint Attorney to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. Dated: Signature (Signature must conform in all respects to the name of the Holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Name Title Dated: , 201
Appears in 1 contract
Samples: Form of Warrant Agreement (Galectin Therapeutics Inc)
Instructions for Exercise of Warrant. To exercise the any Warrants evidenced herebyhereby for Warrant Debt Securities (as hereinafter defined), the holder mustHolder must pay, in lawful money of the United States of America, [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck in New York Clearing House funds] [by bank wire transfer in immediately available funds], in each case payable to the Company, in an amount equal to the Exercise Warrant Price in full for the Warrants exercised, to [●] [address of Warrant Agent], Attention: [●], which payment must specify the name of the Holder and the number of Warrants exercised by such Holder. In addition, the Warrant holder Holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth belowabove. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified Exercise Datepayment. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY (To be executed upon exercise of Warrants) The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise [●] Warrants, evidenced represented by this Warrant Certificate, to purchase, purchase $[●] principal amount of the shares [Title of Common Stock Warrant Debt Securities] (each a the “ShareWarrant Debt Securities”) of Homeowners ChoiceCardica, Inc., a Florida corporation (the “Company”), Inc. and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Debt Securities, in lawful money of the United States of America, [in cash or by certified check or official bank check in New York Clearing House funds] [by bank wire transfer in immediately available funds], to the order of the CompanyCardica, Inc., c/o [insert name and address of Warrant Agent], in the amount of $ $[●] in accordance with the terms hereof. The undersigned requests that said number principal amount of Shares Warrant Debt Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing the Warrants for the aggregate principal amount of Warrant Debt Securities remaining balance of the Warrants evidenced hereby unexercised be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated: , Name: (Please Print) Print Address: (Insert Social Security or Other Identifying Number of Holder) Address:Signature Guaranteed: Signature (Signature must conform in all respects to name of holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a FINRA member firm). This Warrant may be exercised at the following addresses: By hand at: By mail at: [Instructions as to form and delivery of Warrant Debt Securities and, if applicable, Warrant Certificates evidencing Warrants for the number of Warrant Debt Securities remaining unexercised—complete as appropriate.]
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder Holder must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a bank wire transfer in immediately available funds, in each case payable to the Company, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder Holder must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York City time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on __________, ____ (the “Exercise Date”), __________ Warrants, evidenced by this Warrant Certificate, to purchase, of __________ shares (the shares of Common Stock (each a “ShareWarrant Shares”) of Homeowners ChoiceCommon Stock, par value of $0.00001 per share (the “Common Stock”) of xG Technology, Inc., a Florida Delaware corporation (the “Company”), and represents that, that on or before the Exercise Date, : ¨ such holder Holder has tendered payment for such Warrant Shares by certified or official bank check payable to the order of the CompanyCompany c/o Continental Stock Transfer & Trust Co., 10 Xxxxxxx Xxxxx, 0xx Xxxxx, Xxx Xxxx, Xxx Xxxx 00000, or by bank wire transfer in immediately available funds payable to the Company at Account No. [ ], in each case in the amount of $ $_______ in accordance with the terms hereof, or ¨ [if permitted] the cancellation of such number of Warrant Shares as is necessary, in accordance with the formula set forth in subsection 3.3.7 of the Warrant Agreement, to exercise this Warrant with respect to the maximum number of Warrant Shares purchasable pursuant to the cashless exercise procedure set forth in subsection 3.3.7. The undersigned requests that said number of Warrant Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Warrant Shares is less than all of the Warrant Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder Holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: ________ __, Name: ____ Name (Please Print) / / / / - / / / - / / / / / (Insert Social Security or Other Identifying Number of Holder) Address:
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Instructions for Exercise of Warrant. To exercise the Warrants evidenced herebyhereof, the holder must, must pay in United States dollars [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank check, check or by bank wire transfer] [by bank wire transfer] in each case payable to [immediately available] [next-day] funds the Company, in an amount equal to the Exercise Warrant Price in full for Warrants exercised to [insert name of Warrant Agent] [Corporate Trust Department] [insert address of Warrant Agent], Attn. _______ [or ___________], which [payment] [wire transfer] must specify the name of the holder and the number of Warrants exercisedexercised by such holder. In addition, the Warrant holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth below. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified Exercise Date[payment] [wire transfer]. ELECTION TO PURCHASE TO BE EXECUTED IF UPON EXERCISE OF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise __________ Warrants, evidenced by this Warrant Certificate, to purchase, purchase ___________ shares of the shares of [Common Stock Stock] [Preferred Stock] (each a “Share”the "Warrant Securities") of Homeowners Choice, Inc., a Florida corporation (the “Company”), The Times Mirror Company and represents that, on or before that the Exercise Date, such holder undersigned has tendered payment for such Shares Warrant Securities in Dollars [in cash or by certified check or official bank check or by bank wire transfer, in each case] [by bank wire transfer] in [immediately available] [next-day] funds to the order of the The Times Mirror Company, c/o [insert name and address of Warrant Agent], in the amount of $ ___________ in accordance with the terms hereof. The undersigned requests that said number amount of Shares Warrant Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing representing the remaining balance of the Warrants warrant evidenced hereby be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions instruction below. Dated: , Name: (Please Print) ____________________ Name ________________________ Address _____________________ ___________________________ (Insert Social Security or _________________________ Other Identifying Number of (Signature must conform in all respects Holder) Address:to name of holder as specified on the Signature Guaranteed face of this Warrant Certificate and must bear a signature guarantee by a ____________________ bank, trust company or member broker of the New York or Pacific Stock Exchange) The Warrants evidenced hereby may be exercised at the following addresses: By hand at _________________________ _________________________ _________________________ _________________________ By mail at _________________________ _________________________ _________________________ _________________________
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the any Warrants evidenced herebyhereby for Warrant Debt Securities (as hereinafter defined), the holder mustHolder must pay, in lawful money of the United States of America, [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck in New York Clearing House funds] [by bank wire transfer in immediately available funds], in each case payable to the Company, in an amount equal to the Exercise Warrant Price in full for the Warrants exercised, to [Warrant Agent] [address of Warrant Agent], Attn: , which payment must specify the name of the Holder and the number of Warrants exercised by such Holder. In addition, the Warrant holder Holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth belowabove. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified Exercise Datepayment. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY (To be executed upon exercise of Warrants) The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise Warrants, evidenced represented by this Warrant Certificate, to purchase, purchase $ principal amount of the shares [Title of Common Stock Warrant Debt Securities] (each a the “ShareWarrant Debt Securities”) of Homeowners ChoiceAffymax, Inc., a Florida corporation (the “Company”), Inc. and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Debt Securities, in lawful money of the United States of America, [in cash or by certified check or official bank check in New York Clearing House funds] [by bank wire transfer in immediately available funds], to the order of the CompanyAffymax, Inc., c/o [insert name and address of Warrant Agent], in the amount of $ in accordance with the terms hereof. The undersigned requests that said number principal amount of Shares Warrant Debt Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing the Warrants for the aggregate principal amount of Warrant Debt Securities remaining balance of the Warrants evidenced hereby unexercised be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated: , Name: (Please Print) Print Address: (Insert Social Security or Other Identifying Number of Holder) Address:Signature Guaranteed: Signature (Signature must conform in all respects to name of holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a FINRA member firm). This Warrant may be exercised at the following addresses: By hand at: By mail at: [Instructions as to form and delivery of Warrant Securities and, if applicable, Warrant Certificates evidencing Warrants for the number of Warrant Securities remaining unexercised—complete as appropriate.] ASSIGNMENT [Form of assignment to be executed if Warrant Holder desires to transfer Warrant] FOR VALUE RECEIVED, hereby sells, assigns and transfers unto: (Please print name and address including zip code) Please print Social Security or other identifying number the right represented by the within Warrant to purchase $ aggregate principal amount of [Title of Warrant Debt Securities] of Affymax, Inc. to which the within Warrant relates and appoints attorney to transfer such right on the books of the Warrant Agent with full power of substitution in the premises. Dated Signature (Signature must conform in all respects to name of holder as specified on the face of the Warrant)
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder must, Registered Holder must pay in full [in lawful money of the United States of America] [in applicable currency] [in cash] [by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck or by bank wire transfer, in each case payable case,] [by bank wire transfer] [in immediately available funds,] the Warrant Price for Warrants exercised (plus any accrued interest as specified in this Warrant Certificate) to [insert name of Warrant Agent] [corporate trust department] [insert address of Warrant Agent], Attn: [or , which [payment] [wire transfer] must specify the Company, in an amount equal to name of the Exercise Price in full for Registered Holder and the number of Warrants exercisedexercised by such Registered Holder. In addition, the Warrant holder Registered Holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth below. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified [payment] [wire transfer]. To be Executed Upon Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY of Warrant The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise _____ Warrants, evidenced by this Warrant Certificate, to purchase, purchase _____ principal amount of the shares [Title of Common Stock Warrant Securities] (each a “Share”the "Warrant Securities") of Homeowners Choice, Inc., a Florida corporation (the “Company”), X.X. Xxxxxx Chase & Co. and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Securities [in lawful money of the United States of America] [in applicable currency] [in cash] [by certified check or official bank check or by bank wire transfer, in each case,] [by bank wire transfer] [in immediately available funds] to the order of the CompanyX.X. Xxxxxx Xxxxx & Co., c/o [insert name and address of Warrant Agent], in the amount of $ _______ in accordance with the terms hereof. The undersigned requests that said number principal amount of Shares Warrant Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less fewer than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing representing the remaining balance of the Warrants evidenced hereby be issued in registered form and delivered either to the holder of the Warrant Certificate unless undersigned or as otherwise specified in the instructions below. Dated: , _________________________ Name: ____________________________________ (Please Print) ______________________________ Address_________________________________ (Insert Social Security or Other Identifying Number of ________________________________________ Holder) Address:Signature_______________________________ The Warrants evidenced hereby may be exercised at the following addresses: By hand at__________________________________________ __________________________________________ __________________________________________ __________________________________________ By mail at__________________________________________ __________________________________________ __________________________________________ __________________________________________ [Instructions as to delivery of Warrant Securities and, if applicable, Warrant Certificates evidencing unexercised Warrants - complete as appropriate.] Assignment (Form of Assignment to be Executed if Holder Desires to Transfer Warrants Evidenced Hereby) FOR VALUE RECEIVED hereby sells, assigns and transfers unto Please insert social security or other identifying number ----------------------------- ----------------------------- ------------------------------------------------------------------------------- (Please print name and address including zip code) ------------------------------------------------------------------------------- the Warrants represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint _______________ Attorney, to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. Dated: ----------------------------------------- Signature (Signature must conform in all respects to name of Registered Holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a bank, trust company or member broker of the New York, Midwest or Pacific Stock Exchange).
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder or Participant must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a bank wire transfer in immediately available funds, in each case payable to the CompanyWarrant Agent at Account No. ____, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder or Participant must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on __________, ____ (the “Exercise Date”), _____________ Warrants, evidenced by this Warrant Certificate, to purchase, of _________________ shares (the shares of Common Stock (each a “ShareWarrant Shares”) of Homeowners ChoiceCommon Stock, Inc.par value of $0.0001 per share (the “Common Stock”) of Medovex Corp., a Florida Nevada corporation (the “Company”), and represents that, that on or before the Exercise Date, : [ ] such holder has tendered payment for such Warrant Shares by certified or official bank check or bank wire transfer in immediately available funds to the order of the Company c/o InterWest Transfer Company, Inc., 0000 Xxxxxx Xxxxxxxx Road, Suite 100, Salt Lake City, UT 84117, in the amount of $ $_____________ in accordance with the terms hereof, or [ ] [if permitted] the cancellation of such number of Warrant Shares as is necessary, in accordance with the formula set forth in subsection 3.3.7 of the Warrant Agreement, to exercise this Warrant with respect to the maximum number of Warrant Shares purchasable pursuant to the cashless exercise procedure set forth in subsection 3.3.7. The undersigned requests that said number of Warrant Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Warrant Shares is less than all of the Warrant Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: ______________ __, Name: ____ Name __________________________ (Please Print) / / / / - / / /- / / / / / (Insert Social Security or Other Identifying Number of Holder) Address _______________________ _______________________ Signature _______________________ This Warrant may only be exercised by presentation to the Warrant Agent at one of the following locations: By hand at: By mail at: The method of delivery of this Warrant Certificate is at the option and risk of the exercising holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to assure timely delivery. (Instructions as to form and delivery of Warrant Shares and/or Warrant Certificates) Name in which Warrant Shares are to be registered if other than in the name of the registered holder of this Warrant Certificate: ______________________________ Address to which Warrant Shares are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: ______________________________ (Street Address:) ______________________________ (City and State) (Zip Code) Name in which Warrant Certificate evidencing unexercised Warrants, if any, are to be registered if other than in the name of the registered holder of this Warrant Certificate: ______________________________ Address to which certificate representing unexercised Warrants, if any, are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: ______________________________ (Street Address) ______________________________ (City and State) (Zip Code) Dated: ______________________________ Signature Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate. If Warrant Shares, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the registered holder hereof or are to be delivered to an address other than the address of such holder as shown on the books of the Warrant Agent, the above signature must be guaranteed by a an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Name Title Dated: __________________________, 201___ ASSIGNMENT (FORM OF ASSIGNMENT TO BE EXECUTED IF WARRANT HOLDER DESIRES TO TRANSFER WARRANTS EVIDENCED HEREBY) FOR VALUE RECEIVED, _________________ HEREBY SELL(S), ASSIGN(S) AND TRANSFER(S) UNTO ________________________________________________________ __________________________________ _______________________________________ (Please print name and address (Please insert social security or including zip code of assignee) other identifying number of assignee) the rights represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint ____________ Attorney to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. Dated: _____________________________________________ Signature (Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Name Title
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder [For Book-Entry Warrant Certificate: or Participant] must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its corporate trust department, a certified or official bank checkcheck or a wire transfer in immediately available funds, in each case payable to the CompanyWarrant Agent at Account No. ____, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder [For Book-Entry Warrant Certificates: or Participant] must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow [For Book-Entry Warrant Certificates: and the Book-Entry Warrants to the Warrant --Agent in its account with the Depository designated for such purpose]. The This Warrant Certificate and this the Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY HEREBY. The undersigned hereby irrevocably elects to exercise, on __________, ____ (the “"Exercise Date”"), _____________ Warrants, evidenced by this Warrant Certificate, to purchase, [$_____________ principal amount] [_________________] of the shares [title of Common Stock Securities purchasable upon exercise of Warrants] [If Warrants for Depositary Shares are to be offered: , each representing a 1/__th interest in a share of [title of securities represented by the Depositary Shares]] (each a “Share”the "Warrant Securities") of Homeowners Choice, Inc.AAR CORP., a Florida Delaware corporation (the “"Company”"), and represents that, that on or before the Exercise Date, Date such holder has tendered payment for such Shares Warrant Securities by certified or official bank check or bank wire transfer in immediately available funds to the order of the CompanyCompany c/o [Name and address of Warrant Agent], in the amount of $ $_____________ in accordance with the terms hereof. The undersigned requests that said [principal amount of] [number of Shares of] Warrant Securities be in fully registered form, in the authorized denominations, registered in such names and delivered, all as specified in accordance with the instructions set forth below. [Unless Warrants may be exercised on only one date: If said number [principal amount] [number] of Shares Warrant Securities is less than all of the Shares Warrant Securities purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. .] Dated: ______________ __, Name: ____ Name __________________________ _________________________ (Please Print) / / / /- / / /- / / / / / (Insert Social Security or Other Identifying Number of Holder) Address _______________________ _______________________ Signature _____________________ This Warrant may only be exercised by presentation to the Warrant Agent at one of the following locations: By hand at By mail at The method of delivery of this Warrant Certificate is at the option and risk of - the exercising holder and the delivery of this Warrant Certificate will be - deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is - recommended. In all cases, sufficient time should be allowed to assure timely delivery. (Instructions as to form and delivery of Warrant Securities and/or Warrant Certificates) Name in which Warrant Securities are to be registered if other than in the name of the registered holder of this Warrant Certificate: ______________________________ Address to which Warrant Securities are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: ______________________________ (Street Address:) ______________________________ (City and State) (Zip Code)
