RECEIPT AND CONSENT. The undersigned hereby acknowledges receipt of __________ shares of Common Stock of [Company Name], a Delaware corporation (the “Company”).
RECEIPT AND CONSENT. The undersigned hereby acknowledges receipt of 2,350,000 shares of Common Stock of Legion Works Inc, a Delaware corporation (the “Company”).
RECEIPT AND CONSENT. The undersigned hereby acknowledges receipt of a photocopy of Certificate No. ______ for ________ shares of Common Stock of Rxxxxx Pharmaceuticals, Inc. (the “Company”). The undersigned further acknowledges that the Secretary of the Company, or his or her designee, is acting as escrow holder pursuant to the Exercise Notice and Restricted Stock Purchase Agreement Participant has previously entered into with the Company. As escrow holder, the Secretary of the Company, or his or her designee, holds the original of the aforementioned certificate issued in the undersigned’s name. Dated: _______________ Mxxxxxx X. Step PARTICIPANT MXXXXXX X. STEP COMPANY RXXXXX PHARMACEUTICALS, INC. SECURITY COMMON STOCK AMOUNT _______ SHARES In connection with the purchase of the above-listed Securities, the undersigned Participant represents to the Company the following:
RECEIPT AND CONSENT. The undersigned hereby acknowledges receipt of a [notice of issuance recorded as] OR [photocopy of] Certificate No. for shares of Common Stock of [Company Name], a Delaware corporation (the “Company”).
RECEIPT AND CONSENT. The undersigned hereby acknowledges receipt of a certificate for 250,000 shares of Common Stock of Rentberry, Inc., a Delaware corporation (the “Company”).
RECEIPT AND CONSENT. The undersigned hereby acknowledges receipt of a photocopy of Certificate No. for Ordinary Shares of Jupai Investment Group (the “Company”).
RECEIPT AND CONSENT. The undersigned hereby acknowledges receipt of Certificate No. for shares of Common Stock of Neothetics, Inc. The undersigned further acknowledges that the Secretary of the Company, or his or her designee, is acting as escrow holder pursuant to the Early Exercise Notice and Restricted Stock Purchase Agreement Purchaser has previously entered into with the Company. As escrow holder, the Secretary of the Company, or his or her designee, holds the original of the aforementioned certificate issued in the undersigned’s name. Dated: [ ] Neothetics, Inc. (the “Company”) hereby acknowledges receipt of (check as applicable): A check in the amount of $ The cancellation of indebtedness in the amount of $ A promissory note in the amount of $ Certificate No. representing shares of the Company’s Common Stock with a fair market value of $ given by as consideration for Certificate No. for shares of Common Stock of the Company. Dated: By: Name: Title: This Agreement (“Agreement”) is made as of , by and between Neothetics, Inc., a Delaware corporation (the “Company”), and (“Purchaser”). To the extent any capitalized terms used in this Agreement are not defined, they shall have the meaning ascribed to them in the Company’s 2007 Stock Plan (the “Plan”).
RECEIPT AND CONSENT. The undersigned hereby acknowledges receipt of a photocopy of Certificate No. for shares of Common Stock of Embarcadero Technologies, Inc. (the “Company”).
RECEIPT AND CONSENT. The undersigned hereby acknowledges issuance of ___________shares of Common Stock of Sezzle Inc., a Delaware corporation (the “Company”).
RECEIPT AND CONSENT. The undersigned Participant hereby acknowledges receipt of a photocopy of Certificate No.- _____ for ____________ shares of Common Stock of Immersion Corporation (the “Company”). The undersigned further acknowledges that the Secretary of the Company, or his or her designee, is acting as escrow holder pursuant to the Restricted Stock Agreement that Participant has previously entered into with the Company. As escrow holder, the Secretary of the Company, or his or her designee, holds the original of the aforementioned certificate issued in the undersigned’s name. To facilitate any transfer of Shares to the Company pursuant to the Restricted Stock Agreement, Participant has executed the attached Assignment Separate from Certificate. Dated: _______________, 20___ US-DOCS\109527166.2 US-DOCS\109527166.2
