PROBEX CORP. ATTEST: -------------------------------- ----------------------------------- Charxxx X. Xxxxxxxx Brucx X. Xxxx Xxxef Executive Officer & President Chief Financial Officer & Secretary TRANSFER FORM For value received, the undersigned hereby sells, assigns, and transfers to Name ------------------------------------ Address --------------------------------- this Warrant and irrevocably appoints _____________________ attorney (with full power of substitution) to transfer this Warrant on the books of the Corporation. Date: ----------------------------------------- ------------------------------------------------ (Please sign exactly as name appears on Warrant) Taxpayer ID No. --------------------------------- In the presence of Signature guaranteed by ----------------------------- ------------------------------------------------ EXERCISE FORM The undersigned hereby: (1) irrevocably subscribes for ________________ shares of your Common Stock pursuant to this Warrant, and encloses payment of $____________________ therefor; (2) requests that a certificate for the shares be issued in the name of the undersigned and delivered to the undersigned at the address below; and (3) if such number of shares is not all of the shares purchasable hereunder, that a new Warrant of like tenor for the balance of the remaining shares purchasable hereunder be issued in the name of the undersigned and delivered to the undersigned at the address below. Date: ---------------------------- ------------------------------------------------ (Please sign exactly as name appears on Warrant) Address: ---------------------------------------- ---------------------------------------- Taxpayer ID No. ---------------------------------
Appears in 1 contract
Samples: Probex Corp
PROBEX CORP. ATTESTBy: -------------------------------- ----------------------------------- Charxxx X. Xxxxxxxx Brucx X. Xxxx Xxxef Executive Officer & President Chief Financial Officer & Secretary --------------------------------- Name: --------------------------------- Title: --------------------------------- TRANSFER FORM For value received, the undersigned hereby sells, assigns, and transfers to Name ------------------------------------ ----------------------------------------- Address --------------------------------- -------------------------------------- this Warrant and irrevocably appoints ______________________ attorney (with full power of substitution) to transfer this Warrant on the books of the Corporation. Date: ----------------------------------------- ---------------------------------------------- ------------------------------------------------ (Please sign exactly as name appears on Warrant) Taxpayer ID No. --------------------------------- -------------------------------- In the presence of Signature guaranteed by ----------------------------- ------------------------------------------------ ----------------------------------- ----------------------------------------- EXERCISE FORM The undersigned hereby: (1) irrevocably subscribes for ________________ shares of your Common Stock pursuant to this Warrant, and encloses payment of $____________________ therefor; (2) requests that a certificate for the shares be issued in the name of the undersigned and delivered to the undersigned at the address below; and (3) if such number of shares is not all of the shares purchasable hereunder, that a new Warrant of like tenor for the balance of the remaining shares purchasable hereunder be issued in the name of the undersigned and delivered to the undersigned at the address below. Date: ---------------------------- ------------------------------------------------ (Please sign exactly as name appears on Warrant) Address: ---------------------------------------- ---------------------------------------- Taxpayer ID No. -------------------------------------------------------------------------
Appears in 1 contract
Samples: Probex Corp
PROBEX CORP. ATTEST: -------------------------------- ----------------------------------- Charxxx X. Xxxxxxxx Brucx X. Xxxx Xxxef Executive Officer & President Chief Financial Officer & Secretary TRANSFER FORM For value received, the undersigned hereby sells, assigns, and transfers to Name ------------------------------------ ---------------------------------- Address --------------------------------- ------------------------------- this Warrant and irrevocably appoints _____________________ attorney (with full power of substitution) to transfer this Warrant on the books of the Corporation. Date: ----------------------------------------- --------------------------- ------------------------------------------------ (Please sign exactly as name appears on Warrant) Taxpayer ID No. --------------------------------- In the presence of Signature guaranteed by ----------------------------- --------------------------- ------------------------------------------------ EXERCISE FORM The undersigned hereby: (1) irrevocably subscribes for ________________ shares of your Common Stock pursuant to this Warrant, and encloses payment of $____________________ therefor; (2) requests that a certificate for the shares be issued in the name of the undersigned and delivered to the undersigned at the address below; and (3) if such number of shares is not all of the shares purchasable hereunder, that a new Warrant of like tenor for the balance of the remaining shares purchasable hereunder be issued in the name of the undersigned and delivered to the undersigned at the address below. Date: ---------------------------- ------------------------------------------------ (Please sign exactly as name appears on Warrant) Address: ---------------------------------------- ---------------------------------------- Taxpayer ID No. ---------------------------------