Appears in 1 contract
Samples: Warrant Agreement (Aar Corp)
Instructions for Exercise of Warrant. To exercise the any Warrants evidenced herebyhereby for Warrant Securities (as hereinafter defined), the holder mustHolder must pay, in lawful money of the United States of America, [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck in New York Clearing House funds] [by bank wire transfer in immediately available funds], in each case payable to the Company, in an amount equal to the Exercise Warrant Price in full for the Warrants exercised, to [●] [address of Warrant Agent], Attention: [●], which payment must specify the name of the Holder and the number of Warrants exercised by such Holder. In addition, the Warrant holder Holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth belowabove. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified Exercise Datepayment. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY (To be executed upon exercise of Warrants) The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise _______ Warrants, evidenced by this Warrant Certificate, to purchase, of the purchase _______ shares of Common Stock (each a “Share”) [Title of Homeowners ChoiceWarrant Securities], Inc., a Florida corporation par value $0.001 per share (the “CompanyWarrant Securities”), of aTyr Pharma, Inc. and represents that, on or before that the Exercise Date, such holder undersigned has tendered payment for such Shares Warrant Securities, in lawful money of the United States of America, [in cash or by certified check or official bank check in New York Clearing House funds] [by bank wire transfer in immediately available funds], to the order of the CompanyaTyr Pharma, Inc., c/o [insert name and address of Warrant Agent], in the amount of $ $_______ in accordance with the terms hereof. The undersigned requests that said number of Shares Warrant Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing the Warrants for the number of Warrant Securities remaining balance of the Warrants evidenced hereby unexercised be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated: , Name: (Please Print) Print Address: (Insert Social Security or Other Identifying Number of Holder) Address:Signature Guaranteed: Signature (Signature must conform in all respects to name of holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a FINRA member firm). This Warrant may be exercised at the following addresses: By hand at: [●]
Appears in 1 contract
Samples: Preferred Stock Warrant Agreement (aTYR PHARMA INC)
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder Holder must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a bank wire transfer in immediately available funds, in each case payable to the Company, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder Holder must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York City time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on __________, ____ (the “Exercise Date”), __________ Warrants, evidenced by this Warrant Certificate, to purchase, of __________ shares (the shares of Common Stock (each a “ShareWarrant Shares”) of Homeowners ChoiceCommon Stock, par value of $0.001 per share (the “Common Stock”) of China Commercial Credit, Inc., a Florida Delaware corporation (the “Company”), and represents that, that on or before the Exercise Date, : o such holder Holder has tendered payment for such Warrant Shares by certified or official bank check payable to the order of the CompanyCompany c/o [__________________], [_________________], or by bank wire transfer in immediately available funds payable to the Company at Account No. , in each case in the amount of $ in accordance with the terms hereof, or o [if permitted] the cancellation of such number of Warrant Shares as is necessary, in accordance with the formula set forth in subsection 3.3.7 of the Warrant Agreement, to exercise this Warrant with respect to the maximum number of Warrant Shares purchasable pursuant to the cashless exercise procedure set forth in subsection 3.3.7. The undersigned requests that said number of Warrant Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. In the event that the Warrant has been called for redemption by the Company pursuant to Section 7 of the Warrant Agreement, the number of shares that this Warrant is exercisable for shall be determined in accordance with Section 7 of the Warrant Agreement. If said number of Warrant Shares is less than all of the Warrant Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder Holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: ________ __, Name: ____ Name (Please Print) / / / / - / / / - / / / / / (Insert Social Security or Other Identifying Number of Holder) Address __________________________ __________________________ Signature __________________________ This Warrant may only be exercised by presentation to the Warrant Agent at one of the following locations: By hand at: [__________________] [__________________] [__________________] By mail at: [__________________] [__________________] [__________________] The method of delivery of this Warrant Certificate is at the option and risk of the exercising Holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to ensure timely delivery. (Instructions as to form and delivery of Warrant Shares and/or Warrant Certificates) Name in which Warrant Shares are to be registered if other than in the name of the Holder of this Warrant Certificate: Address to which Warrant Shares are to be mailed if other than to the address of the Holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address) (City and State) (Zip Code) Name in which Warrant Certificate evidencing unexercised Warrants, if any, is to be registered if other than in the name of the Holder of this Warrant Certificate: Address to which certificate representing unexercised Warrants, if any, is to be mailed if other than to the address of the Holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address) (City and State) (Zip Code) Dated: Signature Signature must conform in all respects to the name of the Holder as specified on the face of this Warrant Certificate. If Warrant Shares, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the Holder hereof or are to be delivered to an address other than the address of such Holder as shown on the books of the Warrant Agent, the above signature must be guaranteed by a an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Name Title Dated: , 20__ ASSIGNMENT (FORM OF ASSIGNMENT TO BE EXECUTED IF WARRANT HOLDER DESIRES TO TRANSFER WARRANTS EVIDENCED HEREBY) FOR VALUE RECEIVED, ____________ HEREBY SELL(S), ASSIGN(S) AND TRANSFER(S) UNTO (Please print name and address including zip code of assignee) (Please insert social security or other identifying number of assignee) the rights represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint ____________ Attorney to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. Dated:
Appears in 1 contract
Instructions for Exercise of Warrant. PRIOR TO MAKING A DECISION TO EXERCISE ANY WARRANTS EVIDENCED HEREBY, THE HOLDER OF THE WARRANTS SHOULD CAREFULLY READ THE PROSPECTUS RELATING TO THE COMMON STOCK UNDERLYING SUCH WARRANTS. A COPY OF SUCH PROSPECTUS IS AVAILABLE FREE OF CHARGE BY CONTACTING GSL HOLDING, INC. AT ITS PRINCIPAL EXECUTIVE OFFICES. THE SECURITIES AND EXCHANGE COMMISSION ALSO MAINTAINS A WEBSITE AT XXX.XXX.XXX THAT CONTAINS SUCH INFORMATION. To exercise the Warrants evidenced hereby, the holder or Participant must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyCorporation, a certified or official bank checkcheck or a wire transfer in immediately available funds, in each case payable to the CompanyCorporation at such an account number as the Corporation may designate from time to time, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder or Participant must provide the information required below and deliver this Warrant Certificate to the Company Corporation at the address set forth belowforth. The Warrant Certificate and this Election to Purchase must be received by the Company Corporation by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), Warrants, evidenced by this Warrant Certificate, to purchase, of the shares of Class A Common Stock (each each, a “Class A Common Share”) of Homeowners ChoiceGlobal Ship Lease, Inc., a Florida Xxxxxxxx Islands corporation (the “CompanyCorporation”), and represents that, that on or before the Exercise Date, Date such holder has tendered payment for such Class A Common Shares by certified or official bank check or bank wire transfer in immediately available funds to the order of the CompanyCorporation c/o [ ] , in the amount of $ in accordance with the terms hereof. The undersigned requests that said number of Class A Common Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Class A Common Shares is less than all of the Class A Common Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: , Name: Name _____________________ (Please Print) / / / / — / / / — / / / / / (Insert Social Security or Other Identifying Number of Holder) Address Signature This Warrant may only be exercised by presentation to the Corporation at one of the following locations: By hand at: By mail at: The method of delivery of this Warrant Certificate is at the option and risk of the exercising holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Corporation. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to assure timely delivery. (Instructions as to form and delivery of Class A Common Shares and/or Warrant Certificates) Name in which Class A Common Shares are to be registered if other than in the name of the registered holder of this Warrant Certificate: Address to which Class A Common Shares are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Corporation: (Street Address:) (City and State) (Zip Code) Name in which Warrant Certificate evidencing unexercised Warrants, if any, are to be registered if other than in the name of the registered holder of this Warrant Certificate: Address to which certificate representing unexercised Warrants, if any, are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Corporation: (Street Address) (City and State) (Zip Code) Dated: Signature Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate. If Class A Common Shares, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the registered holder hereof or are to be delivered to an address other than the address of such holder as shown on the books of the Corporation, the above signature must be guaranteed by a an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Name Title Dated: , 200__ ASSIGNMENT (FORM OF ASSIGNMENT TO BE EXECUTED IF WARRANT HOLDER DESIRES TO TRANSFER WARRANTS EVIDENCED HEREBY) FOR VALUE RECEIVED, HEREBY SELL(S), ASSIGN(S) AND TRANSFER(S) UNTO (Please print name and address including zip code of assignee) (Please insert social security or other identifying number of assignee) the rights represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint Attorney to transfer said Warrant Certificate on the books of the Corporation with full power of substitution in the premises. Dated: (Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Name Title Dated: , 200__ Schedule I Initial Holder Maximum Number of Shares CMA CGM S.A. 3,131,900 Marathon Founders LLC 3,007,288 Xxxx Xxxx 16,300 Xxxxx X. Xxxxx 16,300 Xxxxxx Xxxxx 16,300 EXHIBIT F CERTIFICATE OF DESIGNATION Exhibit F CERTIFICATE OF DESIGNATION GSL Holdings, Inc. CERTIFICATE OF DESIGNATION OF MANDATORILY REDEEMABLE PREFERRED SHARES, SERIES A, SETTING FORTH THE POWERS, PREFERENCES, RIGHTS, QUALIFICATIONS, LIMITATIONS AND RESTRICTIONS OF SUCH SERIES OF PREFERRED STOCK
Appears in 1 contract
Samples: Common Stock Warrant Agreement (Marathon Acquisition Corp.)
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder or Participant must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a bank wire transfer in immediately available funds, in each case payable to the CompanyWarrant Agent at Account No. ____, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder or Participant must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on __________, ____ (the “Exercise Date”), _____________ Warrants, evidenced by this Warrant Certificate, to purchase, of _________________ shares (the shares of Common Stock (each a “ShareWarrant Shares”) of Homeowners ChoiceCommon Stock, par value of $0.001 per share (the “Common Stock”) of Northwest Biotherapeutics, Inc., a Florida Delaware corporation (the “Company”), and represents that, that on or before the Exercise Date, Date £ such holder has tendered payment for such Warrant Shares by certified or official bank check or bank wire transfer in immediately available funds to the order of the Company c/o Computershare Trust Company, N.A.________________, in the amount of $ $_____________ in accordance with the terms hereof, or £ [if permitted] the cancellation of such number of Warrant Shares as is necessary, in accordance with the formula set forth in subsection 3.3.7 of the Warrant Agreement, to exercise this Warrant with respect to the maximum number of Warrant Shares purchasable pursuant to the cashless exercise procedure set forth in subsection 3.3.7. The undersigned requests that said number of Warrant Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Warrant Shares is less than all of the Warrant Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: ______________ __, Name: ____ Name (Please Print) / / / / - / / /- / / / / / (Insert Social Security or Other Identifying Number of Holder) Address:
Appears in 1 contract
Samples: Warrant Agency Agreement (Northwest Biotherapeutics Inc)
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder or Participant must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a wire transfer in immediately available funds, in each case payable to the CompanyWarrant Agent at Account No. , in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder or Participant must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), Warrants, evidenced by this Warrant Certificate, to purchase, of the shares of Common Stock (each a “Share”) of Homeowners Choice, Inc., a Florida corporation (the “Company”), and represents that, on or before the Exercise Date, such holder has tendered payment for such Shares by certified or official bank check or bank wire transfer in immediately available funds to the order of the Company c/o American Stock Transfer & Trust Company, LLC, 0000 00xx Xxxxxx, Xxxxxxxx, Xxx Xxxx 00000, in the amount of $ in accordance with the terms hereof. The undersigned requests that said number of Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Shares is less than all of the Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: , Name: (Please Print) (Insert Social Security or Other Identifying Number of Holder) Address:
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder must, must pay [in United States dollars][in applicable currency] [in cash] [by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck or by bank wire transfer, in each case payable to case] [by bank wire transfer] [in immediately available funds], the Company, in an amount equal to the Exercise Warrant Price in full for Warrants exercised to [insert of name of Warrant Agent] [corporate trust department] [insert address of Warrant Agent], Attn. _______________ [or ______________], which [payment] [wire transfer] must specify the name of the Holder and the number of Warrants exercisedexercised by such Holder. In addition, the Warrant holder Holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth below. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified [payment] [wire transfer]. To be Executed Upon Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY of Warrant The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise __________ Warrants, evidenced by this Warrant Certificate, to purchase, purchase ______ shares of the shares [Title of Common Stock Warrant Securities] (each a “Share”the "Warrant Securities") of Homeowners Choice, Inc., a Florida corporation (the “Company”), Company and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Securities [in United States dollars] [in applicable currency] [in cash] [by certified check or official bank check or by bank wire transfer, in each case] [by bank wire transfer] [in immediately available funds] to the order of the CompanyXxxxxxxxx, Lufkin & Xxxxxxxx, Inc., c/o [insert name and address of Warrant Agent], in the amount of $ ___________ in accordance with the terms hereof. The undersigned requests that said number principal amount of Shares Warrant Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. [If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing representing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated: , .] Date:_________________________ Name: (Please Print) __________________________ ______________________________ Address_______________________ (Insert Social Security or Other Identifying Number of Holder) Address:______________________________ Signature Guaranteed ______________________________ Signature_____________________ (Signature must conform in all respects to name of holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a bank, trust company or member broker of the New York, Midwest or Pacific Stock Exchange) The Warrants evidenced hereby may be exercised at the following addresses: By hand at_____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ By mail at_____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ [Instructions as to form and delivery of Warrant Securities and, if applicable, Warrant Certificates evidencing unexercised Warrants -- complete as appropriate.]
Appears in 1 contract
Samples: Preferred Stock Warrant Agreement (Donaldson Lufkin & Jenrette Inc /Ny/)
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder or Participant must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a bank wire transfer in immediately available funds, in each case payable to the CompanyWarrant Agent at Account No. ____, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder or Participant must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on __________, ____ (the “Exercise Date”), _____________ Warrants, evidenced by this Warrant Certificate, to purchase, of _________________ shares (the shares of Common Stock (each a “ShareWarrant Shares”) of Homeowners ChoiceCommon Stock, par value of $0.0001 per share (the “Common Stock”) of InterCloud Systems, Inc., a Florida Delaware corporation (the “Company”), and represents that, that on or before the Exercise Date, Date £ such holder has tendered payment for such Warrant Shares by certified or official bank check or bank wire transfer in immediately available funds to the order of the CompanyCompany c/o Corporate Stock Transfer, 0000 Xxxxxx Xxxxx Xxxxx Xxxxx, Xxxxx 000, Xxxxxx, Xxxxxxxx 00000, in the amount of $ $_____________ in accordance with the terms hereof, or £ [if permitted] the cancellation of such number of Warrant Shares as is necessary, in accordance with the formula set forth in subsection 3.3.7 of the Warrant Agreement, to exercise this Warrant with respect to the maximum number of Warrant Shares purchasable pursuant to the cashless exercise procedure set forth in subsection 3.3.7. The undersigned requests that said number of Warrant Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Warrant Shares is less than all of the Warrant Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: ______________ __, Name: ____ Name (Please Print) / / / / - / / /- / / / / / (Insert Social Security or Other Identifying Number of Holder) Address:
Appears in 1 contract
Samples: Warrant Agency Agreement (Intercloud Systems, Inc.)
