Sign Name. Date: The party submitting the above information consents to being provided future electronic mailings from Atlantic Business Brokerage, Inc. ATLANTIC BUSINESS BROKERAGE, INC. - 00 XXXX XXXXXXXX XXXX, XXXXX 000, XXXXXXXX, XX 00000
Sign Name. Date ..................................................................... Date .................................................................... Xxxx Xxxx
Sign Name. Print Name: ------------------------------ Address: ------------------------------ ------------------------------ ------------------------------ Telephone: ------------------------------ Facsimile: ------------------------------ Number of Securities Purchased ------------ Aggregate Purchase Price ------------------
Sign Name. Xxxxxxx X. Xxxxx --------------------------------- Print Name: Xxxxxxx X. Xxxxx -------------------------------- Address: ----------------------------------- -------------------------------------------- -------------------------------------------- Telephone: --------------------------------- Facsimile: --------------------------------- Number of Shares: 76,923 -------------------------- Name in which Shares and Warrants Are to Be Held (please print): OTATO L.P. -------------------------------------------- Manner in which Shares and Warrants Are to Be Held (check the correct line): ___ Individual ___ Tenants in Common ___ JTWROS ___ Corporation ___ Partnership ___ Trust Aggregate Purchase Price: 250,000 ----------------- OMNIBUS SIGNATURE PAGE TO AKSYS, LTD. SECURITIES PURCHASE AGREEMENT The undersigned hereby executes and delivers the Securities Purchase Agreement to which this Signature Page is attached, which, together with all counterparts of the Agreement and Signature Pages of the other Investors and the Company to said Agreement, shall constitute one and the same document in accordance with the terms of the Agreement.