Appears in 1 contract
Samples: Probex Corp
PROBEX CORP. ATTESTBy: -------------------------------- ----------------------------------- Name: Charxxx X. Xxxxxxxx Brucx X. Xxxx Xxxef Title: President & Chief Executive Officer & President Chief Financial Officer & Secretary TRANSFER FORM For value received, the undersigned hereby sells, assigns, and transfers to Name ------------------------------------ ----------------------------------------- Address --------------------------------- -------------------------------------- this Warrant and irrevocably appoints _____________________ attorney (with full power of substitution) to transfer this Warrant on the books of the Corporation. Date: ----------------------------------------- ---------------------------------------------- ------------------------------------------------ (Please sign exactly as name appears on Warrant) Taxpayer ID No. --------------------------------- -------------------------------- In the presence of Signature guaranteed by ----------------------------- ------------------------------------------------ ----------------------------------- ----------------------------------------- EXERCISE FORM The undersigned hereby: (1) irrevocably subscribes for ________________ shares of your Common Stock pursuant to this Warrant, and encloses payment of $____________________ therefor; (2) requests that a certificate for the shares be issued in the name of the undersigned and delivered to the undersigned at the address below; and (3) if such number of shares is not all of the shares purchasable hereunder, that a new Warrant of like tenor for the balance of the remaining shares purchasable hereunder be issued in the name of the undersigned and delivered to the undersigned at the address below. Date: ---------------------------- ------------------------------------------------ (Please sign exactly as name appears on Warrant) Address: ---------------------------------------- ---------------------------------------- Taxpayer ID No. -----------------------------------------------------------------
Appears in 1 contract
Samples: Probex Corp
PROBEX CORP. ATTESTBy: -------------------------------- ----------------------------------- Charxxx X. Xxxxxxxx Brucx Name: Xxxxx X. Xxxx Xxxef Executive Officer & Title: Senior Vice President Chief Financial Officer & Secretary Class "AS" Warrant No. __ Page 6 TRANSFER FORM For value received, the undersigned hereby sells, assigns, and transfers to Name ------------------------------------ --------------------------------------- Address --------------------------------- ------------------------------------- this Warrant and irrevocably appoints _________________________ attorney (with full power of substitution) to transfer this Warrant on the books of the Corporation. Date: ----------------------------------------- -------------------------------------------- ------------------------------------------------ (Please sign exactly as name appears on Warrant) Taxpayer ID No. --------------------------------- -------------------------------- In the presence of Signature guaranteed by ----------------------------- ------------------------------------------------ Class "AS" Warrant No. __ Page 7 EXERCISE FORM The undersigned hereby: (1) irrevocably subscribes for ________________ shares of your Common Stock pursuant to this Warrant, and encloses payment of $____________________ therefor; (2) requests that a certificate for the shares be issued in the name of the undersigned and delivered to the undersigned at the address below; and (3) if such number of shares is not all of the shares purchasable hereunder, that a new Warrant of like tenor for the balance of the remaining shares purchasable hereunder be issued in the name of the undersigned and delivered to the undersigned at the address below. Date: ---------------------------- ------------------------------------------------ (Please sign exactly as name appears on Warrant) Address: ---------------------------------------- ---------------------------------------- Taxpayer ID No. ---------------------------------
Appears in 1 contract
Samples: Probex Corp