Instructions for Exercise of Warrant. To exercise the any Warrants evidenced herebyhereby for Warrant Securities (as hereinafter defined), the holder mustHolder must pay, in lawful money of the United States of America, [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck in New York Clearing House funds] [by bank wire transfer in immediately available funds], in each case payable to the Company, in an amount equal to the Exercise Warrant Price in full for the Warrants exercised, to [•] [address of Warrant Agent], Attention: [•], which payment must specify the name of the Holder and the number of Warrants exercised by such Holder. In addition, the Warrant holder Holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth belowabove. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified Exercise Datepayment. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY (To be executed upon exercise of Warrants) The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise [•] Warrants, evidenced by this Warrant Certificate, to purchase, purchase [•] shares of the shares [Title of Common Stock (each a “Share”) of Homeowners Choice, Inc., a Florida corporation Warrant Securities] (the “CompanyWarrant Securities”), of AcelRx Pharmaceuticals, Inc. and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Securities, in lawful money of the United States of America, [in cash or by certified check or official bank check in New York Clearing House funds] [by bank wire transfer in immediately available funds], to the order of the CompanyAcelRx Pharmaceuticals, Inc., c/o [insert name and address of Warrant Agent], in the amount of $ $[•] in accordance with the terms hereof. The undersigned requests that said number of Shares Warrant Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing the Warrants for the number of Warrant Securities remaining balance of the Warrants evidenced hereby unexercised be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated: , Name: (Please Print) Print Address: (Insert Social Security or Other Identifying Number of Holder) Address:Signature Guaranteed: Signature (Signature must conform in all respects to name of holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a FINRA member firm). This Warrant may be exercised at the following addresses: By hand at: By mail at: [Instructions as to form and delivery of Warrant Securities and, if applicable, Warrant Certificates evidencing Warrants for the number of Warrant Securities remaining unexercised — complete as appropriate.]
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder or Participant must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a bank wire transfer in immediately available funds, in each case payable to the CompanyWarrant Agent at Account No. ____, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder or Participant must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on __________, ____ (the “Exercise Date”), _____________ Warrants, evidenced by this Warrant Certificate, to purchase, of _________________ shares (the shares of Common Stock (each a “ShareWarrant Shares”) of Homeowners ChoiceCommon Stock, par value of $0.0001 per share (the “Common Stock”) of Auddia Inc., a Florida Delaware corporation (the “Company”), and represents that, that on or before the Exercise Date, Date [ ] such holder has tendered payment for such Warrant Shares by certified or official bank check or bank wire transfer in immediately available funds to the order of the Company c/o V-Stock Transfer Company, Inc., 00 Xxxxxxxxx Xxxxx, Xxxxxxxx, XX 00000, in the amount of $ $_____________ in accordance with the terms hereof, or [ ] the cancellation of such number of Warrant Shares as is necessary, in accordance with the formula set forth in subsection 3.3.7 of the Agreement, to exercise this Warrant with respect to the maximum number of Warrant Shares purchasable pursuant to the cashless exercise procedure set forth in subsection 3.3.7. The undersigned requests that said number of Warrant Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Warrant Shares is less than all of the Warrant Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: ______________ __, Name: ____ Name __________________________ (Please Print) / / / / - / / /- / / / / / (Insert Social Security or Other Identifying Number of Holder) Address ________________________ ________________________ Signature _______________________ This Warrant may only be exercised by presentation to the Warrant Agent at one of the following locations: By hand at: By mail at: The method of delivery of this Warrant Certificate is at the option and risk of the exercising holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to assure timely delivery. (Instructions as to form and delivery of Warrant Shares and/or Warrant Certificates) Name in which Warrant Shares are to be registered if other than in the name of the registered holder of this Warrant Certificate: ___________________________________ Address to which Warrant Shares are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: ______________________________ (Street Address:) ______________________________ (City and State) (Zip Code) Name in which Warrant Certificate evidencing unexercised Warrants, if any, are to be registered if other than in the name of the registered holder of this Warrant Certificate: ____________________________________ Address to which certificate representing unexercised Warrants, if any, are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: __________________________ (Street Address) __________________________ (City and State) (Zip Code) Dated: __________________________ Signature Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate. If Warrant Shares, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the registered holder hereof or are to be delivered to an address other than the address of such holder as shown on the books of the Warrant Agent, the above signature must be guaranteed by a an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm: _______________________ Address: __________________________ Area Code and Telephone Number: _______________________ Authorized Signature: __________________________________ Print Name: ________________________ Title: ____________________________ Dated: ___________________, 202___
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder or Participant must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a wire transfer in immediately available funds, in each case payable to the Company, Warrant Agent in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder or Participant must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), Warrants, evidenced by this Warrant Certificate, to purchase, of the shares of Common Stock (each a “Share”) of Homeowners Choice, Inc., a Florida corporation (the “Company”), and represents that, on or before the Exercise Date, such holder has tendered payment for such Shares by certified or official bank check or bank wire transfer in immediately available funds to the order of the Company c/o American Stock Transfer & Trust Company, LLC, in the amount of $ in accordance with the terms hereof. The undersigned requests that said number of Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Shares is less than all of the Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: , Name: (Please Print) (Insert Social Security or Other Identifying Number of Holder) Address: Signature: This Warrant may only be exercised by presentation to the Warrant Agent. The method of delivery of this Warrant Certificate is at the option and risk of the exercising holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to assure timely delivery. (Instructions as to form and delivery of Shares and/or Warrant Certificates) Name in which Shares are to be registered if other than in the name of the registered holder of this Warrant Certificate: Address to which Shares are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address) (City and State) (Zip Code) Name in which Warrant Certificate evidencing unexercised Warrants, if any, are to be registered if other than in the name of the registered holder of this Warrant Certificate: Address to which certificate representing unexercised Warrants, if any, are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address) (City and State) (Zip Code) Dated: Signature Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate. If Shares, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the registered holder hereof or are to be delivered to an address other than the address of such holder as shown on the books of the Warrant Agent, the above signature must be guaranteed by an Eligible Guarantor Institution (Banks, Stockbrokers, Savings and Loan Associations and Credit Unions with membership in an approved Signature Guarantee Medallion Program), pursuant to S.E.C. Rule 17Ad-15. SIGNATURE GUARANTEE Name of Firm: Address: Area Code and Number: Authorized Signature: Name: Title: Dated: ASSIGNMENT (FORM OF ASSIGNMENT TO BE EXECUTED IF WARRANT HOLDER DESIRES TO TRANSFER WARRANTS EVIDENCED HEREBY) FOR VALUE RECEIVED, HEREBY SELL(S), ASSIGN(S) AND TRANSFER(S) UNTO: (Please print name and address including zip code of assignee) (Please insert social security or other identifying number of assignee) the rights represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint Attorney to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. Dated: (Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by an Eligible Guarantor Institution (Banks, Stockbrokers, Savings and Loan Associations and Credit Unions with membership in an approved Signature Guarantee Medallion Program), pursuant to S.E.C. Rule 17Ad-15. SIGNATURE GUARANTEE Name of Firm: Address: Area Code and Number: Authorized Signature: Name: Title:
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the any Warrants evidenced herebyhereby for Warrant Securities (as hereinafter defined), the holder mustHolder must pay, in lawful money of the United States of America, [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck in New York Clearing House funds] [by bank wire transfer in immediately available funds], in each case payable to the Company, in an amount equal to the Exercise Warrant Price in full for the Warrants exercised, to [●] [address of Warrant Agent], Attention: [●], which payment must specify the name of the Holder and the number of Warrants exercised by such Holder. In addition, the Warrant holder Holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth belowabove. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified Exercise Datepayment. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY (To be executed upon exercise of Warrants) The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise _______ Warrants, evidenced by this Warrant Certificate, to purchase, purchase _______ shares of the shares of Common Stock (each a “Share”) of Homeowners ChoiceStock, Inc., a Florida corporation par value $0.001 per share (the “CompanyWarrant Securities”), of aTyr Pharma, Inc. and represents that, on or before that the Exercise Date, such holder undersigned has tendered payment for such Shares Warrant Securities, in lawful money of the United States of America, [in cash or by certified check or official bank check in New York Clearing House funds] [by bank wire transfer in immediately available funds], to the order of the CompanyaTyr Pharma, Inc., c/o [insert name and address of Warrant Agent], in the amount of $ $_______ in accordance with the terms hereof. The undersigned requests that said number of Shares Warrant Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing the Warrants for the number of Warrant Securities remaining balance of the Warrants evidenced hereby unexercised be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated: , Name: (Please Print) Print Address: (Insert Social Security or Other Identifying Number of Holder) AddressSignature Guaranteed: Signature (Signature must conform in all respects to name of holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a FINRA member firm). This Warrant may be exercised at the following addresses: By hand at:
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified or official bank check, in each case payable to the Company, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder must provide the information required below and deliver this Warrant Certificate to the Company at the address set forth below. The Warrant Certificate and this Election to Purchase must be received by the Company by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), Warrants, evidenced by this Warrant Certificate, to purchase, of the shares of Common Stock (each a “Share”) of Homeowners ChoiceLM Funding America, Inc., a Florida Delaware corporation (the “Company”), and represents that, on or before the Exercise Date, such holder has tendered payment for such Shares by certified or official bank check to the order of the Company, in the amount of $ in accordance with the terms hereof. The undersigned requests that said number of Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Shares is less than all of the Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: , 2015 Name: (Please Print) (Insert Social Security or Other Identifying Number of Holder) Address: Signature: This Warrant may only be exercised by presentation to the Company at the following location: By hand at: 000 Xxxxxxx Xxx Xxxxxx, Suite 1000, Tampa, Florida 33602 By mail at: 000 Xxxxxxx Xxx Xxxxxx, Suite 1000, Tampa, Florida 33602, Attn: The method of delivery of this Warrant Certificate is at the option and risk of the exercising holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Company. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to assure timely delivery. (Instructions as to form and delivery of Shares and/or Warrant Certificates) Name in which Shares are to be registered if other than in the name of the registered holder of this Warrant Certificate: Address to which Shares are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the warrant ledger: (Street Address) (City and State) (Zip Code) Name in which Warrant Certificate evidencing unexercised Warrants, if any, are to be registered if other than in the name of the registered holder of this Warrant Certificate: Address to which certificate representing unexercised Warrants, if any, are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the warrant ledger: (Street Address) (City and State) (Zip Code) Dated: Signature Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate. If Shares, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the registered holder hereof or are to be delivered to an address other than the address of such holder as shown on the warrant ledger, the above signature must be guaranteed by a an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm: Address: Area Code and Number: Authorized Signature: Name: Title: Dated: ASSIGNMENT (FORM OF ASSIGNMENT TO BE EXECUTED IF WARRANT HOLDER DESIRES TO TRANSFER WARRANTS EVIDENCED HEREBY) FOR VALUE RECEIVED, HEREBY SELL(S), ASSIGN(S) AND TRANSFER(S) UNTO: (Please print name and address including zip code of assignee) (Please insert social security or other identifying number of assignee) the rights represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint Attorney to transfer said Warrant Certificate on the books of the Company with full power of substitution in the premises. Dated: Signature (Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm: Address: Area Code and Number: Authorized Signature: Name: Title: Dated:
Appears in 1 contract
Instructions for Exercise of Warrant. PRIOR TO MAKING A DECISION TO EXERCISE ANY WARRANTS EVIDENCED HEREBY, THE HOLDER OF THE WARRANTS SHOULD CAREFULLY READ THE PROSPECTUS RELATING TO THE COMMON STOCK UNDERLYING SUCH WARRANTS. A COPY OF SUCH PROSPECTUS IS AVAILABLE FREE OF CHARGE BY CONTACTING MARATHON ACQUISITION CORP. AT ITS PRINCIPAL EXECUTIVE OFFICES. THE SECURITIES AND EXCHANGE COMMISSION ALSO MAINTAINS A WEBSITE AT XXX.XXX.XXX THAT CONTAINS SUCH INFORMATION. To exercise the Warrants evidenced hereby, the holder or Participant must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a wire transfer in immediately available funds, in each case payable to the CompanyWarrant Agent at such an account number as the Warrant Agent may designate from time to time, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder or Participant must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), Warrants, evidenced by this Warrant Certificate, to purchase, of the shares of Common Stock (each each, a “Share”) of Homeowners Choice, Inc.Marathon Acquisition Corp., a Florida Delaware corporation (the “Company”), and represents that, that on or before the Exercise Date, Date such holder has tendered payment for such Shares by certified or official bank check or bank wire transfer in immediately available funds to the order of the CompanyCompany x/x Xxx Xxxx xx Xxx Xxxx, 000 Xxxxxxx Xxxxxx (11E), New York, NY 10286, in the amount of $ in accordance with the terms hereof. The undersigned requests that said number of Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Shares is less than all of the Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: , Name: Name (Please Print) / / / / - / / / - / / / / / (Insert Social Security or Other Identifying Number of Holder) Address Signature This Warrant may only be exercised by presentation to the Warrant Agent at one of the following locations: By hand at: By mail at: The method of delivery of this Warrant Certificate is at the option and risk of the exercising holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to assure timely delivery. (Instructions as to form and delivery of Shares and/or Warrant Certificates) Name in which Shares are to be registered if other than in the name of the registered holder of this Warrant Certificate: Address to which Shares are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address:) (City and State) (Zip Code) Name in which Warrant Certificate evidencing unexercised Warrants, if any, are to be registered if other than in the name of the registered holder of this Warrant Certificate: Address to which certificate representing unexercised Warrants, if any, are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address) (City and State) (Zip Code) Dated: Signature Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate. If Shares, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the registered holder hereof or are to be delivered to an address other than the address of such holder as shown on the books of the Warrant Agent, the above signature must be guaranteed by a an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Name Title Dated: , 200 ASSIGNMENT (FORM OF ASSIGNMENT TO BE EXECUTED IF WARRANT HOLDER DESIRES TO TRANSFER WARRANTS EVIDENCED HEREBY) FOR VALUE RECEIVED, HEREBY SELL(S), ASSIGN(S) AND TRANSFER(S) UNTO (Please print name and address (Please insert social security or including zip code of assignee) other identifying number of assignee) the rights represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint Attorney to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. Dated: Signature (Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Name Title
Appears in 1 contract
Samples: Common Stock Warrant Agreement (Global Ship Lease, Inc.)
Instructions for Exercise of Warrant. To exercise the any Warrants evidenced herebyhereby for Warrant Securities (as hereinafter defined), the holder mustHolder must pay, in lawful money of the United States of America, [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck in New York Clearing House funds] [by bank wire transfer in immediately available funds], in each case payable to the Company, in an amount equal to the Exercise Warrant Price in full for the Warrants exercised, to [●] [address of Warrant Agent], Attention: [●], which payment must specify the name of the Holder and the number of Warrants exercised by such Holder. In addition, the Warrant holder Holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth belowabove. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified Exercise Datepayment. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY (To be executed upon exercise of Warrants) The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise [●] Warrants, evidenced by this Warrant Certificate, to purchase, purchase [●] shares of the shares of Common Stock (each a “Share”) of Homeowners ChoiceStock, Inc., a Florida corporation par value $0.0001 per share (the “CompanyWarrant Securities”), of Cidara Therapeutics, Inc. and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Securities, in lawful money of the United States of America, [in cash or by certified check or official bank check in New York Clearing House funds] [by bank wire transfer in immediately available funds], to the order of the CompanyCidara Therapeutics, Inc., c/o [insert name and address of Warrant Agent], in the amount of $ $[●] in accordance with the terms hereof. The undersigned requests that said number of Shares Warrant Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing the Warrants for the number of Warrant Securities remaining balance of the Warrants evidenced hereby unexercised be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated: , Name: (Please Print) Print Address: (Insert Social Security or Other Identifying Number of Holder) AddressSignature Guaranteed: Signature (Signature must conform in all respects to name of holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a FINRA member firm). This Warrant may be exercised at the following addresses: By hand at:
Appears in 1 contract
Samples: Common Stock Warrant Agreement (Cidara Therapeutics, Inc.)
