ISSUE TO. (NAME) -------------------------------------------------------------------------------- (ADDRESS, INCLUDING ZIP CODE) -------------------------------------------------------------------------------- (SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER) DELIVER TO: --------------------------------------------------------------------- (NAME) -------------------------------------------------------------------------------- (ADDRESS, INCLUDING ZIP CODE) If the number of shares of Common Stock purchased hereby is less than the number of shares of Common Stock covered by the Warrant, the undersigned requests that a new Warrant representing the number of shares of Common Stock not so purchased be issued and delivered as follows:
ISSUE TO. (NAME OF HOLDER)
ISSUE TO. (NAME OF HOLDER) -------------------------------------------------------------------------------- (ADDRESS, INCLUDING ZIP CODE) DELIVER TO: -------------------------------------------------------------------- (NAME OF HOLDER) -------------------------------------------------------------------------------- (ADDRESS, INCLUDING ZIP CODE) Dated: , 200 [NAME OF HOLDER] ------------ - By ------------------------------------- Name: Title: EXHIBIT B to Common Stock Purchase Warrant [FORM OF] ASSIGNMENT FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers unto the Assignee named below all of the rights of the undersigned to purchase Common Stock, par value $__________ per share ("Common Stock") of XANODYNE PHARMACEUTICALS, INC. represented by the Warrant, with respect to the number of shares of Common Stock set forth below: Name of Assignee Address No. of Shares ---------------- ------- ------------- and does hereby irrevocably constitute and appoint ___________ Attorney to make such transfer on the books of XANODYNE PHARMACEUTICALS, INC. maintained for that purpose, with full power of substitution in the premises. Dated: , 200 [NAME OF HOLDER] ------------ - By: ------------------------------------ Name: Title: EXHIBIT C to Common Stock Purchase Warrant
ISSUE TO. (NAME OF HOLDER) -------------------------------------------------------------------------------- (ADDRESS, INCLUDING ZIP CODE) -------------------------------------------------------------------------------- DELIVER TO: (NAME OF HOLDER) -------------------------------------------------------------------------------- (ADDRESS, INCLUDING ZIP CODE)
ISSUE TO. (NAME OF HOLDER(1)) ------------------------------------------------------------------------------- (ADDRESS, INCLUDING ZIP CODE) DELIVER TO: -------------------------------------------------------------------- (NAME OF HOLDER(1)) ------------------------------------------------------------------------------- (ADDRESS, INCLUDING ZIP CODE) Dated: ____________ , 20__ [NAME OF HOLDER(1)] By: ----------------------------------- Name: Title: ------------------------- (1) Name of Holder must conform in all respects to name of holder as specified on the face of the Warrant. EXHIBIT B to Series C Convertible Preferred Shares Purchase Warrant [FORM OF] ASSIGNMENT FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers unto the Assignee named below all of the rights of the undersigned to purchase Series C Convertible Preferred Stock, par value $_____ per share ("Series C Shares") of GILAT-TO-HOME INC. represented by the Warrant, with respect to the number of Series C Shares set forth below: Name of Assignee Address No. of Shares ---------------- ------- ------------- and does hereby irrevocably constitute and appoint ________ Attorney to make such transfer on the books of GILAT-TO-HOME INC. maintained for that purpose, with full power of substitution in the premises. Dated: , 20 [NAME OF HOLDER(1)] --------------- -- By: --------------------------------- Name: Title: ------------------------ (1) Name of Holder must conform in all respects to name of holder as specified on the face of the Warrant. AMENDMENT TO WARRANT AGREEMENT Reference is hereby made to (i) the Gilat-to-Home Inc. Series C Convertible Preferred Stock Purchase Warrant, dated as of January 26, 2000, between Gilat-to-Home Inc. (the "Company") and Israel Discount Bank Ltd. (the "Holder") whereby the Holder is entitled to purchase from the Company shares of Series C Convertible Preferred Stock (the "Warrant Agreement") and (ii) the Financing Agreement, dated as of August 7, 2000, between the Company, the financial institutions from time to time party thereto (collectively the "Lenders"), and Bank Leumi USA, as agent for the Lenders (as amended by the First Amendment and Joinder to the Financing Agreement, dated as of August 7, 2000, hereinafter referred to as the "Financing Agreement"). The undersigned hereby agree that, upon execution of this Amendment, Section 10(b) of the Warrant Agreement shall be amended by adding the following phrase immediately after the words "Investor Agreements...
