Common use of To Rights Agent Clause in Contracts

To Rights Agent. The undersigned hereby irrevocably elects to exercise __________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of and delivered to: Please insert social security or other identifying number _________________________ ------------------------------------------------------------------ (Please print name and address) ------------------------------------------------------------------ If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ------------------------------------------------------------------ (Please print name and address) Dated: __________, ____ ------------------------------ Signature Signature Guaranteed: Signatures must be guaranteed by a participant in a Securities Transfer Association recognized signature guarantee program.

To Rights Agent. The undersigned hereby irrevocably elects to exercise __________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of and delivered to: Please insert social security or other identifying number _________________________ ------------------------------------------------------------------ (Please print name and address) ------------------------------------------------------------------ If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number __________________ ------------------------------------------------------------------ (Please print name and address) Dated: __________, ____ ------------------------------ Signature Signature Guaranteed: Signatures must be guaranteed by a participant in a Securities Transfer Association recognized signature guarantee program.