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder or Participant must, by 5:00 P.M.p.m., New York City Philadelphia time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a wire transfer in immediately available funds, in each case payable to the Company, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder or Participant must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M.p.m., New York Philadelphia time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), Warrants, evidenced by this Warrant Certificate, to purchase, of the shares of Common Stock Ordinary Shares (each a “Share”) of Homeowners Choice, Inc.Oxbridge Re Holdings Limited, a Florida corporation Cayman Islands exempted company (the “Company”), and represents that, on or before the Exercise Date, such holder has tendered payment for such Shares by certified or official bank check or bank wire transfer in immediately available funds to the order of the CompanyCompany c/o Broadridge Corporate Issuer Solutions, Inc., in the amount of $ in accordance with the terms hereof. The undersigned requests that said number of Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Shares is less than all of the Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: , Name: (Please Print) (Insert Social Security or Other Identifying Number of Holder) Address: Signature: This Warrant may only be exercised by presentation to the Warrant Agent. The method of delivery of this Warrant Certificate is at the option and risk of the exercising holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to assure timely delivery. (Instructions as to form and delivery of Shares and/or Warrant Certificates) Name in which Shares are to be registered if other than in the name of the registered holder of this Warrant Certificate: Address to which Shares are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address) (City and State) (Zip Code) Name in which Warrant Certificate evidencing unexercised Warrants, if any, are to be registered if other than in the name of the registered holder of this Warrant Certificate: Address to which certificate representing unexercised Warrants, if any, are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address) (City and State) (Zip Code) Dated: Signature Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate. If Shares, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the registered holder hereof or are to be delivered to an address other than the address of such holder as shown on the books of the Warrant Agent, the above signature must be guaranteed by an Eligible Guarantor Institution (Banks, Stockbrokers, Savings and Loan Associations and Credit Unions with membership in an approved Signature Guarantee Medallion Program), pursuant to S.E.C. Rule 17Ad-15. SIGNATURE GUARANTEE Name of Firm: Address: Area Code and Number: Authorized Signature: Name: Title: Dated: ASSIGNMENT (FORM OF ASSIGNMENT TO BE EXECUTED IF WARRANT HOLDER DESIRES TO TRANSFER WARRANTS EVIDENCED HEREBY) FOR VALUE RECEIVED, HEREBY SELL(S), ASSIGN(S) AND TRANSFER(S) UNTO: (Please print name and address including zip code of assignee) (Please insert social security or other identifying number of assignee) the rights represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint Attorney to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. Dated: Signature (Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by an Eligible Guarantor Institution (Banks, Stockbrokers, Savings and Loan Associations and Credit Unions with membership in an approved Signature Guarantee Medallion Program), pursuant to S.E.C. Rule 17Ad-15. SIGNATURE GUARANTEE Name of Firm: Address: Area Code and Number: Authorized Signature: Name: Title: Dated:
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder must, must pay [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck or by bank wire transfer] [by bank wire transfer], in each case payable to immediately available funds, the Company, in an amount equal to the Exercise Warrant Price in full for Warrants exercised to [insert name of Warrant Agent] Corporation Trust Department, [insert address of Warrant Agent], Attn. _______________ [or ______________], which [payment] [wire transfer] must specify the name of the holder and the number of Warrants exercisedexercised by such holder. In addition, the Warrant holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (registered mail is recommended) to the Company Warrant Agent at the address addresses set forth below. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified [payment] [wire transfer]. To be Executed Upon Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY of Warrant The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), Warrants, exercise _______________ Warrants evidenced by this Warrant Certificate, Certificate to purchase, purchase $_____________ principal amount of the shares [Title of Common Stock Warrant Securities] (each a “Share”the "Warrant Securities") of Homeowners Choice, Inc., a Florida corporation (the “Company”), Fleet Boston Corporation and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Securities [in cash or by certified check or official bank check or by bank wire transfer in each case] [by bank wire transfer], in immediately available funds, to the order of the CompanyFleet Boston Corporation, c/o [insert name and address of Warrant Agent], in the amount of $ $______________ in accordance with the terms hereof. The undersigned requests that said number principal amount of Shares Warrant Securities be in fully registered formfrom in the authorized denominations, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing representing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated: , Name: ------------------------------ (Please Print) Address: --------------------------- --------------------------- Signature: ------------------------- ------------ -------- ---------- ------------ -------- ---------- (Insert Social Security or Other Identifying Indemnifying Number of Holder) Address:)
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the any Warrants evidenced herebyhereby for Warrant Securities (as hereinafter defined), the holder mustHolder must pay, in lawful money of the United States of America, [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck in New York Clearing House funds] [by bank wire transfer in immediately available funds], in each case payable to the Company, in an amount equal to the Exercise Warrant Price in full for the Warrants exercised, to [●] [address of Warrant Agent], Attention: [●], which payment must specify the name of the Holder and the number of Warrants exercised by such Holder. In addition, the Warrant holder Holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth belowabove. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified Exercise Datepayment. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY (To be executed upon exercise of Warrants) The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise [●] Warrants, evidenced by this Warrant Certificate, to purchase, purchase [●] shares of the shares of Common Stock (each a “Share”) of Homeowners ChoiceStock, Inc., a Florida corporation par value $0.001 per share (the “CompanyWarrant Securities”), of Cardica, Inc. and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Securities, in lawful money of the United States of America, [in cash or by certified check or official bank check in New York Clearing House funds] [by bank wire transfer in immediately available funds], to the order of the CompanyCardica, Inc., c/o [insert name and address of Warrant Agent], in the amount of $ $[●] in accordance with the terms hereof. The undersigned requests that said number of Shares Warrant Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing the Warrants for the number of Warrant Securities remaining balance of the Warrants evidenced hereby unexercised be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated: , Name: (Please Print) Print Address: (Insert Social Security or Other Identifying Number of Holder) AddressSignature Guaranteed:
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder Holder must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a bank wire transfer in immediately available funds, in each case payable to the Company, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder Holder must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York City time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on __________, ____ (the “Exercise Date”), __________ Warrants, evidenced by this Warrant Certificate, to purchase, of __________ shares (the shares of Common Stock (each a “ShareWarrant Shares”) of Homeowners ChoiceCommon Stock, par value of $0.0001 per share (the “Common Stock”) of Atheronova Inc., a Florida Delaware corporation (the “Company”), and represents that, that on or before the Exercise Date, : such holder Holder has tendered payment for such Warrant Shares by certified or official bank check payable to the order of the CompanyCompany c/o Securities Transfer Corporation, 0000 Xxxxxx Xxxxxxx, Xxxxx 000, Xxxxxx, Xxxxx 00000, or by bank wire transfer in immediately available funds payable to the Company at Account No. , in each case in the amount of $ in accordance with the terms hereof. The undersigned requests that said , or [if permitted] the cancellation of such number of Warrant Shares be in fully registered formas is necessary, registered in such names and delivered, all as specified in accordance with the instructions formula set forth below. If said in Section 1(d) hereof, to exercise this Warrant with respect to the maximum number of Shares is less than all of the Warrant Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered pursuant to the holder of the Warrant Certificate unless otherwise specified cashless exercise procedure set forth in the instructions below. Dated: , Name: (Please Print) (Insert Social Security or Other Identifying Number of Holder) Address:Section 1(d).
Appears in 1 contract
Samples: Warrant Agreement (AtheroNova Inc.)
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder must, must pay [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank check, check or by bank wire transfer] [by bank wire transfer] [in each case payable to immediately available funds] the Company, in an amount equal to the Exercise Warrant Price in full for Warrants exercised to [insert name of Warrant Agent] Corporate Trust Department, [insert address of Warrant Agent], Attn: [or ____________], which [payment] [wire transfer] must specify the name of the holder and the number of Warrants exercisedexercised by such holder. In addition, the Warrant holder must provide complete the information required below and deliver present this Warrant Certificate in person or by registered mail to the Company Warrant Agent at the address addresses set forth below. The [Form of Exercise] To Be Executed Upon Exercise of Warrant Certificate and this Election to Purchase must be received by the Company by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise _____ Warrants, evidenced by this Warrant Certificate, to purchase, purchase [SPECIFY CURRENCY OR CURRENCY UNIT] __________ principal amount of the shares [Title of Common Stock Warrant Securities] (each a “Share”the "Warrant Securities") of Homeowners Choice, Inc., a Florida corporation (the “Company”), Kraft Foods Inc. and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Securities [in cash or by certified check or official bank check or by bank wire transfer, in each case,] [by bank wire transfer] in immediately available funds to the order of the CompanyKraft Foods Inc., c/o [insert name and address of Warrant Agent] in the amount of $ [SPECIFY CURRENCY OR CURRENCY UNIT] __________ in accordance with the terms hereof. The undersigned requests that said number principal amount of Shares Warrant Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing representing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated: , Name: Name ____________________________ (Please Print) _________________________________ Address _________________________ (Insert Social Security or Other other Identifying Number of Holder) Address:_________________________________ Signature _______________________ (Signature must conform in all respects to name of holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a bank, trust company or member broker of the New York, the American, Midwest or Pacific Stock Exchange.) The Warrants evidenced hereby may be exercised at the following addresses: By hand at ___________________________________ By mail at ___________________________________ [Instructions as to form and delivery of Warrant Securities and, if applicable, Warrant Certificates evidencing unexercised Warrants--complete as appropriate.] Signature Guaranteed: Assignment (Form of Assignment To Be Executed if Holder Desires To Transfer Warrants Evidenced Hereby) FOR VALUE RECEIVED hereby sells, assigns and transfers unto -------------------------------------------------------------------------------- (Please print name and address including zip code) (Please insert social security or other identifying number) -------------------------------------------------------------------------------- the Warrants represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint Attorney, to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises.
Appears in 1 contract
Samples: Warrant Agreement (Kraft Foods Inc)
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder [For Global Warrant Certificate: or Participant] must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its corporate trust department, a certified or official bank checkcheck or a wire transfer in immediately available funds, in each case payable to the CompanyWarrant Agent at Account No. ____, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder [For Global Warrant Certificates: or Participant] must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow [For Global Warrant Certificates: and the Book-Entry Warrants to the Warrant Agent in its account with the Depositary designated for such purpose]. The This Warrant Certificate and this the Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on [__________, ____] (the “"Exercise Date”"), [_____________] Warrants, evidenced by this Warrant Certificate, to purchase, [$_____________ principal amount] [_________________] of the shares [title of Common Stock Securities purchasable upon exercise of Warrants] [If Warrants for Depositary Shares are to be offered: , each representing a [1/__th] interest in a share of [title of securities represented by the Depositary Shares]] (each a “Share”the "Warrant Securities") of Homeowners ChoiceForest City Enterprises, Inc., a Florida an Ohio corporation (the “"Company”"), and represents that, that on or before the Exercise Date, Date such holder has tendered payment for such Shares Warrant Securities by certified or official bank check or bank wire transfer in immediately available funds to the order of the CompanyCompany c/o [Name and address of Warrant Agent], in the amount of $ [$_____________] in accordance with the terms hereof. The undersigned requests that said [principal amount of] [number of Shares of] Warrant Securities be in fully registered form, in the authorized denominations, registered in such names and delivered, all as specified in accordance with the instructions set forth below. [Unless Warrants may be exercised on only one date: If said number [principal amount] [number] of Shares Warrant Securities is less than all of the Shares Warrant Securities purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. .] Dated: ______________ __, Name: ____ Name --------------------------------------------------------- (Please Print) - - (Insert Social Security or Other Identifying Number of Holder) -------------------------------------------------------------- Address ------------------------------------------------------- ------------------------------------------------------- ------------------------------------------------------- Signature ----------------------------------------------------- This Warrant may only be exercised by presentation to the Warrant Agent at one of the following locations: By hand at: ---------------------------- ---------------------------- ---------------------------- By mail at: ---------------------------- ---------------------------- ---------------------------- The method of delivery of this Warrant Certificate is at the option and risk of the exercising holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to assure timely delivery. (Instructions as to form and delivery of Warrant Securities and/or Warrant Certificates) Name in which Warrant Securities are to be registered if other than in the name of the registered holder of this Warrant Certificate: ---------- Address to which Warrant Securities are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: ------------------------------------------------ (Street Address:) ------------------------------------------------ (City and State) (Zip Code) [Except for Global Warrant Certificate:] Name in which Warrant Certificate evidencing unexercised Warrants, if any, are to be registered if other than in the name of the registered holder of this Warrant Certificate: ---------------------------- Address to which certificate representing unexercised Warrants, if any, are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: ------------------------------------------------ (Street Address) ------------------------------------------------ (City and State) (Zip Code) Dated: --------------------- ------------------------------------------------ Signature ([Except for Global Warrant Certificate:] Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate.] If Warrant Securities, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the registered holder hereof or are to be delivered to an address other than the address of such holder as shown on the books of the Warrant Agent, the above signature must be guaranteed by a member firm of a registered national stock exchange, a member of the National Association of Securities Dealers, Inc., a participant in the Security Transfer Agents Medallion Program or the Stock Exchange Medallion Program, or by a commercial bank or trust company having an office or correspondent in the United States.) SIGNATURE GUARANTEE Name of Firm ----------------------------------- Address ---------------------------------------- Area Code and Number --------------------------- Authorized Signature --------------------------- Name ------------------------------------------- Title ------------------------------------------ Dated: ---------------------- ASSIGNMENT (FORM OF ASSIGNMENT TO BE EXECUTED IF WARRANT HOLDER DESIRES TO TRANSFER WARRANTS EVIDENCED HEREBY) FOR VALUE RECEIVED _________________ HEREBY SELLS, ASSIGNS AND TRANSFERS UNTO ________________________________ Please print name and address --------------------------------------------- --------------------------------------------- --------------------------------------------- --------------------------------------------- Please insert social security or other identifying number --------------------------------------------- The rights represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint ____________ Attorney, to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. Dated: ---------------------- --------------------------------------------- Signature (Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a member firm of a registered national securities exchange, a member of the National Association of Securities Dealers, Inc., a participant in the Security Transfer Agents Medallion Program or the Stock Exchange Medallion Program, or by a commercial bank or trust company having an office or correspondent in the United States) SIGNATURE GUARANTEE Name of Firm ------------------------------- Address ------------------------------------ Area Code and Number ----------------------- Authorized Signature ----------------------- Name --------------------------------------- Title -------------------------------------- Dated: ----------------------