ISSUE TO. (NAME) --------------------------------------------------------------------------- (ADDRESS, INCLUDING ZIP CODE) --------------------------------------------------------------------------- (SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER) DELIVER TO: ---------------------------------------------------------------- (NAME) --------------------------------------------------------------------------- (ADDRESS, INCLUDING ZIP CODE) If the number of Series C Shares purchased (and/or reduced) hereby is less than the number of Series C Shares covered by the Warrant, the undersigned requests that a new Warrant representing the number of Series C Shares not so purchased (or reduced) be issued and delivered as follows:
ISSUE TO. Xxx Xxxxx one hundred (100) shares of nonqualified preferred stock of Auto Specialty (the "Xxx Xxxxx Auto Specialty Preferred Stock"); and
ISSUE TO. (NAME) -------------------------------------------------------------------------------- (ADDRESS, INCLUDING ZIP CODE) -------------------------------------------------------------------------------- (SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER) DELIVER TO: ---------------------------------------------------------------------- (NAME) -------------------------------------------------------------------------------- (ADDRESS, INCLUDING ZIP CODE) If the number of Common Shares purchased (and/or reduced) hereby is less than the number of Common Shares covered by the Warrant, the undersigned requests that a new Warrant representing the number of Common Shares not so purchased (or reduced) be issued and delivered as follows:
ISSUE TO. (NAME OF HOLDER) -------------------------------------------------------------------------------- (ADDRESS, INCLUDING ZIP CODE) DELIVER TO: -------------------------------------------------------------------- (NAME OF HOLDER) -------------------------------------------------------------------------------- (ADDRESS, INCLUDING ZIP CODE) Dated: [NAME OF HOLDER] -------------- By ------------------------- Name: Title: __________________, as transfer agent and registrar of the Common Stock, is hereby authorized and directed to issue the above number of shares of Common Stock in the name of the above referenced entity or person and to deliver the certificates representing such shares using an overnight delivery service.
ISSUE TO. (NAME) ---------------------------- (ADDRESS, INCLUDING ZIP CODE) ---------------------------- (SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER) DELIVER TO: ---------------------------- (NAME) at ---------------------------- (ADDRESS, INCLUDING ZIP CODE) If the number of Warrants hereby exercised is less than all the Warrants represented by this Warrant Certificate, the undersigned requests that a new Warrant Certificate representing the number of full Warrants not exercised be issued and delivered as set forth below. In full payment of the purchase price with respect to the Warrants exercised and transfer taxes, if any, the undersigned hereby tenders payment of $____________ by check or money order payable representing good funds in United States currency to the order of the Warrant Agent. Date:__________________ Signature:___________________________ (Signature must conform in all particulars to name of holder as specified on the face of the Warrant Certificate without alteration or enlargement or any change whatsoever, or if signed by other person, the form of assignment hereof must be duly executed and this Form of Election must be signed by the assignee whose signature must correspond with the name set forth on the Form of Assignment in every particular. Signature must be guaranteed by a commercial bank or trust company located in the United States or by a broker or dealer which is a member of a registered national securities exchange or the National Association of Securities Dealers, Inc.) Signature Guaranteed: ________________________________________ [FORM OF] ASSIGNMENT (To be signed only upon assignment of Warrants evidenced by this Certificate) FOR VALUE RECEIVED, the undersigned hereby sells, assigns and transfer unto --------------------------------------------------- (Name and Address of Assignee Must be Printed or Typewritten) Insert Social Security Number or Identifying Number of Assignee all of the rights of the undersigned represented by the within Warrant Certificate with respect to ______________________ Warrants and hereby irrevocably constitutes and appoints Attorney to transfer said Warrant on the books of GEN TRAK, INC. with full power of substitution in the premises. DATED: _____________ 19__