PROBEX CORP. ATTEST: -------------------------------- ----------------------------------- Charxxx ----------------------------------- Thomxx X. Xxxxxxxx Brucx X. Xxxx Xxxef Executive Officer & President Chief Financial Officer & Secretary TRANSFER FORM For value received, the undersigned hereby sells, assigns, and transfers to Name ------------------------------------ --------------------------------------------- Address --------------------------------- ------------------------------------------ this Warrant and irrevocably irrevocable appoints _____________________ attorney (with full power of substitution) to transfer this Warrant on the books of the Corporation. Date: ----------------------------------------- ------------------------------------------------ ------------------------------------------------- ------------------------------------------------- (Please sign exactly as name appears on Warrant) Taxpayer ID No. --------------------------------- ---------------------------------- In the presence of Signature guaranteed by ----------------------------- ------------------------------------------------ --------------------------- ------------------------------------------------- EXERCISE FORM The undersigned hereby: (1) irrevocably subscribes for ________________ shares of your Common Stock pursuant to this Warrant, and encloses payment of $____________________ therefor; (2) requests that a certificate for the shares be issued in the name of the undersigned and delivered to the undersigned at the address below; and (3) if such number of shares is not all of the shares purchasable hereunder, that a new Warrant of like tenor for the balance of the remaining shares purchasable hereunder be issued in the name of the undersigned and delivered to the undersigned at the address below. Date: ---------------------------- ------------------------------------------------ -------------------------------------------------- (Please sign exactly as name appears on Warrant) Address: ---------------------------------------- ---------------------------------------- ------------------------------------------ ------------------------------------------ Taxpayer ID No. --------------------------------------------------------------------
Appears in 1 contract
Samples: Probex Corp
PROBEX CORP. ATTEST: -------------------------------- ----------------------------------- Charxxx Thomxx X. Xxxxxxxx Brucx X. Xxxx Xxxef Executive Officer & President Chief Financial Officer & Secretary TRANSFER FORM For value received, the undersigned hereby sells, assigns, and transfers to Name ------------------------------------ ---------------------------------- Address --------------------------------- ------------------------------- this Warrant and irrevocably irrevocable appoints ______________________ attorney (with full power of substitution) to transfer this Warrant on the books of the Corporation. Date: ----------------------------------------- ------------------------------------------------ (Please sign exactly as name appears on Warrant) Taxpayer ID No. --------------------------------- In the presence of Signature guaranteed by ----------------------------- ------------------------------------------------ EXERCISE FORM The undersigned hereby: (1) irrevocably subscribes for ________________ shares of your Common Stock pursuant to this Warrant, and encloses payment of $____________________ therefor; (2) requests that a certificate for the shares be issued in the name of the undersigned and delivered to the undersigned at the address below; and (3) if such number of shares is not all of the shares purchasable hereunder, that a new Warrant of like tenor for the balance of the remaining shares purchasable hereunder be issued in the name of the undersigned and delivered to the undersigned at the address below. Date: ---------------------------- ------------------------------------------------ (Please sign exactly as name appears on Warrant) Address: ---------------------------------------- ---------------------------------------- Taxpayer ID No. ---------------------------------
Appears in 1 contract
Samples: Probex Corp
PROBEX CORP. ATTESTBy: -------------------------------- ----------------------------------- Charxxx X. Xxxxxxxx Brucx X. Xxxx Xxxef Executive Officer & President Chief Financial Officer & Secretary Name: ------------------------------- Title: ------------------------------ TRANSFER FORM For value received, the undersigned hereby sells, assigns, and transfers to Name ------------------------------------ Address --------------------------------- -------------------------------- this Warrant and irrevocably irrevocable appoints _____________________ attorney (with full power of substitution) to transfer this Warrant on the books of the Corporation. Date: ----------------------------------------- ------------------------------------------------ ------------------------------------- (Please sign exactly as name appears on Warrant) Taxpayer ID No. --------------------------------- ------------------- In the presence of Signature guaranteed by ----------------------------- ------------------------------------------------ EXERCISE FORM ----------------------------------------- ------------------------------------ The undersigned hereby: (1) irrevocably subscribes for ________________ shares of your Common Stock pursuant to this Warrant, and encloses payment of $____________________ therefor; (2) requests that a certificate for the shares be issued in the name of the undersigned and delivered to the undersigned at the address below; and (3) if such number of shares is not all of the shares purchasable hereunder, that a new Warrant of like tenor for the balance of the remaining shares purchasable hereunder be issued in the name of the undersigned and delivered to the undersigned at the address below. Date: ---------------------------- ------------------------------------------------ ------------------------------------- (Please sign exactly as name appears on Warrant) Address: ---------------------------------------- ---------------------------------------- --------------------------- --------------------------- Taxpayer ID No. ----------------------------------------------------