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder or Participant must, by 5:00 P.M.p.m., New York City Philadelphia time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a wire transfer in immediately available funds, in each case payable to the Company, in an amount equal to the Exercise Price in full for the Warrants exercisedexercised (unless the holder has elected a Cashless Exercise, in which case no such payment must be made). In addition, the The Warrant holder or Participant must also provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M.p.m., New York Philadelphia time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on _______________, _____ (the “Exercise Date”), ___________ Warrants, evidenced by this Warrant Certificate, to purchase, of the shares of Common Stock _______________ Ordinary Shares (each a “Share”) of Homeowners Choice, Inc.Oxbridge Re Holdings Limited, a Florida corporation Cayman Islands exempted company (the “Company”), and represents that: _____ this exercise is intended to be a Cash Exercise and that such holder has, on or before the Exercise Date, such holder has tendered payment for such Shares by certified or official bank check or bank wire transfer in immediately available funds to the order of the CompanyCompany c/o Broadridge Corporate Issuer Solutions, LLC, in the amount of $ ___________ in accordance with the terms hereof; or _______ this exercise is intended to be a Cashless Exercise. The undersigned requests that said number of Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Shares is less than all of the Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: _____________________, _____ Name: ______________________________ (Please Print) ___________________________________ (Insert Social Security or Other Identifying Number of Holder) Address:: ____________________________ ___________________________________ ___________________________________ Signature: ___________________________ This Warrant may only be exercised by presentation to the Warrant Agent. The method of delivery of this Warrant Certificate is at the option and risk of the exercising holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to assure timely delivery. (Instructions as to form and delivery of Shares and/or Warrant Certificates) Name in which Shares are to be registered if other than in the name of the registered holder of this Warrant Certificate: Address to which Shares are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address) (City and State) (Zip Code) Name in which Warrant Certificate evidencing unexercised Warrants, if any, are to be registered if other than in the name of the registered holder of this Warrant Certificate: Address to which certificate representing unexercised Warrants, if any, are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address) (City and State) (Zip Code) Dated: Signature Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate. If Shares, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the registered holder hereof or are to be delivered to an address other than the address of such holder as shown on the books of the Warrant Agent, the above signature must be guaranteed by an Eligible Guarantor Institution (Banks, Stockbrokers, Savings and Loan Associations and Credit Unions with membership in an approved Signature Guarantee Medallion Program), pursuant to S.E.C. Rule 17Ad-15. SIGNATURE GUARANTEE Name of Firm: ______________________________________________ Address: __________________________________________________ Area Code and Number: _____________________________________________ Authorized Signature: _______________________________________________ Name: ____________________________________________________ Title: _____________________________________________________ Dated: ____________________________________________________ ASSIGNMENT (FORM OF ASSIGNMENT TO BE EXECUTED IF WARRANT HOLDER DESIRES TO TRANSFER WARRANTS EVIDENCED HEREBY) FOR VALUE RECEIVED, ______________________ HEREBY SELL(S), ASSIGN(S) AND TRANSFER(S) UNTO: (Please print name and address (Please insert social security or including zip code of assignee) other identifying number of assignee) the rights represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint _______________________ Attorney to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. Dated: (Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by an Eligible Guarantor Institution (Banks, Stockbrokers, Savings and Loan Associations and Credit Unions with membership in an approved Signature Guarantee Medallion Program), pursuant to S.E.C. Rule 17Ad-15. SIGNATURE GUARANTEE Name of Firm: ______________________________________________ Address: __________________________________________________ Area Code and Number: _____________________________________________ Authorized Signature: _______________________________________________ Name: ____________________________________________________ Title: _____________________________________________________ Dated: ____________________________________________________
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder or Participant must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a bank wire transfer in immediately available funds, in each case payable to the CompanyWarrant Agent at Account No. ____, in an amount equal to the Exercise Price in full for the Warrants exercised, and all applicable taxes and charges due in connection therewith. In addition, the Warrant holder or Participant must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on __________, ____ (the “Exercise Date”), _____________ Warrants, evidenced by this Warrant Certificate, to purchase, of _________________ shares (the shares of Common Stock (each a “ShareWarrant Shares”) of Homeowners ChoiceCommon Stock, par value of $0.01 per share (the “Common Stock”) of Pimi Agro Cleantech, Inc., a Florida Delaware corporation (the “Company”), and represents that, that on or before the Exercise Date, such holder has tendered payment for such Shares by certified or official bank check to the order of the Company, in the amount of $ in accordance with the terms hereof. The undersigned requests that said number of Warrant Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Warrant Shares is less than all of the Warrant Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: ______________ __, Name: ____ Name __________________________ (Please Print) / / / / - / / /- / / / / / (Insert Social Security or Other Identifying Number of Holder) Address ________________________ ________________________ {Pimi Agro Cleantech, Inc. Warrant Agreement} 20 This Warrant may only be exercised by presentation to the Warrant Agent at one of the following locations: By hand at: By mail at: The method of delivery of this Warrant Certificate is at the option and risk of the exercising holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to assure timely delivery. (Instructions as to form and delivery of Warrant Shares and/or Warrant Certificates) Name in which Warrant Shares are to be registered if other than in the name of the registered holder of this Warrant Certificate: Address to which Warrant Shares are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address:) (City and State) (Zip Code) Name in which Warrant Certificate evidencing unexercised Warrants, if any, are to be registered if other than in the name of the registered holder of this Warrant Certificate: {Pimi Agro Cleantech, Inc. Warrant Agreement} 21 Address to which certificate representing unexercised Warrants, if any, are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address) (City and State) (Zip Code) Dated: Signature Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate. If Warrant Shares, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the registered holder hereof or are to be delivered to an address other than the address of such holder as shown on the books of the Warrant Agent, the above signature must be guaranteed by a participant in a Medallion Signature Guarantee Program at a guarantee level acceptable to the Warrant Agent. A notary public is not sufficient. SIGNATURE GUARANTEE Name of Firm __________________ Address ______________________ Area Code and Number __________________ Authorized Signature ____________________ Name ________________________ Title _________________________ Dated: __________________________, 20___ {Pimi Agro Cleantech, Inc. Warrant Agreement} 22
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder [For Global Warrant Certificate: or Participant] must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its corporate trust department, a certified or official bank checkcheck or a wire transfer in immediately available funds, in each case payable to the CompanyWarrant Agent at Account No. ____, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder [For Global Warrant Certificates: or Participant] must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow [For Global Warrant Certificates: and the Book-Entry Warrants to the Warrant Agent in its account with the Depositary designated for such purpose]. The This Warrant Certificate and this the Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on [__________, ____] (the “"Exercise Date”"), [_____________] Warrants, evidenced by this Warrant Certificate, to purchase, [$_____________ principal amount] [_________________] of the shares [title of Common Stock Securities purchasable upon exercise of Warrants] [If Warrants for Depositary Shares are to be offered: , each representing a [1/__th] interest in a share of [title of securities represented by the Depositary Shares]] (each a “Share”the "Warrant Securities") of Homeowners Choice, Inc.Citizens Communications Company, a Florida Delaware corporation (the “"Company”"), and represents that, that on or before the Exercise Date, Date such holder has tendered payment for such Shares Warrant Securities by certified or official bank check or bank wire transfer in immediately available funds to the order of the CompanyCompany c/o [Name and address of Warrant Agent], in the amount of $ [$_____________] in accordance with the terms hereof. The undersigned requests that said [principal amount of] [number of Shares of] Warrant Securities be in fully registered form, in the authorized denominations, registered in such names and delivered, all as specified in accordance with the instructions set forth below. [Unless Warrants may be exercised on only one date: If said number [principal amount] [number] of Shares Warrant Securities is less than all of the Shares Warrant Securities purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. .] Dated: ______________ __, Name: ____ Name ---------------------------------------------- (Please Print) / / / /- / / /- / / / / / (Insert Social Security or Other Identifying Number of Holder) -------------------------------------------- Address ---------------------------------------------- ------------------------------------------------------- ------------------------------------------------------- Signature --------------------------------------------- This Warrant may only be exercised by presentation to the Warrant Agent at one of the following locations: By hand at By mail at The method of delivery of this Warrant Certificate is at the option and risk of the exercising holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to assure timely delivery. (Instructions as to form and delivery of Warrant Securities and/or Warrant Certificates) Name in which Warrant Securities are to be registered if other than in the name of the registered holder of this Warrant Certificate: Address to which Warrant Securities are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: -------------------------------------------- (Street Address:) -------------------------------------------- (City and State) (Zip Code) [Except for Global Warrant Certificate: Name in which Warrant Certificate evidencing unexercised Warrants, if any, are to be registered if other than in the name of the registered holder of this Warrant Certificate: -------------------------------------------- Address to which certificate representing unexercised Warrants, if any, are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: -------------------------------------------- (Street Address) -------------------------------------------- (City and State) (Zip Code) Dated: ------------------ -------------------------------------------- Signature
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the any Warrants evidenced herebyhereby for Warrant Debt Securities (as hereinafter defined), the holder mustHolder must pay, in lawful money of the United States of America, [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck in New York Clearing House funds] [by bank wire transfer in immediately available funds], in each case payable to the Company, in an amount equal to the Exercise Warrant Price in full for the Warrants exercised, to [●] [address of Warrant Agent], Attention: [●], which payment must specify the name of the Holder and the number of Warrants exercised by such Holder. In addition, the Warrant holder Holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth belowabove. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified Exercise Datepayment. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY (To be executed upon exercise of Warrants) The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise ______ Warrants, evidenced by this Warrant Certificate, to purchase, purchase _______ $[●] principal amount of the shares of Common Stock (each a “Share”) of Homeowners Choice, Inc., a Florida corporation [TITLE OF WARRANT DEBT SECURITIES] (the “CompanyWarrant Debt Securities”), of ChromaDex Corporation and represents that, on or before that the Exercise Date, such holder undersigned has tendered payment for such Shares Warrant Debt Securities, in lawful money of the United States of America, [in cash or by certified check or official bank check in New York Clearing House funds] [by bank wire transfer in immediately available funds], to the order of the CompanyChromaDex Corporation, c/o [insert name and address of Warrant Agent], in the amount of $ $_________ in accordance with the terms hereof. The undersigned requests that said number principal amount of Shares Warrant Debt Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing the Warrants for the aggregate principal amount of Warrant Debt Securities remaining balance of the Warrants evidenced hereby unexercised be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated: , Name: (Please Print) Print Address: (Insert Social Security or Other Identifying Number of Holder) Address:Signature Guaranteed: Signature (Signature must conform in all respects to name of holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a FINRA member firm). This Warrant may be exercised at the following addresses: By hand at: [●] By mail at: [Instructions as to form and delivery of Warrant Debt Securities and, if applicable, Warrant Certificates evidencing Warrants for the number of Warrant Debt Securities remaining unexercised—complete as appropriate.]
Appears in 1 contract
Samples: Debt Securities Warrant Agreement (ChromaDex Corp.)
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder must, must pay in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank check, in each case payable to check or by bank wire transfer the Company, in an amount equal to the Exercise Warrant Price in full for Warrants exercised to Xxxxxxxx Brands International, Inc., c/o Securities Transfer Company, One East Fourth Street, 12th Floor, Room 1201, Xxxxxxxxxx, Xxxx 00000, which payment and/or wire transfer in immediately available funds must specify the name of the holder and the number of Warrants exercisedexercised by such holder. In addition, the Warrant holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth below. The To Be Executed Upon Exercise of Warrant Certificate and this Election to Purchase must be received by the Company by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise [____________] Warrants, evidenced by this Warrant Certificate, to purchase, purchase [____________] shares of the shares of Common Stock (each a “Share”the "Warrant Shares") of Homeowners ChoiceXxxxxxxx Brands -------------- International, Inc., a Florida corporation (the “Company”), Inc. and represents that, on that he or before the Exercise Date, such holder it has tendered payment for such Warrant Shares in cash or by certified check or official bank check or by bank wire transfer, in each case in immediately available funds to the order of the Xxxxxxxx Brands International, Inc. c/o Securities Transfer Company, One East Fourth Street, 12th Floor, Room 1201, Xxxxxxxxxx, Xxxx 00000, Attn., in the amount of $ $[____________] in accordance with the terms hereof. The undersigned requests that said number of Warrant Shares be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing representing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated: , ____________________ Name: (Please Print) ___________________________ _____________________________ Address________________________ (Insert Social Security or Other Identifying Number of Holder) Address:Signature Guaranteed Signature______________________ ____________________________ (Signature must conform in all respects to name of holder as specified on face of this Warrant Certificate and must bear a signature guarantee by a bank, trust company or member broker of the New York, Midwest or Pacific Stock Exchange) The Warrants evidenced hereby may be exercised by hand or mail at the following address: Xxxxxxxx Brands International, Inc. c/o Securities Transfer Company One East Fourth Street, 12/th/ Floor Room 1201 Xxxxxxxxxx, XX 00000
Appears in 1 contract
Samples: Warrant Agreement (Chiquita Brands International Inc)
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder Holder must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a bank wire transfer in immediately available funds, in each case payable to the Company, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder Holder must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York City time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on __________, ____ (the “Exercise Date”), __________ Warrants, evidenced by this Warrant Certificate, to purchase, of __________ shares (the shares of Common Stock (each a “ShareWarrant Shares”) of Homeowners ChoiceCommon Stock, par value of $0.01 per share (the “Common Stock”) of MabVax Therapeutics Holdings, Inc., a Florida Delaware corporation (the “Company”), and represents that, that on or before the Exercise Date, : · such holder Holder has tendered payment for such Warrant Shares by certified or official bank check payable to the order of the CompanyCompany c/o Equity Stock Transfer, LLC, 000 X. 00xx Xxxxxx, Xxx Xxxx, XX 00000, or by bank wire transfer in immediately available funds payable to the Company at Account No. [·], in each case in the amount of $ $[·] in accordance with the terms hereof. The undersigned requests that said number of Warrant Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Warrant Shares is less than all of the Warrant Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder Holder of the Warrant Certificate unless otherwise specified in the instructions below. The undersigned hereby represents and warrants that after giving effect to the exercise of the Warrants contemplated by this Exercise Notice, such holder will not be in violation of the beneficial ownership limits specified in Section 6 of this Warrant Certificate. Dated: ________ __, Name: ____ Name (Please Print) / / / / - / / / - / / / / / (Insert Social Security or Other Identifying Number of Holder) Address Signature This Warrant may only be exercised by presentation to the Warrant Agent at one of the following locations: By hand at: Equity Stock Transfer, LLC. 000 X. 00xx Xxxxxx Xxx Xxxx, XX 00000 By mail at: Equity Stock Transfer, LLC. 000 X. 00xx Xxxxxx Xxx Xxxx, XX 00000 The method of delivery of this Warrant Certificate is at the option and risk of the exercising Holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to ensure timely delivery. (Instructions as to form and delivery of Warrant Shares and/or Warrant Certificates) Name in which Warrant Shares are to be registered if other than in the name of the Holder of this Warrant Certificate: Address to which Warrant Shares are to be mailed if other than to the address of the Holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address:) (City and State) (Zip Code) Name in which Warrant Certificate evidencing unexercised Warrants, if any, is to be registered if other than in the name of the Holder of this Warrant Certificate: Address to which certificate representing unexercised Warrants, if any, is to be mailed if other than to the address of the Holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address) (City and State) (Zip Code) Dated: Signature Signature must conform in all respects to the name of the Holder as specified on the face of this Warrant Certificate. If Warrant Shares, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the Holder hereof or are to be delivered to an address other than the address of such Holder as shown on the books of the Warrant Agent, the above signature must be guaranteed by a an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Name Title Dated: , 20__ ASSIGNMENT (FORM OF ASSIGNMENT TO BE EXECUTED IF WARRANT HOLDER DESIRES TO TRANSFER WARRANTS EVIDENCED HEREBY) FOR VALUE RECEIVED, ____________ HEREBY SELL(S), ASSIGN(S) AND TRANSFER(S) UNTO (Please print name and address including zip code of assignee) (Please insert social security or other identifying number of assignee) the rights represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint ____________ Attorney to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. Dated: Signature (Signature must conform in all respects to the name of the Holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Name Title Dated: , 20__
Appears in 1 contract
Samples: Warrant Agency Agreement (Mabvax Therapeutics Holdings, Inc.)
