Ownership of Registrable Securities. (a) Type and Number of Registrable Securities beneficially owned:
Ownership of Registrable Securities. (a) Type and Number of Registrable Securities beneficially owned: ____________________________ ____________________________ ____________________________
(b) Number of shares of Common Stock to be registered pursuant to this Notice for resale: ____________________________ ____________________________ ____________________________
Ownership of Registrable Securities. (a) Type and Principal Amount of Registrable Securities beneficially owned: __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________
Ownership of Registrable Securities. Issuable Pursuant to the Purchase Agreement:
(a) Type and Number of Registrable Securities beneficially owned and issued pursuant to the Agreement:
(b) Number of shares of Common Stock to be registered pursuant to this Notice for resale:
Ownership of Registrable Securities. (a) Type and Number of Registrable Securities beneficially owned:
(b) Number of shares of Common Stock to be registered pursuant to this Notice for resale:
Ownership of Registrable Securities. Selling Stockholder: Number of Registrable Securities owned:
Ownership of Registrable Securities. (a) Number of Registrable Securities beneficially owned and issued or issuable pursuant to preferred stock:
(b) Number of Registrable Securities to be registered pursuant to this Questionnaire for resale:
Ownership of Registrable Securities. This question covers your beneficial ownership of Registrable Securities as of the date this Questionnaire is signed. Please consult Appendix A to this Questionnaire for information as to the meaning of "beneficial ownership."
(a) State the number of shares of the Company's Registrable Securities that you beneficially own: --------------------------------------------------------------------
(b) State the number of Registrable Securities that you have the right to acquire under any Warrants, Options or other rights, or upon conversion of any security convertible into Registrable Securities. Please list each Warrant, Option, right, or convertible security separately below (attach additional sheets if necessary): -------------------------------------------------------------------------------- Number of Shares which Option, Warrant, May be Right, or Acquired on Exercise or Date First Convertible Exercise or Conversion Exercisable or Termination Security Conversion Price Convertible Date -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- --------------------------------------------------------------------------------
(c) State the number of shares of Registrable Securities proposed to be sold under the Registration Statement (including shares of Registrable Securities underlying Warrants and Options, rights or convertible securities): --------------------------------------------------------------------
(d) Have you agreed to act in concert with any other persons or affiliates of the Company for the purpose of selling the Registrable Securities? Yes _____ No _____ If "Yes," give full details. -------------------------------------------------------------------- --------------------------------------------------------------------
Ownership of Registrable Securities. Except as set forth below in this Item (3), the undersigned Selling Securityholder does not beneficially or of record own any Units or Underlying Securities.
(a) Number and stated amount of Units owned: [CUSIP No(s).:]
(b) Number of Purchase Contracts owned:
(c) Principal amount of Senior Notes owned: [CUSIP No(s).:]
(d) Number of shares of common stock (if any) issuable upon settlement of the Purchase Contracts: __________________________________________________________________________________________________
(e) Number and stated amount of Units (including Underlying Securities) beneficially owned by the undersigned and included in the Shelf Registration Statement: _____________________________________________________________________ [CUSIP No(s). of such Registrable Securities to be included in the Shelf Registration Statement:] __________________________________________________________________________________________________
Ownership of Registrable Securities. Issuable Pursuant to the Conversion Agreement:
(a) Type and Number of Registrable Securities beneficially owned and to be issued pursuant to the Conversion Agreement: shares of common stock Class H warrants Class I warrants shares of common stock underlying the warrants (the “Warrant Shares”.
(b) Number of shares of Registrable Securities issuable pursuant to the Conversion Agreement to be registered pursuant to this Notice for resale: shares of common stock Class H warrants Class I warrants
