Nonstatutory Stock Option Grant Agreement Under The TeleCommunication Systems, Inc.
EXHIBIT 99.4
Under The
TeleCommunication Systems, Inc.
Amended and Restated Stock Incentive Plan
The Stock Option Certificate that is attached hereto constitutes a part of this Nonstatutory
Stock Option Grant Agreement.
1. Terminology. All capitalized words that are not defined in this Agreement have the
meanings ascribed to them in the Plan or the Stock Option Certificate. For purposes of this
Agreement, the terms below have the following meanings:
(a) “Cause” has the meaning ascribed to such term or words of similar import in the Optionee’s
written employment or service contract with the Company and, in the absence of such agreement or
definition, means: (i) the willful commission by the Optionee of a criminal or other act that
causes or is likely to cause substantial economic damage to the Company or substantial injury to
the business reputation of the Company; (ii) the commission by the Optionee of an act of fraud in
the performance of such Optionee’s duties on behalf of the Company; or (iii) the continuing willful
failure of the Optionee to perform the duties of such Optionee to the Company (other than such
failure resulting from the Optionee’s incapacity due to physical or mental illness), all as
determined by the Administrator, which determination will be conclusive. For purposes of this
Agreement, no act, or failure to act, on the Optionee’s part shall be considered “willful” unless
done or omitted to be done by the Optionee not in good faith with the reasonable belief that the
Optionee’s action or omission was in the best interest of the Company.
(b) “Change in Control” means: (i) an acquisition (other than from the Company) in a
transaction, or a series of related transactions, by any person, entity or “group,” within the
meaning of Section 13(d)(3) or 14(d)(2) of the Securities Exchange Act of 1934 (the “Exchange
Act”), (excluding for this purpose, (A) the Company or its subsidiaries, (B) any employee benefit
plan of the Company or its subsidiaries which acquires beneficial ownership of voting securities of
the Company, (C) an underwriter temporarily holding securities pursuant to an offering of such
securities, or (D) any corporation owned, directly or indirectly, by the stockholders of the
Company in substantially the same proportions as their ownership of the then outstanding voting
securities of the Company entitled to vote generally in the election of directors) of beneficial
ownership, within the meaning of Rule 13d-3 promulgated under the Exchange Act, of 50% or more of
either the then outstanding shares of common stock or the combined voting power of the Company’s
then outstanding voting securities entitled to vote generally in the election of directors (the
“Company Voting Stock”); (ii) the effective time of any merger, share exchange, consolidation or
other reorganization or business combination of the Company if immediately after such transaction
persons who hold a majority of the outstanding voting securities entitled to vote generally in the
election of directors of the surviving entity (or the entity owning 100% of such surviving entity)
are not persons who held the Company Voting Stock immediately prior to such transaction; (iii) the
closing of a sale or conveyance of all or substantially all of the assets of the Company;
(iv) individuals who were the Board’s nominees for election as directors immediately prior to a
meeting of the stockholders of the
Company involving an actual or threatened election contest relating to the election of the
directors of the Company, as such terms are used in Rule 14a-11 of Regulation 14A promulgated under
the Exchange Act, cease to constitute a majority of the Board following the election; or (v) the
dissolution or liquidation of the Company; provided, however, that the term “Change
in Control” does not include a public offering of capital stock of the Company that is effected
pursuant to a registration statement filed with, and declared effective by, the Securities and
Exchange Commission under the Securities Act of 1933.
(c) “Company” means TeleCommunication Systems, Inc. and its Affiliates, except where the
context otherwise requires. For purposes of determining whether a Change in Control has occurred,
Company shall mean only TeleCommunication Systems, Inc.
(d) “Option Shares” mean the shares of Common Stock underlying the Options.
(e) “Total and Permanent Disability” means the inability to engage in any substantial gainful
activity by reason of any medically determinable physical or mental impairment which can be
expected to result in death or which has lasted or can be expected to last for a continuous period
of not less than twelve months. The Administrator may require such proof of Total and Permanent
Disability as the Administrator in its sole discretion deems appropriate and the Administrator’s
good faith determination as to whether the Optionee is totally and permanently disabled will be
final and binding on all parties concerned.