Instructions for Exercise of Warrant. To exercise the any Warrants evidenced herebyhereby for Warrant Securities (as hereinafter defined), the holder mustHolder must pay, in lawful money of the United States of America, [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck in New York Clearing House funds] [by bank wire transfer in immediately available funds], in each case payable to the Company, in an amount equal to the Exercise Warrant Price in full for the Warrants exercised, to [Warrant Agent] [address of Warrant Agent], Attention: ____________, which payment must specify the name of the Holder and the number of Warrants exercised by such Holder. In addition, the Warrant holder Holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth belowabove. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified Exercise Datepayment. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY (To be executed upon exercise of Warrants) The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise ____________ Warrants, evidenced by this Warrant Certificate, to purchasepurchase ________ Common Shares, of the shares of Common Stock (each a “Share”) of Homeowners Choice, Inc., a Florida corporation no par value (the “CompanyWarrant Securities”), of Lineage Cell Therapeutics, Inc. and represents that, on or before that the Exercise Date, such holder undersigned has tendered payment for such Shares Warrant Securities, in lawful money of the United States of America, [in cash or by certified check or official bank check in New York Clearing House funds] [by bank wire transfer in immediately available funds], to the order of the CompanyLineage Cell Therapeutics, Inc., c/o [insert name and address of Warrant Agent], in the amount of $ ________in accordance with the terms hereof. The undersigned requests that said number of Shares Warrant Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing the Warrants for the number of Warrant Securities remaining balance of the Warrants evidenced hereby unexercised be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. DatedDated Name Please Print Address: , Name: (Please Print) (Insert Social Security or Other Identifying Number of Holder) Address:Signature Guaranteed Signature (Signature must conform in all respects to name of holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a FINRA member firm). This Warrant may be exercised at the following addresses: By hand at: By mail at: [Instructions as to form and delivery of Warrant Securities and, if applicable, Warrant Certificates evidencing Warrants for the number of Warrant Securities remaining unexercised—complete as appropriate.] ASSIGNMENT [Form of assignment to be executed if Warrant Holder desires to transfer Warrant] For Value Received, ________hereby sells, assigns and transfers unto: (Please print name and address including zip code) Please print Social Security or other identifying number the right represented by the within Warrant to purchase ________shares of [Title of Warrant Securities] of Lineage Cell Therapeutics, Inc. to which the within Warrant relates and appoints ________ attorney to transfer such right on the books of the Warrant Agent with full power of substitution in the premises. Dated: Name: Signature (Signature must conform in all respects to name of holder as specified on the face of the Warrant) Signature Guaranteed
Appears in 1 contract
Samples: Common Share Warrant Agreement (Lineage Cell Therapeutics, Inc.)
Instructions for Exercise of Warrant. To exercise the any Warrants evidenced herebyhereby for Warrant Securities (as hereinafter defined), the holder mustHolder must pay, in lawful money of the United States of America, [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck in New York Clearing House funds] [by bank wire transfer in immediately available funds], in each case payable to the Company, in an amount equal to the Exercise Warrant Price in full for the Warrants exercised, to [●] [address of Warrant Agent], Attention: [●], which payment must specify the name of the Holder and the number of Warrants exercised by such Holder. In addition, the Warrant holder Holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth belowabove. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified Exercise Datepayment. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY (To be executed upon exercise of Warrants) The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise [●] Warrants, evidenced by this Warrant Certificate, to purchasepurchase [●] shares of the [Title of Warrant Securities] (the "Warrant Securities"), of the shares of Common Stock (each a “Share”) of Homeowners ChoiceAutoWeb, Inc., a Florida corporation (the “Company”), Inc. and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Securities, in lawful money of the United States of America, [in cash or by certified check or official bank check in New York Clearing House funds] [by bank wire transfer in immediately available funds], to the order of the CompanyAutoWeb, Inc., c/o [insert name and address of Warrant Agent], in the amount of $ $[●] in accordance with the terms hereof. The undersigned requests that said number of Shares Warrant Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing the Warrants for the number of Warrant Securities remaining balance of the Warrants evidenced hereby unexercised be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated: , ____________________________ Name: (________________________________ Please Print) Print Address: ____________________________ ______________________ (Insert Social Security or Other Identifying Number of Holder) Address:Signature Guaranteed: ____________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a FINRA member firm). This Warrant may be exercised at the following addresses: By hand at: By mail at: [Instructions as to form and delivery of Warrant Securities and, if applicable, Warrant Certificates evidencing Warrants for the number of Warrant Securities remaining unexercised—complete as appropriate.]
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the any Warrants evidenced herebyhereby for Warrant Securities (as hereinafter defined), the holder mustHolder must pay, in lawful money of the United States of America, [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck in New York Clearing House funds] [by bank wire transfer in immediately available funds], in each case payable to the Company, in an amount equal to the Exercise Warrant Price in full for the Warrants exercised, to [Warrant Agent] [address of Warrant Agent], Attn: , which payment must specify the name of the Holder and the number of Warrants exercised by such Holder. In addition, the Warrant holder Holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth belowabove. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified Exercise Datepayment. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY (To be executed upon exercise of Warrants) The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise Warrants, evidenced by this Warrant Certificate, to purchase, purchase shares of the shares [Title of Common Stock (each a “Share”) of Homeowners Choice, Inc., a Florida corporation Warrant Securities] (the “CompanyWarrant Securities”), of Chimerix, Inc. and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Securities, in lawful money of the United States of America, [in cash or by certified check or official bank check in New York Clearing House funds] [by bank wire transfer in immediately available funds], to the order of the CompanyChimerix, Inc., c/o [insert name and address of Warrant Agent], in the amount of $ in accordance with the terms hereof. The undersigned requests that said number of Shares Warrant Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing the Warrants for the number of Warrant Securities remaining balance of the Warrants evidenced hereby unexercised be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. DatedDated Name Please Print Address: , Name: (Please Print) ___________________________________________________ (Insert Social Security or Other Identifying Number of Holder) Address:Signature Guaranteed Signature (Signature must conform in all respects to name of holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a FINRA member firm). This Warrant may be exercised at the following addresses: By hand at By mail at [Instructions as to form and delivery of Warrant Securities and, if applicable, Warrant Certificates evidencing Warrants for the number of Warrant Securities remaining unexercised—complete as appropriate.]
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the any Warrants evidenced herebyhereby for Warrant Debt Securities (as hereinafter defined), the holder mustHolder must pay, in lawful money of the United States of America, [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck in New York Clearing House funds] [by bank wire transfer in immediately available funds], in each case payable to the Company, in an amount equal to the Exercise Warrant Price in full for the Warrants exercised, to [●] [address of Warrant Agent], Attention: [●], which payment must specify the name of the Holder and the number of Warrants exercised by such Holder. In addition, the Warrant holder Holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth belowabove. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified Exercise Datepayment. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY (To be executed upon exercise of Warrants) The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise [●] Warrants, evidenced represented by this Warrant Certificate, to purchase, purchase $[●] principal amount of the shares [Title of Common Stock Warrant Debt Securities] (each a the “ShareWarrant Debt Securities”) of Homeowners ChoiceCidara Therapeutics, Inc., a Florida corporation (the “Company”), Inc. and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Debt Securities, in lawful money of the United States of America, [in cash or by certified check or official bank check in New York Clearing House funds] [by bank wire transfer in immediately available funds], to the order of the CompanyCidara Therapeutics, Inc., c/o [insert name and address of Warrant Agent], in the amount of $ $[●] in accordance with the terms hereof. The undersigned requests that said number principal amount of Shares Warrant Debt Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing the Warrants for the aggregate principal amount of Warrant Debt Securities remaining balance of the Warrants evidenced hereby unexercised be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated: , Name: (Please Print) Print Address: (Insert Social Security or Other Identifying Number of Holder) Address:Signature Guaranteed: Signature (Signature must conform in all respects to name of holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a FINRA member firm). This Warrant may be exercised at the following addresses: By hand at: By mail at: [Instructions as to form and delivery of Warrant Debt Securities and, if applicable, Warrant Certificates evidencing Warrants for the number of Warrant Debt Securities remaining unexercised—complete as appropriate.]
Appears in 1 contract
Samples: Securities Warrant Agreement (Cidara Therapeutics, Inc.)
Instructions for Exercise of Warrant. To exercise the any Warrants evidenced herebyhereby for Warrant Debt Securities (as hereinafter defined), the holder mustHolder must pay, in lawful money of the United States of America, [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck in New York Clearing House funds] [by bank wire transfer in immediately available funds], in each case payable to the Company, in an amount equal to the Exercise Warrant Price in full for the Warrants exercised, to [•] [address of Warrant Agent], Attention: [•], which payment must specify the name of the Holder and the number of Warrants exercised by such Holder. In addition, the Warrant holder Holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth belowabove. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified Exercise Datepayment. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY (To be executed upon exercise of Warrants) The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise [•] Warrants, evidenced represented by this Warrant Certificate, to purchase, purchase $[•] principal amount of the shares [Title of Common Stock Warrant Debt Securities] (each a the “ShareWarrant Debt Securities”) of Homeowners ChoiceAcelRx Pharmaceuticals, Inc., a Florida corporation (the “Company”), Inc. and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Debt Securities, in lawful money of the United States of America, [in cash or by certified check or official bank check in New York Clearing House funds] [by bank wire transfer in immediately available funds], to the order of the CompanyAcelRx Pharmaceuticals, Inc., c/o [insert name and address of Warrant Agent], in the amount of $ $[•] in accordance with the terms hereof. The undersigned requests that said number principal amount of Shares Warrant Debt Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing the Warrants for the aggregate principal amount of Warrant Debt Securities remaining balance of the Warrants evidenced hereby unexercised be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated: , Name: (Please Print) Print Address: (Insert Social Security or Other Identifying Number of Holder) AddressSignature Guaranteed:
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the any Warrants evidenced herebyhereby for Warrant Debt Securities (as hereinafter defined), the holder mustHolder must pay, in lawful money of the United States of America, [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck in New York Clearing House funds] [by bank wire transfer in immediately available funds], in each case payable to the Company, in an amount equal to the Exercise Warrant Price in full for the Warrants exercised, to [Warrant Agent] [address of Warrant Agent], Attn: , which payment must specify the name of the Holder and the number of Warrants exercised by such Holder. In addition, the Warrant holder Holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth belowabove. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified Exercise Datepayment. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY (To be executed upon exercise of Warrants) The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise Warrants, evidenced represented by this Warrant Certificate, to purchase, purchase $ principal amount of the shares [Title of Common Stock Warrant Debt Securities] (each a the “ShareWarrant Debt Securities”) of Homeowners ChoiceSenomyx, Inc., a Florida corporation (the “Company”), Inc. and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Debt Securities, in lawful money of the United States of America, [in cash or by certified check or official bank check in New York Clearing House funds] [by bank wire transfer in immediately available funds], to the order of the CompanySenomyx, Inc., c/o [insert name and address of Warrant Agent], in the amount of $ in accordance with the terms hereof. The undersigned requests that said number principal amount of Shares Warrant Debt Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing the Warrants for the aggregate principal amount of Warrant Debt Securities remaining balance of the Warrants evidenced hereby unexercised be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. DatedDated Name Please Print Address: , Name: (Please Print) (Insert Social Security or Other Identifying Number of Holder) Address:Signature Guaranteed Signature (Signature must conform in all respects to name of holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a FINRA member firm). This Warrant may be exercised at the following addresses: By hand at By mail at [Instructions as to form and delivery of Warrant Debt Securities and, if applicable, Warrant Certificates evidencing Warrants for the number of Warrant Debt Securities remaining unexercised—complete as appropriate.]