Appears in 1 contract
Samples: Probex Corp
PROBEX CORP. ATTESTBy: -------------------------------- ----------------------------------- Charxxx X. Xxxxxxxx Brucx X. Name: Bruce A. Hall Title: Seniox Xxxx Xxxef Executive Officer & President Chief Financial Officer & Secretary Xxxxxxent Class "AS" Warrant No. __ Page 6 TRANSFER FORM For value received, the undersigned hereby sells, assigns, and transfers to Name ------------------------------------ ----------------------------------- Address --------------------------------- -------------------------------- this Warrant and irrevocably appoints ______________________ attorney (with full power of substitution) to transfer this Warrant on the books of the Corporation. Date: ----------------------------------------- --------------------------------------- ------------------------------------------------ (Please sign exactly as name appears on Warrant) Taxpayer ID No. --------------------------------- -------------------------------- In the presence of Signature guaranteed by ----------------------------- ------------------------------------------------ Class "AS" Warrant No. __ Page 7 EXERCISE FORM The undersigned hereby: (1) irrevocably subscribes for ________________ shares of your Common Stock pursuant to this Warrant, and encloses payment of $____________________ therefor; (2) requests that a certificate for the shares be issued in the name of the undersigned and delivered to the undersigned at the address below; and (3) if such number of shares is not all of the shares purchasable hereunder, that a new Warrant of like tenor for the balance of the remaining shares purchasable hereunder be issued in the name of the undersigned and delivered to the undersigned at the address below. Date: ---------------------------- ------------------------------------------------ (Please sign exactly as name appears on Warrant) Address: ---------------------------------------- ---------------------------------------- Taxpayer ID No. -------------------------------------------------------------------------
Appears in 1 contract
Samples: Probex Corp
PROBEX CORP. ATTEST: -------------------------------- ----------------------------------- Charxxx By: -------------------------- ------------------------------------- Alex X. Xxxxxxxx Brucx Xxxxxx Thomxx X. Xxxx Xxxef Xxxxxx President Chief Executive Officer & President Chief Financial Officer & Secretary 5 CLASS "S" WARRANT NO. PAGE 5 TRANSFER FORM For value received, the undersigned hereby sells, assigns, and transfers to Name ------------------------------------ Address --------------------------------- this Warrant and irrevocably appoints Name__________________________________ attorney Address_________________________________ this Warrant and irrevocable appoints________________attorney (with full power of substitution) to transfer this Warrant on the books of the Corporation. Date: ----------------------------------------- ----------------------------- ------------------------------------------------ (Please sign exactly as name appears on Warrant) Taxpayer ID No. --------------------------------- ________________________________ In the presence of Signature guaranteed by ----------------------------- ------------------------------------------------ 6 CLASS "R-a" WARRANT NO. PAGE 6 EXERCISE FORM The undersigned hereby: (1) irrevocably subscribes for ________________ shares of your Common Stock pursuant to this Warrant, and encloses payment of $____________________ therefor; (2) requests that a certificate for the shares be issued in the name of the undersigned and delivered to the undersigned at the address below; and (3) if such number of shares is not all of the shares purchasable hereunder, that a new Warrant of like tenor for the balance of the remaining shares purchasable hereunder be issued in the name of the undersigned and delivered to the undersigned at the address below. Date: ---------------------------- ------------------------------------------------ ____________________________ ________________________________________________ (Please sign exactly as name appears on Warrant) Address: ---------------------------------------- ---------------------------------------- Taxpayer ID No. ---------------------------------:________________________________________
Appears in 1 contract
Samples: Probex Corp
