INSTRUCTIONS FOR REGISTRATION OF SECURITIES. Name --------------------------------------------------------------- (please typewrite or print in block letters) Address ------------------------------------------------------------ Signature ---------------------------------------------------------- ASSIGNMENT FORM FOR VALUE RECEIVED, ____________________________________________________________ hereby sells, assigns and transfers unto Name____________________________________________________________________________ (please typewrite or print in block letters) Address_________________________________________________________________________ The right to purchase ___________ shares of Common Stock as represented by this Warrant to the extent of _______________ shares of Common Stock as to which such right is exercisable and does hereby irrevocably constitute and appoint ____________________, attorney, to transfer the same on the books of the Company with full power of substitution in the premises. -------------------------------- Signature Dated: ________________, 2000
Appears in 2 contracts
Samples: Genetic Vectors Inc, Genetic Vectors Inc
INSTRUCTIONS FOR REGISTRATION OF SECURITIES. Name --------------------------------------------------------------- ------------------------------------------------------------------------ (please typewrite or print in block letters) Address ------------------------------------------------------------ ------------------------------------------------------------------------ Signature ---------------------------------------------------------- ------------------------------------------------------------------------ ASSIGNMENT FORM FOR VALUE RECEIVED, ____________________________________________________________ ------------------------------------------------------------------------ hereby sells, assigns and transfers unto Name____________________________________________________________________________ Name ------------------------------------------------------------------------ (please typewrite or print in block letters) Address_________________________________________________________________________ The Address ------------------------------------------------------------------------ the right to purchase ___________ shares of Common Stock common stock as represented by this Warrant to the extent of _______________ shares of Common Stock as to which such right is exercisable and does hereby irrevocably constitute and appoint appoint, ____________________, _ attorney, to transfer the same on the books of the Company with full power of substitution in the premises. -------------------------------- Signature Dated: ________________, 2000------------------------------------------------------------------------
Appears in 1 contract
Samples: Weststar Environmental Inc
INSTRUCTIONS FOR REGISTRATION OF SECURITIES. Name --------------------------------------------------------------- (please typewrite or print in block letters) Address ------------------------------------------------------------ Signature ---------------------------------------------------------- ASSIGNMENT FORM FOR VALUE RECEIVED, ____________________________________________________________ hereby sells, assigns and transfers unto Name____________________________________________________________________________ (please typewrite or print in block letters) AddressAddress ________________________________________________________________________ Signature ______________________________________________________________________ ASSIGNMENT FORM FOR VALUE RECEIVED, ____________________________________________________________ hereby sells, assigns and transfers unto Name ___________________________________________________________________________ The right to purchase ___________ shares of Common Stock as represented by this Warrant to the extent of _______________ shares of Common Stock as to which such right is exercisable and does hereby irrevocably constitute and appoint (please typewrite or print in block letters) Address ________________________________________________________________________ the right to purchase shares of Common Stock as represented by this Warrant to the extent of shares of Common Stock as to which such right is exercisable and does hereby irrevocably constitute and appoint, ________________________________ _______________________________ attorney, to transfer the same on the books of the Company with full power of substitution in the premises. -------------------------------- Signature Dated: __________ 20 _______, 2000
Appears in 1 contract
Samples: Nations Express Inc
INSTRUCTIONS FOR REGISTRATION OF SECURITIES. Name --------------------------------------------------------------- -------------------------------------------------------------------------------- (please typewrite or print in block letters) Address ------------------------------------------------------------ ------------------------------------------------------------------------ Signature ---------------------------------------------------------- ----------------------------------------------------------------------- ASSIGNMENT FORM FOR VALUE RECEIVED, ____________________________________________________________ ------------------------------------------------------------- hereby sells, assigns and transfers unto Name____________________________________________________________________________ Name --------------------------------------------------------------------------- (please typewrite or print in block letters) Address_________________________________________________________________________ The Address ------------------------------------------------------------------------ the right to purchase ___________ shares of Common Stock as represented by this Warrant to the extent of _______________ shares of Common Stock as to which such right is exercisable and does hereby irrevocably constitute and appoint ____________________appoint, -------------------------------- attorney, to transfer the same on the books of the Company with full power of substitution in the premises. -------------------------------- Signature ----------------------------------------------------------------------- Dated: _________20_______, 2000
Appears in 1 contract
Samples: Nations Express Inc