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder Holder must, by 5:00 P.M.p.m., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a bank wire transfer in immediately available funds, in each case payable to the Company, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder Holder must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M.p.m., New York City time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on __________, ____ (the “Exercise Date”), __________ Warrants, evidenced by this Warrant Certificate, to purchase, of __________ shares (the shares of Common Stock (each a “ShareWarrant Shares”) of Homeowners ChoiceCommon Stock, par value of $0.0001 per share (the “Common Stock”) of ENDRA Life Sciences Inc., a Florida Delaware corporation (the “Company”), and represents that, that on or before the Exercise Date, : ☐ such holder Holder has tendered payment for such Warrant Shares by certified or official bank check payable to the order of the CompanyCompany c/o Corporate Stock Transfer, Inc., 0000 Xxxxxx Xxxxx Xxxxx Xxxxx, #000, Xxxxxx, Xxxxxxxx 00000, or by bank wire transfer in immediately available funds payable to the Company at Account No. [ ], in each case in the amount of $ $_______ in accordance with the terms hereof, or ☐ [if permitted] the cancellation of such number of Warrant Shares as is necessary, in accordance with the formula set forth in subsection 3.3.8 of the Warrant Agreement, to exercise this Warrant with respect to the maximum number of Warrant Shares purchasable pursuant to the cashless exercise procedure set forth in subsection 3.3.8. The undersigned requests that said number of Warrant Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Warrant Shares is less than all of the Warrant Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder Holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: ________ __, ____ Name: _________________________________________ (Please Printplease print) / / / / - / / / - / / / / / (Insert Social Security or Other Identifying Number of Holder) Address ___________________________________________________ ___________________________________________________ Signature __________________________ This Warrant may only be exercised by presentation to the Warrant Agent at one of the following locations: Corporate Stock Transfer, Inc. 0000 Xxxxxx Xxxxx Xxxxx Xxxxx, #000 Xxxxxx, Xxxxxxxx 00000 By e-mail or fax at: Corporate Stock Transfer, Inc. 0000 Xxxxxx Xxxxx Xxxxx Xxxxx, #000 Xxxxxx, Xxxxxxxx 80209E-mail: xxxxxxxxx@xxxxxxxxxxxxxx.xxxXxx: (000) 000-0000 The method of delivery of this Warrant Certificate is at the option and risk of the exercising Holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to ensure timely delivery. Instructions as to form and delivery of Warrant Shares and/or Warrant Certificates Name in which Warrant Shares are to be registered if other than in the name of the Holder of this Warrant Certificate: _________________________________________ (Name) Address to which Warrant Shares are to be mailed if other than to the address of the Holder of this Warrant Certificate as shown on the books of the Warrant Agent: _________________________________________ (Street Address:) _________________________________________ (City and State)(Zip Code) Name in which Warrant Certificate evidencing unexercised Warrants, if any, is to be registered if other than in the name of the Holder of this Warrant Certificate: _________________________________________ (Name) Address to which certificate representing unexercised Warrants, if any, is to be mailed if other than to the address of the Holder of this Warrant Certificate as shown on the books of the Warrant Agent: _________________________________________ (Street Address) _________________________________________ (City and State)(Zip Code) Dated: _________________________________________ Signature: _________________________________________ Signature must conform in all respects to the name of the Holder as specified on the face of this Warrant Certificate. If Warrant Shares, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the Holder hereof or are to be delivered to an address other than the address of such Holder as shown on the books of the Warrant Agent, the above signature must be guaranteed by an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm _______________________________________________ Address ____________________________________________________ Tel.: _______________________________________________________ Authorized Signature _________________________________________ Name ______________________________________________________ Title _______________________________________________________ Dated: __________, 20__ ASSIGNMENT (FORM OF ASSIGNMENT TO BE EXECUTED IF WARRANT HOLDER DESIRES TO TRANSFER WARRANTS EVIDENCED HEREBY) FOR VALUE RECEIVED, ____________ HEREBY SELL(S), ASSIGN(S) AND TRANSFER(S) UNTO: ______________________________________________ (Name of Assignee) ______________________________________________ (Xxxxxx Xxxxxxx) ______________________________________________ (City and State)(Zip Code) ______________________________________________ (Social Security or Other Identifying Number of Assignee) the rights represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint ___________________ Attorney to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. Dated: _________________________________________ Signature: _________________________________________ Signature must conform in all respects to the name of the Holder as specified on the face of this Warrant Certificate. If Warrant Shares, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the Holder hereof or are to be delivered to an address other than the address of such Holder as shown on the books of the Warrant Agent, the above signature must be guaranteed by a an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm _______________________________________________ Address ____________________________________________________ Tel.: _______________________________________________________ Authorized Signature _________________________________________ Name ______________________________________________________ Title _______________________________________________________ Dated: __________, 20__
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder or Participant must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a bank wire transfer in immediately available funds, in each case payable to the CompanyWarrant Agent at Account No. ____, in an amount equal to the Exercise Price in full for the Warrants exercised, and all applicable taxes and charges due in connection therewith. In addition, the Warrant holder or Participant must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on __________, ____ (the “Exercise Date”), _____________ Warrants, evidenced by this Warrant Certificate, to purchase, of _________________ shares (the shares of Common Stock (each a “ShareWarrant Shares”) of Homeowners ChoiceCommon Stock, Inc.par value of $0.001 per share (the “Common Stock”) of Vuzix Corporation, a Florida Delaware corporation (the “Company”), and represents that, that on or before the Exercise Date, Date [ ] such holder has tendered payment for such Shares Warrant Shares, and all applicable taxes and charges due in connection therewith, by certified or official bank check or bank wire transfer in immediately available funds to the order of the Company c/o Computershare Trust Company, N.A.________________, in the amount of $ $_____________ in accordance with the terms hereof, or [ ] [if permitted] the cancellation of such number of Warrant Shares as is necessary, in accordance with the formula set forth in subsection 3.3.7 of the Warrant Agreement, to exercise this Warrant with respect to the maximum number of Warrant Shares purchasable pursuant to the cashless exercise procedure set forth in subsection 3.3.7. The undersigned requests that said number of Warrant Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Warrant Shares is less than all of the Warrant Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: ______________ __, Name: ____ Name __________________________ (Please Print) / / / / - / / /- / / / / / (Insert Social Security or Other Identifying Number of Holder) Address:
Appears in 1 contract
Samples: Vuzix Corporation Warrant Agency Agreement (Vuzix Corp)
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder or Participant must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a wire transfer in immediately available funds, in each case payable to the CompanyWarrant Agent at Account No. , in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder or Participant must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), Warrants, evidenced by this Warrant Certificate, to purchase, of the shares of Common Stock (each each, a “Share”) of Homeowners Choice, Inc.Platform Acquisition Corp. International, a Florida Delaware corporation (the “Company”), and represents that, that on or before the Exercise Date, Date such holder has tendered payment for such Shares by certified or official bank check or bank wire transfer in immediately available funds to the order of the CompanyCompany c/o Mellon Investor Services LLC, [address], in the amount of $ in accordance with the terms hereof. The undersigned requests that said number of Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Shares is less than all of the Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: , Name: Name (Please Print) / / / / - / / /- / / / / / (Insert Social Security or Other Identifying Number of Holder) Address This Warrant may only be exercised by presentation to the Warrant Agent at one of the following locations: By hand at: By mail at: The method of delivery of this Warrant Certificate is at the option and risk of the exercising holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to assure timely delivery. (Instructions as to form and delivery of Shares and/or Warrant Certificates) Name in which Shares are to be registered if other than in the name of the registered holder of this Warrant Certificate: Address to which Shares are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address:) (City and State) (Zip Code) Dated: Signature Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate. If Shares, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the registered holder hereof or are to be delivered to an address other than the address of such holder as shown on the books of the Warrant Agent, the above signature must be guaranteed by a an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Name Title Dated: , 200 ASSIGNMENT (FORM OF ASSIGNMENT TO BE EXECUTED IF WARRANT HOLDER DESIRES TO TRANSFER WARRANTS EVIDENCED HEREBY) FOR VALUE RECEIVED, HEREBY SELL(S), ASSIGN(S) AND TRANSFER(S) UNTO (Please print name and address including zip code of assignee) (Please insert social security or other identifying number of assignee) the rights represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint Attorney to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. Dated: Signature (Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Name Title Dated: , 200
Appears in 1 contract
Samples: Common Stock Warrant Agreement (Platform Acquisition Corp. International)
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder must, must pay [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck or by bank wire transfer] [by bank wire transfer], in each case payable to immediately available funds, the Company, in an amount equal to the Exercise Warrant Price in full for Warrants exercised to [insert name of Warrant Agent] Corporate Trust Department [insert address of Warrant Agent], Attn: [or ], which [payment] [wire transfer] must specify the name of the holder and the number of Warrants exercisedexercised by such holder. In addition, the Warrant holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (registered mail is recommended) to the Company Warrant Agent at the address addresses set forth below. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified [payment] [wire transfer]. To Be Executed Upon Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY of Warrant The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), Warrants, exercise Warrants evidenced by this Warrant Certificate, to purchase, purchase [$]_____________ principal amount of the shares [Title of Common Stock Warrant Securities] (each a “Share”the "Warrant Securities") of Homeowners ChoicePattxxxxx Xxxrgy, Inc., a Florida corporation (the “Company”), Inc. and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Securities [in cash or by certified check or official bank check or by bank wire transfer, in each case] [by bank wire transfer], in immediately available funds, to the order of the CompanyPattxxxxx Xxxrgy, Inc., c/o [insert name and address of Warrant Agent], in the amount of $ [$]_____________ in accordance with the terms hereof. The undersigned requests that said number principal amount of Shares Warrant Securities be in fully registered formform and in the authorized denominations, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing the representing he remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated: , Name: Dated Name ------------------ ------------------------------- (Please Print) (Insert --------------------------------------- Address --------------------------------------- Social Security or Other Identifying Number of HolderHolder --------------------------------------- Signature The Warrants evidenced hereby may be exercised at the following addresses: By hand at ------------------------------------------------ ------------------------------------------------ By mail at ------------------------------------------------ ------------------------------------------------ [Instructions as to form and delivery of Warrant Securities and, if applicable, Warrant Certificates evidencing unexercised Warrants--complete as appropriate.] Assignment (Form of Assignment to be Executed if Holder Desires to Transfer Warrants Evidenced Hereby) Address:For value received _______________________ hereby sells, assigns and transfers unto _________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ (Please print name and address, including zip code of assignee, and Social Security Number or other identifying number) the Warrants represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint Attorney, to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. Dated ------------------------ -------------------------------- Signature (Signature must conform in all respect to name of holder as specified on the face of this Warrant Certificate and must bear a signature guarantee of a commercial bank, trust company, or member broker of the New York, American, Midwest or Pacific Stock Exchange.)
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder Holder must, by 5:00 P.M.p.m., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a bank wire transfer in immediately available funds, in each case payable to the Company, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder Holder must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M.p.m., New York City time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on __________, ____ (the “Exercise Date”), __________ Warrants, evidenced by this Warrant Certificate, to purchase, of __________ shares (the shares of Common Stock (each a “ShareWarrant Shares”) of Homeowners ChoiceCommon Stock, par value of $0.0001 per share (the “Common Stock”) of ENDRA Life Sciences Inc., a Florida Delaware corporation (the “Company”), and represents that, that on or before the Exercise Date, : ☐ such holder Holder has tendered payment for such Warrant Shares by certified or official bank check payable to the order of the CompanyCompany c/o Corporate Stock Transfer, Inc., 0000 Xxxxxx Xxxxx Xxxxx Xxxxx, #000, Xxxxxx, Xxxxxxxx 00000, or by bank wire transfer in immediately available funds payable to the Company at Account No. [ ], in each case in the amount of $ $_______ in accordance with the terms hereof, or ☐ [if permitted] the cancellation of such number of Warrant Shares as is necessary, in accordance with the formula set forth in subsection 3.3.8 of the Warrant Agreement, to exercise this Warrant with respect to the maximum number of Warrant Shares purchasable pursuant to the cashless exercise procedure set forth in subsection 3.3.8. The undersigned requests that said number of Warrant Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Warrant Shares is less than all of the Warrant Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder Holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: ________ __, ____ Name: _________________________________________ (Please Printplease print) / / / / - / / / - / / / / / (Insert Social Security or Other Identifying Number of Holder) Address:Address ___________________________________________________ ___________________________________________________
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder Holder must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a bank wire transfer in immediately available funds, in each case payable to the Company, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder Holder must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York City time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on __________, ____ (the “Exercise Date”), __________ Warrants, evidenced by this Warrant Certificate, to purchase, of __________ shares (the shares of Common Stock (each a “ShareWarrant Shares”) of Homeowners ChoiceCommon Stock, par value of $0.001 per share (the “Common Stock”) of Micronet Enertec Technologies, Inc., a Florida Delaware corporation (the “Company”), and represents that, that on or before the Exercise Date, : o such holder Holder has tendered payment for such Warrant Shares by certified or official bank check payable to the order of the CompanyCompany c/o Continental Stock Transfer & Trust Co., 00 Xxxxxxx Xxxxx, 0xx Xxxxx, Xxx Xxxx, Xxx Xxxx 00000, or by bank wire transfer in immediately available funds payable to the Company at Account No. [ ], in each case in the amount of $ $_______ in accordance with the terms hereof, or o [if permitted] the cancellation of such number of Warrant Shares as is necessary, in accordance with the formula set forth in subsection 3.3.7 of the Warrant Agreement, to exercise this Warrant with respect to the maximum number of Warrant Shares purchasable pursuant to the cashless exercise procedure set forth in subsection 3.3.7. The undersigned requests that said number of Warrant Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Warrant Shares is less than all of the Warrant Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder Holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: ________ __, Name: ____ Name (Please Print) / / / / - / / / - / / / / / (Insert Social Security or Other Identifying Number of Holder) Address __________________________ __________________________ Signature __________________________ This Warrant may only be exercised by presentation to the Warrant Agent at one of the following locations: By hand at: Continental Stock Transfer & Trust Co. 00 Xxxxxxx Xxxxx, 0xx Xxxxx Xxx Xxxx, Xxx Xxxx 00000 By mail at: Continental Stock Transfer & Trust Co. 00 Xxxxxxx Xxxxx, 0xx Xxxxx Xxx Xxxx, Xxx Xxxx 00000 The method of delivery of this Warrant Certificate is at the option and risk of the exercising Holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to ensure timely delivery. (Instructions as to form and delivery of Warrant Shares and/or Warrant Certificates) Name in which Warrant Shares are to be registered if other than in the name of the Holder of this Warrant Certificate: Address to which Warrant Shares are to be mailed if other than to the address of the Holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address) (City and State) (Zip Code) Name in which Warrant Certificate evidencing unexercised Warrants, if any, is to be registered if other than in the name of the Holder of this Warrant Certificate: Address to which certificate representing unexercised Warrants, if any, is to be mailed if other than to the address of the Holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Xxxxxx Xxxxxxx) (Xxxx xxx Xxxxx) (Xxx Code) Dated:
Appears in 1 contract
Samples: Warrant Agreement (Micronet Enertec Technologies, Inc.)
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder must, must pay [in United States dollars][in applicable currency] [in cash] [by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck or by bank wire transfer, in each case payable to case] [by bank wire transfer] [in immediately available funds], the Company, in an amount equal to the Exercise Warrant Price in full for Warrants exercised to [insert of name of Warrant Agent] [corporate trust department] [insert address of Warrant Agent], Attn. _____________ [or ________________], which [payment] [wire transfer] must specify the name of the Holder and the number of Warrants exercisedexercised by such Holder. In addition, the Warrant holder Holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth below. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified [payment] [wire transfer]. To be Executed Upon Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY of Warrant The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise __________ Warrants, evidenced by this Warrant Certificate, to purchase, purchase ______ shares of the shares [Title of Common Stock Warrant Securities] (each a “Share”the "Warrant Securities") of Homeowners Choice, Inc., a Florida corporation (the “Company”), Company and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Securities [in United States dollars] [in applicable currency] [in cash] [by certified check or official bank check or by bank wire transfer, in each case] [by bank wire transfer] [in immediately available funds] to the order of the CompanyXxxxxxxxx, Xxxxxx & Xxxxxxxx, Inc., c/o [insert name and address of Warrant Agent], in the amount of $ __________ in accordance with the terms hereof. The undersigned requests that said number principal amount of Shares Warrant Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. [If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing representing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated.] Date: , Name: (Please Print) Name ----------------------------- -------------------------- Address ---------------------------------- ----------------------- (Insert Social Security or Other Identifying Number of Holder) Address:Signature Guaranteed Signature ---------------------------------- -------------------- (Signature must conform in all respects to name of holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a bank, trust company or member broker of the New York, Midwest or Pacific Stock Exchange) The Warrants evidenced hereby may be exercised at the following addresses: By hand at --------------------------------------------------------------------- --------------------------------------------------------------------- --------------------------------------------------------------------- By mail at --------------------------------------------------------------------- --------------------------------------------------------------------- --------------------------------------------------------------------- --------------------------------------------------------------------- [Instructions as to form and delivery of Warrant Securities and, if applicable, Warrant Certificates evidencing unexercised Warrants -- complete as appropriate.]
Appears in 1 contract
Samples: Debt Warrant Agreement (Donaldson Lufkin & Jenrette Inc /Ny/)
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder or Participant must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a wire transfer in immediately available funds, in each case payable to the CompanyWarrant Agent at Account No. 530-061686, in an amount equal to the Exercise Price in full for the Warrants exercisedexercised or inform the Warrant Agent that it is exercising the Warrants on a cashless basis. In addition, the Warrant holder or Participant must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), Warrants, evidenced by this Warrant Certificate, to purchase, of the shares of Class A Common Stock (each a “Share”) of Homeowners ChoiceWestway Group, Inc., a Florida Delaware corporation (the “Company”), and represents that, on or before the Exercise Date, such holder has tendered payment for such Shares by certified or official bank check or bank wire transfer in immediately available funds to the order of the Company c/o Continental Stock Transfer & Trust Company, 00 Xxxxxxx Xxxxx, Xxx Xxxx, Xxx Xxxx 00000, in the amount of $ or has informed the Warrant Agent that it is exercising the Warrants on a cashless basis in accordance with the terms hereof. The undersigned requests that said number of Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Shares is less than all of the Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. ¨ Check Box if Exercising on Cashless Basis Dated: , Name: (Please Print) (Insert Social Security or Other Identifying Number of Holder) Signature Name (Please Print) Address This Warrant may only be exercised by presentation to the Warrant Agent at one of the following locations: By hand at: Continental Stock Transfer & Trust Company, 00 Xxxxxxx Xxxxx, XX, XX 00000 By mail at: Continental Stock Transfer & Trust Company, 00 Xxxxxxx Xxxxx, XX, XX 00000 The method of delivery of this Warrant Certificate is at the option and risk of the exercising holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to assure timely delivery. (Instructions as to form and delivery of Shares and/or Warrant Certificates) Name in which Shares are to be registered if other than in the name of the registered holder of this Warrant Certificate: Name in which Warrant Certificate evidencing unexercised Warrants, if any, are to be registered if other than in the name of the registered holder of this Warrant Certificate: Dated: , 20 Address to which Shares are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address:) (City and State) (Zip Code) Address to which certificate representing unexercised Warrants, if any, are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address) (City and State) (Zip Code) SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Signature Name Title Dated: , 20 Signature Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate. If Shares, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the registered holder hereof or are to be delivered to an address other than the address of such holder as shown on the books of the Warrant Agent, the above signature must be guaranteed by an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). ASSIGNMENT (FORM OF ASSIGNMENT TO BE EXECUTED IF WARRANT HOLDER DESIRES TO TRANSFER WARRANTS EVIDENCED HEREBY) FOR VALUE RECEIVED, HEREBY SELL(S), ASSIGN(S) AND TRANSFER(S) UNTO (Please Print Name and Address Including Zip Code of Assignee) (Please Insert Social Security or Other Identifying Number of Assignee) the rights represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint Attorney to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. Dated: , 20 SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Signature Name Title Dated: , 20 Signature Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended).
