Print Name Sample Clauses
Print Name. Date: ..........................................................................
Print Name. Designation ...................................
Print Name. Designation ......................................... Dated this .. day of ........................ 20..........
Print Name. Position ............................................................................................................................................................. Date ..............................
Print Name. Creative Investors Group, LLC --------------------------------- By: /s/ Xxxxxx Xxxxx --------------------------------- Name: Xxxxxx Xxxxx --------------------------------- Title: Managing Member --------------------------------- Address: XXXXXXX --------------------------------- XXXXXXX --------------------------------- Telephone: (XXX) XXX-XXXX --------------------------------- Facsimile: (XXX) XXX-XXXX --------------------------------- SOC/EIN#: XX-XXXXXXX --------------------------------- Number of Shares of Common Stock to be Purchased 25,000 --------------------------------- Series 2003-1 Warrants to be Purchased 12,500 --------------------------------- Aggregate Purchase Price $ 102,500 ----------------- OMNIBUS SIGNATURE PAGE TO SPECTRUM PHARMACEUTICALS, INC. COMMON STOCK AND WARRANT PURCHASE AGREEMENT The undersigned hereby executes and delivers the Common Stock and Warrant Purchase Agreement to which this signature page is attached, which, together with all counterparts of the Agreement and signature pages of the other parties named in said Agreement, shall constitute one and the same document in accordance with the terms of the Agreement.
Print Name. Number of shares owned subject to warrants, options or convertible securities: Certificate numbers:
Print Name. Position ......................................................................................................................
Print Name. Date: .......................................................................... Signed: .......................................................................
Print Name. (Instruction: Please do not fill in any blanks other than the signature line. The purpose of the assignment is to enable the Corporation to exercise its sale/purchase option set forth in the Restricted Stock Award Agreement without requiring additional signatures on the part of the Individual.)
Print Name. By: ------------------------------------------ Signature Title: --------------------------------------- (required for any purchaser that is a corporation, partnership, trust or other entity) EXHIBIT C AMYLIN PHARMACEUTICALS, INC. CERTIFICATE OF SUBSEQUENT SALE ChaseMellon Shareholder Services RE: Sale of Shares of Common Stock of Amylin Pharmaceuticals, Inc. (the "Company") pursuant to the Company's Prospectus dated _______________, 2000 (the "Prospectus") Dear Sir/Madam: The undersigned hereby certifies, in connection with the sale of shares of Common Stock of the Company included in the table of Selling Shareholders in the Prospectus, that the undersigned has sold the Shares pursuant to the Prospectus and in a manner described under the caption "Plan of Distribution" in the Prospectus and that such sale complies with all applicable securities laws, including, without limitation, the Prospectus delivery requirements of the Securities Act of 1933, as amended. Selling Shareholder (the beneficial owner): ----------------------------- Record Holder (e.g., if held in name of nominee): ----------------------- Restricted Stock Certificate No.(s): ------------------------------------ Number of Shares Sold: -------------------------------------------------- Date of Sale: ----------------------------------------------------------- In the event that you receive a stock certificate(s) representing more shares of Common Stock than have been sold by the undersigned, then you should return to the undersigned a newly issued certificate for such excess shares in the name of the Record Holder and BEARING A RESTRICTIVE LEGEND. Further, you should place a stop transfer on your records with regard to such certificate. Very truly yours, By: ------------------------------------- Print Name: ----------------------------- Title: ---------------------------------- Dated: -------------------