PROBEX CORP. ATTEST: -------------------------------- ----------------------------------- Charxxx ----------------------------------- Thomxx X. Xxxxxxxx Brucx X. Xxxx Xxxef Executive Officer & President Chief Financial Officer & Secretary TRANSFER FORM For value received, the undersigned hereby sells, assigns, and transfers to Name ------------------------------------ ----------------------------------- Address --------------------------------- -------------------------------- this Warrant and irrevocably irrevocable appoints _____________________ attorney (with full power of substitution) to transfer this Warrant on the books of the Corporation. Date: ----------------------------------------- ------------------------------------------------ (Please sign exactly as name appears on Warrant) Taxpayer ID No. --------------------------------- In the presence of Signature guaranteed by ----------------------------- ------------------------------------------------ EXERCISE FORM The undersigned hereby: (1) irrevocably subscribes for ________________ shares of your Common Stock pursuant to this Warrant, and encloses payment of $____________________ therefor; (2) requests that a certificate for the shares be issued in the name of the undersigned and delivered to the undersigned at the address below; and (3) if such number of shares is not all of the shares purchasable hereunder, that a new Warrant of like tenor for the balance of the remaining shares purchasable hereunder be issued in the name of the undersigned and delivered to the undersigned at the address below. Date: ---------------------------- ------------------------------------------------ ----------------------------------------------- (Please sign exactly as name appears on Warrant) Address: ---------------------------------------- ---------------------------------------- Taxpayer ID No. ------------------------------------------------------------------------ ---------------------------------------
Appears in 1 contract
Samples: Probex Corp
PROBEX CORP. ATTEST: -------------------------------- ----------------------------------- -------------------------------- Charxxx X. Xxxxxxxx Brucx X. Xxxx Xxxef Executive Officer & President Chief Financial Officer & Secretary TRANSFER FORM For value received, the undersigned hereby sells, assigns, and transfers to Name ------------------------------------ ---------------------------------- Address --------------------------------- ------------------------------- this Warrant and irrevocably irrevocable appoints _____________________ attorney (with full power of substitution) to transfer this Warrant on the books of the Corporation. Date: ----------------------------------------- -------------------------------------- ------------------------------------------------ (Please sign exactly as name appears on Warrant) Taxpayer ID No. --------------------------------- In the presence of Signature guaranteed by ----------------------------- ------------------------------------------------ EXERCISE FORM The undersigned hereby: (1) irrevocably subscribes for ________________ shares of your Common Stock pursuant to this Warrant, and encloses payment of $____________________ therefor; (2) requests that a certificate for the shares be issued in the name of the undersigned and delivered to the undersigned at the address below; and (3) if such number of shares is not all of the shares purchasable hereunder, that a new Warrant of like tenor for the balance of the remaining shares purchasable hereunder be issued in the name of the undersigned and delivered to the undersigned at the address below. Date: ---------------------------- -------------------------------------- ------------------------------------------------ (Please sign exactly as name appears on Warrant) Address: ---------------------------------------- ---------------------------------------- Taxpayer ID No. -------------------------------------------------------------------------
Appears in 1 contract
Samples: Probex Corp
PROBEX CORP. ATTEST: -------------------------------- ----------------------------------- ------------------------------------ ------------------------------------ Charxxx X. Xxxxxxxx Brucx X. Xxxx Xxxef Executive Officer & President Sen. VP, Chief Financial Officer & Secretary TRANSFER FORM For value received, the undersigned hereby sells, assigns, and transfers to Name --------------------------------------- Address ------------------------------------ Address --------------------------------- this Warrant and irrevocably irrevocable appoints ______________________ attorney (with full power of substitution) to transfer this Warrant on the books of the Corporation. Date: ------------------------------------------- ----------------------------------------- ------------------------------------------------ (Please sign exactly as name appears on Warrant) Taxpayer ID No. --------------------------------- -------------------------- In the presence of Signature guaranteed by ----------------------------- ------------------------------------------------ EXERCISE FORM ---------------------------------- ----------------------------------------- The undersigned hereby: (1) irrevocably subscribes for ________________ shares of your Common Stock pursuant to this Warrant, and encloses payment of $____________________ therefor; (2) requests that a certificate for the shares be issued in the name of the undersigned and delivered to the undersigned at the address below; and (3) if such number of shares is not all of the shares purchasable hereunder, that a new Warrant of like tenor for the balance of the remaining shares purchasable hereunder be issued in the name of the undersigned and delivered to the undersigned at the address below. Date: ---------------------------- --------------------------------- ------------------------------------------------ (Please sign exactly as name appears on Warrant) Address: ---------------------------------------- ---------------------------------------- Taxpayer ID No. ---------------------------------
Appears in 1 contract
Samples: Probex Corp