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder must, must pay [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank check, check or by bank wire transfer] [by bank wire transfer] [in each case payable to immediately available funds] the Company, in an amount equal to the Exercise Warrant Price in full for Warrants exercised to [insert name of Warrant Agent] Corporate Trust Department, [insert address of Warrant Agent], Attn. _______________________________________ [or ________________________________] which [payment] [wire transfer] must specify the name of the holder and the number of Warrants exercisedexercised by such holder. In addition, the Warrant holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (registered mail is recommended) to the Company Warrant Agent at the address addresses set forth below. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company Warrant Agent together with such [payment] [wire transfer]. [If the undersigned is requesting delivery of Warrant Securities in bearer form, the person entitled to physical delivery of such Warrant Securities will be required to deliver a certificate (copies of which may be obtained from the Warrant Agent [or _________________________]) certifying that such Warrant Securities are not being acquired by 5:00 P.M., New York time, or on the specified Exercise Date. ELECTION TO PURCHASE behalf of a U.S. person or for resale to a U.S. person unless such U.S. person is a qualified financial institution as defined under United States tax laws and regulations.] TO BE EXECUTED IF UPON EXERCISE OF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise _________________ Warrants, evidenced by this Warrant Certificate, to purchase, purchase $_____________ principal amount of the shares [Title of Common Stock Warrant Securities] (each a “Share”the "Warrant Securities") of Homeowners Choice, Inc., a Florida corporation (the “Company”), Amoco Company guaranteed by Amoco Corporation and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Securities [in cash or by certified check or official bank check or by bank wire transfer, in each case] [by bank wire transfer] [in immediately available funds] to the order of the Amoco Company, c/o [insert name and address of Warrant Agent], in the amount of $ $____________ in accordance with the terms hereof. The undersigned requests that said number principal amount of Shares Warrant Securities be in [bearer form in the authorized denominations] [fully registered formform in the authorized denominations, registered in such names and delivered, ] all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing representing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated: , Name: :______________________________ (Please Print) _________________________________ (Insert Social Security or Other Address:___________________________ Identifying Number of Holder) Address:___________________________ Signature__________________________ The Warrants evidenced hereby may be exercised at the following addresses: By hand at ________________________________________________ ________________________________________________ ________________________________________________ By hand at ________________________________________________ ________________________________________________ ________________________________________________ [Instructions as to form and delivery of Warrant Securities and, if applicable, Warrant Certificates evidencing unexercised Warrants -- complete as appropriate. [IF REGISTERED WARRANT] ASSIGNMENT (FORM OF ASSIGNMENT TO BE EXECUTED IF HOLDER DESIRES TO TRANSFER WARRANTS EVIDENCED HEREBY) FOR VALUE RECEIVED ______________________ hereby sells, assigns and translates unto Please insert social security or other identifying number __________________________________________ __________________________________________ ______________________________ (Please print name and address including zip code ___________________________________________________________________________ the Warrants represented by the within Warrant Certificates and does hereby irrevocably constitute and appoint ______________________________ Attorney, to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. Dated: _____________________________________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a bank, trust company or member broker of the New York, Midwest or Pacific Stock Exchange.) Signature Guaranteed: _____________________________
Appears in 1 contract
Samples: Warrant Agreement (Amoco Corp)
Instructions for Exercise of Warrant. To exercise the any Warrants evidenced herebyhereby for Warrant Securities (as hereinafter defined), the holder mustHolder must pay, in lawful money of the United States of America, [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck in New York Clearing House funds] [by bank wire transfer in immediately available funds], in each case payable to the Company, in an amount equal to the Exercise Warrant Price in full for the Warrants exercised, to [·] [address of Warrant Agent], Attention: [·], which payment must specify the name of the Holder and the number of Warrants exercised by such Holder. In addition, the Warrant holder Holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth belowabove. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified Exercise Datepayment. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY (To be executed upon exercise of Warrants) The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise [·] Warrants, evidenced by this Warrant Certificate, to purchase, purchase [·] shares of the shares [Title of Common Stock (each a “Share”) of Homeowners ChoiceWarrant Securities], Inc., a Florida corporation par value $0.01 per share (the “CompanyWarrant Securities”), of Eagle Pharmaceuticals, Inc. and represents that, on or before that the Exercise Date, such holder undersigned has tendered payment for such Shares Warrant Securities, in lawful money of the United States of America, [in cash or by certified check or official bank check in New York Clearing House funds] [by bank wire transfer in immediately available funds], to the order of the CompanyEagle Pharmaceuticals, Inc., c/o [insert name and address of Warrant Agent], in the amount of $ $[·] in accordance with the terms hereof. The undersigned requests that said number of Shares Warrant Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing the Warrants for the number of Warrant Securities remaining balance of the Warrants evidenced hereby unexercised be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated: , Name: (Please Print) Print Address: (Insert Social Security or Other Identifying Number of Holder) Address:Signature Guaranteed: Signature (Signature must conform in all respects to name of holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a FINRA member firm). This Warrant may be exercised at the following addresses: By hand at: By mail at: [Instructions as to form and delivery of Warrant Securities and, if applicable, Warrant Certificates evidencing Warrants for the number of Warrant Securities remaining unexercised — complete as appropriate.] ASSIGNMENT [Form of assignment to be executed if Warrant Holder desires to transfer Warrant] FOR VALUE RECEIVED, [·] hereby sells, assigns and transfers unto: (Please print name and address including zip code) Please print Social Security or other identifying number the right represented by the within Warrant to purchase [·] shares of [Title of Warrant Securities] of Eagle Pharmaceuticals, Inc. to which the within Warrant relates and appoints [·] attorney to transfer such right on the books of the Warrant Agent with full power of substitution in the premises. Dated: Signature (Signature must conform in all respects to name of holder as specified on the face of the Warrant) Signature Guaranteed
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder must, Registered Holder must pay in full [in lawful money of the United States of America] [in applicable currency] [in cash] [by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank checkcheck or by bank wire transfer, in each case payable case,] [by bank wire transfer] [in immediately available funds,] the Warrant Price for Warrants exercised (plus any accrued interest as specified in this Warrant Certificate) to [insert name of Warrant Agent] [corporate trust department] [insert address of Warrant Agent], Attn: [or ], which [payment] [wire transfer] must specify the Company, in an amount equal to name of the Exercise Price in full for Registered Holder and the number of Warrants exercisedexercised by such Registered Holder. In addition, the Warrant holder Registered Holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth below. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified [payment] [wire transfer]. To be Executed Upon Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY of Warrant The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise ________ Warrants, evidenced by this Warrant Certificate, to purchase, purchase ______________ principal amount of the shares [Title of Common Stock Warrant Securities] (each a “Share”the "Warrant Securities") of Homeowners ChoiceFortune Brands, Inc., a Florida corporation (the “Company”), Inc. and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Securities [in lawful money of the United States of America) [in applicable currency] [in cash] [by certified check or official bank check or by bank wire transfer, in each case,] [by bank wire transfer] [in immediately available funds] to the order of the CompanyFortune Brands, Inc., c/o [insert name and address of Warrant Agent], in the amount of $ _____ in accordance with the terms hereof. The undersigned requests that said number principal amount of Shares Warrant Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less fewer than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing representing the remaining balance of the Warrants evidenced hereby be issued in registered form and delivered either to the holder of the Warrant Certificate unless undersigned or as otherwise specified in the instructions below. Dated: , ________________________ Name: ___________________________ (Please Print) _____________________________ (Insert Social Security Address________________________ or Other Identifying Number of Holder) Address:________________________ Signature______________________ The Warrants evidenced hereby may be exercised at the following addresses: By hand at________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ By mail at________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ [Instructions as to delivery of Warrant Securities and, if applicable, Warrant Certificates evidencing unexercised Warrants - complete as appropriate.] Assignment (Form of Assignment to be Executed if Holder Desires to Transfer Warrants Evidenced Hereby) FOR VALUE RECEIVED hereby sells, assigns and transfers unto Please insert social security or other identifying number --------------------------- ___________________________ __________________________________________________________________ (Please print name and address including zip code) ______________________________________________________________________________ the Warrants represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint ______________________ Attorney, to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. Dated: _________________________________ Signature (Signature must conform in all respects to name of Registered Holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by a bank, trust company or member broker of the New York, Midwest or Pacific Stock Exchange).
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder must, must pay in [Dollars] [applicable currency] [in cash or by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the Company, a certified check or official bank check, check or by bank wire transfer] [by bank wire transfer] [in each case payable to immediately available funds] the Company, in an amount equal to the Exercise Warrant Price in full for Warrants exercised to [insert name of Warrant Agent] [corporate trust department] [insert address of Warrant Agent], Attn. _________________________ [or _________________________], which [payment] [wire transfer] must specify the name of the holder and the number of Warrants exercisedexercised by such holder. In addition, the Warrant holder must provide complete the information required below and deliver present this Warrant Certificate in person or by mail (certified or registered mail is recommended) to the Company Warrant Agent at the appropriate address set forth below. The This Warrant Certificate Certificate, completed and this Election to Purchase duly executed, must be received by the Company by 5:00 P.M., New York time, on Warrant Agent within five business days of the specified [payment] [wire transfer]. To Be Executed Upon Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY of Warrant The undersigned hereby irrevocably elects to exercise, on , (the “Exercise Date”), exercise __________ Warrants, evidenced by this Warrant Certificate, to purchase, purchase __________ principal amount of the shares [Title of Common Stock Warrant Securities] (each a “Share”the "Warrant Securities") of Homeowners Choice, Inc., a Florida corporation (the “Company”), Transamerica Finance Corporation and represents that, on or before the Exercise Date, such holder that he has tendered payment for such Shares Warrant Securities in [Dollars] [applicable currency] [in cash or by certified check or official bank check or by bank wire transfer, in each case] [by bank wire transfer] in immediately available funds to the order of the CompanyTransamerica Finance Corporation, c/o [insert name and address of Warrant Agent], in the amount of $ __________ in accordance with the terms hereof. The undersigned requests that said number principal amount of Shares Warrant Securities be in fully registered formform in the authorized denominations, registered in such names and delivered, delivered all as specified in accordance with the instructions set forth below. If said the number of Shares Warrants exercised is less than all of the Shares purchasable hereunderWarrants evidenced hereby, the undersigned requests that a new Warrant Certificate evidencing representing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate undersigned unless otherwise specified in the instructions below. Dated: , Name: (Please Print) ________________________ Name _________________________ ______________________________ Address ______________________ (Insert Social Security or Other ______________________________ Identifying Number of Holder) Address:Signature ____________________ The Warrants evidenced hereby may be exercised at the following addresses: By hand at ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ By mail at ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ [Instructions as to form and delivery of Warrant Securities and, if applicable, Warrant Certificates evidencing unexercised Warrants -- complete as appropriate.]
Appears in 1 contract
Instructions for Exercise of Warrant. To exercise the Warrants evidenced hereby, the holder Holder must, by 5:00 P.M., New York City time, on the specified Exercise Date, deliver to the CompanyWarrant Agent at its stock transfer division, a certified or official bank checkcheck or a bank wire transfer in immediately available funds, in each case payable to the Company, in an amount equal to the Exercise Price in full for the Warrants exercised. In addition, the Warrant holder Holder must provide the information required below and deliver this Warrant Certificate to the Company Warrant Agent at the address set forth belowbelow and the Book-Entry Warrants to the Warrant Agent in its account with the Depository designated for such purpose. The Warrant Certificate and this Election to Purchase must be received by the Company Warrant Agent by 5:00 P.M., New York City time, on the specified Exercise Date. ELECTION TO PURCHASE TO BE EXECUTED IF WARRANT HOLDER DESIRES TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on __________, ____ (the “Exercise Date”), __________ Warrants, evidenced by this Warrant Certificate, to purchase, of __________ shares (the shares of Common Stock (each a “ShareWarrant Shares”) of Homeowners ChoiceCommon Stock, par value of $0.00001 per share (the “Common Stock”) of xG Technology, Inc., a Florida Delaware corporation (the “Company”), and represents that, that on or before the Exercise Date, : o such holder Holder has tendered payment for such Warrant Shares by certified or official bank check payable to the order of the CompanyCompany c/o Continental Stock Transfer & Trust Co., 00 Xxxxxxx Xxxxx, 0xx Xxxxx, Xxx Xxxx, Xxx Xxxx 00000, or by bank wire transfer in immediately available funds payable to the Company at Account No. [ ], in each case in the amount of $ $_______ in accordance with the terms hereof, or o [if permitted] the cancellation of such number of Warrant Shares as is necessary, in accordance with the formula set forth in subsection 3.3.7 of the Warrant Agreement, to exercise this Warrant with respect to the maximum number of Warrant Shares purchasable pursuant to the cashless exercise procedure set forth in subsection 3.3.7. The undersigned requests that said number of Warrant Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Warrant Shares is less than all of the Warrant Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder Holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: ________ __, Name: ____ Name (Please Print) / / / / - / / / - / / / / / (Insert Social Security or Other Identifying Number of Holder) Address __________________________ __________________________ Signature __________________________ This Warrant may only be exercised by presentation to the Warrant Agent at one of the following locations: By hand at: Continental Stock Transfer & Trust Co. 00 Xxxxxxx Xxxxx, 0xx Xxxxx Xxx Xxxx, Xxx Xxxx 00000 By mail at: Continental Stock Transfer & Trust Co. 00 Xxxxxxx Xxxxx, 0xx Xxxxx Xxx Xxxx, Xxx Xxxx 00000 The method of delivery of this Warrant Certificate is at the option and risk of the exercising Holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to ensure timely delivery. (Instructions as to form and delivery of Warrant Shares and/or Warrant Certificates) Name in which Warrant Shares are to be registered if other than in the name of the Holder of this Warrant Certificate: Address to which Warrant Shares are to be mailed if other than to the address of the Holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address:) (City and State) (Zip Code) Name in which Warrant Certificate evidencing unexercised Warrants, if any, is to be registered if other than in the name of the Holder of this Warrant Certificate: Address to which certificate representing unexercised Warrants, if any, is to be mailed if other than to the address of the Holder of this Warrant Certificate as shown on the books of the Warrant Agent: (Street Address) (City and State) (Zip Code) Dated: Signature: Signature must conform in all respects to the name of the Holder as specified on the face of this Warrant Certificate. If Warrant Shares, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the Holder hereof or are to be delivered to an address other than the address of such Holder as shown on the books of the Warrant Agent, the above signature must be guaranteed by a an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm _____________________________ Address _____________________________ Area Code and Number _____________________________ Authorized Signature _________________________ Name ____________________________________ Title ____________________________________ Dated: __________, 20__ ASSIGNMENT (FORM OF ASSIGNMENT TO BE EXECUTED IF WARRANT HOLDER DESIRES TO TRANSFER WARRANTS EVIDENCED HEREBY) FOR VALUE RECEIVED, ____________ HEREBY SELL(S), ASSIGN(S) AND TRANSFER(S) UNTO (Please print name and address including zip code of assignee) (Please insert social security or other identifying number of assignee) the rights represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint ____________ Attorney to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. Dated: Signature (Signature must conform in all respects to the name of the Holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Name Title Dated: , 20__
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