Name; Address. Unless you have promptly notified the Manager In Writing otherwise, your name as it should appear in the Registration Statement, Prospectus or Offering Circular and any advertisement, if different, and your address, are as set forth on the signature pages hereof.
Name; Address. Purchaser’s exact legal name is as set forth in the Preamble to this Agreement. Purchaser has not conducted business under or used any other name other than as set forth in the Preamble to this Agreement. The chief executive office and principal place of business for Purchaser is located at 0000 Xxxxxxxxx Xxxxxx, Xxxxxxxxx, Xxxxxxxxx 00000.
Name; Address. If the certificates representing the Shares being purchased pursuant hereto are to be registered in a name or names other than the name of the holder of this Warrant, all transfer taxes payable upon such transfer shall be paid by the undersigned at the time of delivering the notice of exercise and such request. Solely with respect to the Warrant Shares being purchased pursuant to this Subscription Form, the representations and warranties of the Holder contained in Section 13.1 of the Warrant are repeated at and as of the time of delivery hereof and are true and correct in all material respects at and as of the time of delivery hereof, except to the extent such representations and warranties are expressly limited to an earlier date or the Company has expressly consented in writing to the contrary. The undersigned acknowledges that each certificate for Warrant Shares issued upon exercise of the Warrant shall bear a legend to the effect that such Warrant Shares may not be transferred except upon compliance with the provisions of the Securities Act and applicable state securities laws, and each certificate for Warrant Shares transferred shall bear such a legend unless, in the opinion of counsel for the Company, such legend is not required. If the number of Shares shall not be all the Warrant Shares purchasable under this Warrant, a new Warrant of like tenor is to be issued in the name of and delivered to the undersigned for the remaining balance of the Shares purchasable thereunder. (Name of Registered Owner) (Signature of Registered Owner) (Street Address) (City) (State) (Zip Code) NOTICE: The signature on this subscription must correspond with the names as written upon the face of the attached Warrant in every particular, without alteration or enlargement or any change whatsoever. EXHIBIT B ASSIGNMENT FORM FOR VALUE RECEIVED the undersigned registered Holder of the attached Warrant hereby sells, assigns and transfers unto the Assignee named below all of the rights of the undersigned under such Warrant, with respect to the number of Shares set forth below: Name and Address of Assignee No. of Shares If the number of Shares is not all of the Warrant Shares represented by this Warrant, a new Warrant of like tenor is to be issued in the name of and delivered to the undersigned for the balance remaining of the Shares represented by this Warrant. Dated: Print Name: Signature: Witness:
Name; Address. The undersigned acknowledges that each certificate for Warrant Shares issued upon exercise of this Warrant shall bear a legend to the effect that such Warrant Shares may not be transferred except upon compliance with the provisions of the First Refusal and Co-Sale Agreement and the Securities Act and applicable state securities laws, and each certificate for Warrant Shares transferred shall also bear such a legend unless, in the opinion of counsel for the Company, such a legend is not required. Solely with respect to the Warrant Shares being received pursuant to this Notice of Conversion, the representations and warranties of the Holder contained in Section 13.1 of the Warrant are repeated at and as of the time of delivery hereof and are true and correct in all material respects at and as of the time of delivery hereof, except to the extent such representations and warranties are expressly limited to an earlier date or the Company has expressly consented in writing to the contrary. If the number of Shares shall not be all the Warrant Shares issuable under this Warrant, a new Warrant of like tenor is to be issued in the name of and delivered to the undersigned for the remaining balance of the Shares issuable thereunder. (Name of Registered Owner) (Signature of Registered Owner) (Street Address) (City) (State) (Zip Code) NOTICE: The signature on this subscription must correspond with the names as written upon the face of the within Warrant in every particular, without alteration or enlargement or any change whatsoever.
Name; Address. Xx Xxx Xxxx 0000, Xxxxxxxx Xxx, Xxxx Xxxx Xxxx, Xxxxxxxx, Xxxxx
Name; Address as long as the second named beneficiary is alive, The balance, if any, : , and any accruing after the death of all persons named in the above designations shall be held for me, in the event of my death before receipt thereof, said balance and amounts accruing shall be paid to the legal representative of my estate. The foregoing direction may be modified time to by letter signed by the undersigned, and any such modifications shall become effective upon receipt of such by you. I agree to and hold the Company harmless from any claims made relating to payments made by the Company pursuant to this direction and further, hereby release the Company from any further claims to compensation paid by it on my behalf under this direction. SIGNATURE , ARTICLE TRAINING AND
Name; Address. References: The Proposer lists below work he has done of similar nature as this solicitation, as references that will afford the County opportunity to judge as to experience, skill, business standing, and financial ability. CONTACT PHONE PERSON TITLE NUMBER/EMAIL -End of This Section- CONTRACT NUMBER C-18-XXXX-01050 SAMPLE CONTRACT FOR SERVICES BY AND BETWEEN XXXXX COUNTY BOARD OF COMMISSIONERS AND This Agreement made and entered into by and between Xxxxx County, Georgia, party of the first part (hereinafter called the “County”) and party of the second part (hereinafter called the “Contractor”); and
Name; Address. Home Phone Cell Phone Work Phone SIGNATURE Name Date 0000 0xx xxxxxx kearney, nebraska 68847 xxx.xxxxxxxxxx.xxx 308 234.9311 phone 888 838.5328 toll free
Name; Address. Identification Number If the Board shall comply with the foregoing, the Union shall defend and hold the Board harmless for all such actions.