2. Vesting. The Options vest in accordance with the vesting schedule identified in
the Stock Option Certificate which is attached hereto and constitutes a part of the Agreement (the
“Vesting Schedule”), so long as the Optionee is in the continuous employ of, or in a service
relationship with, the Company from the Grant Date through the applicable date upon which vesting
is scheduled to occur. No vesting will accrue to any Options after the Optionee ceases to be in
either an employment or other service relationship with the Company.
3. Exercise of Options.
(a) Right to Exercise. The Optionee may exercise the Options to the extent vested at
any time on or before the Expiration Date or the earlier termination of the Options, unless
otherwise provided in this Agreement. Section 4 below describes certain limitations on exercise of
the Options that apply in the event of the Optionee’s death, Total and Permanent Disability,
discharge by the Company without Cause or other termination of employment or other service
relationship with the Company. The Options may be exercised only in multiples of whole shares and
may not be exercised at any one time as to fewer than one hundred shares (or such lesser number of
shares as to which the Options are then exercisable). No fractional shares will be issued under
the Options.
(b) Exercise Procedure. In order to exercise the Options, the following items must be
delivered to the Administrator before the expiration or termination of the Options: (i) an exercise
notice, in such form as the Administrator may require from time to time, specifying the number of
Option Shares to be purchased, and (ii) full payment of the Exercise Price for such Option Shares
or properly executed, irrevocable instructions, in such form as the Administrator may require from
time to time, to effectuate a broker-assisted cashless exercise, each in accordance with
Section 3(c) of this Agreement. An exercise will not be effective until the Administrator receives
all of the foregoing items.
(c) Method of Payment. Payment of the Exercise Price may be made by delivery of cash,
certified or cashier’s check, money order or other cash equivalent acceptable to the Administrator
in
its discretion, a broker-assisted cashless exercise in accordance with Regulation T of the
Board of Governors of the Federal Reserve System through a brokerage firm approved by the
Administrator, or a combination of the foregoing. In addition, payment of the Exercise Price may
be made by any of the following methods, or a combination thereof, as determined by the
Administrator in its discretion at the time of exercise:
(iv) by tender (via actual delivery or attestation) to the Company of other shares of
Common Stock of the Company which have a Fair Market Value on the date of tender equal to
the Exercise Price;
(v) by delivery of the Optionee’s full recourse promissory note payable to the Company
in a form approved by the Administrator; or
(vi) by any other method approved by the Administrator.
(d) Issuance of Shares upon Exercise. Upon exercise of the Options in accordance with
the terms of this Agreement, the Company will issue to the Optionee, the brokerage firm specified
in the Optionee’s delivery instructions pursuant to a broker-assisted cashless exercise, or such
other person exercising the Options, as the case may be, the number of shares of Common Stock so
paid for, in the form of fully paid and nonassessable stock. The Company, in its discretion, will
either retain the Option Shares in uncertificated book entry form or deliver stock certificates for
the Option Shares as soon as practicable after exercise, which certificates will, unless such
Option Shares are registered or an exemption from registration is available under applicable
federal and state law, bear a legend restricting transferability of such shares. Notwithstanding
the issuance of the Option Shares or the delivery of one or more stock certificates for such Option
Shares, the Option Shares shall be subject to applicable restrictions on transfer or liquidation,
if any, as set forth in the Optionee’s written employment or service contract with the Company or
pursuant to any policy adopted by the Company, now or hereafter existing, that imposes stock
ownership requirements, stock holding requirements or stock liquidation restrictions on the
Optionee. The Company may place legends reflecting the requirements and restrictions described in
the immediately foregoing sentence on any stock certificates for the Option Shares.
4. Termination of Employment or Service.
(a) Exercise Period Following Cessation of Employment or Other Service Relationship, In
General. If the Optionee ceases to be employed by, or in a service relationship with, the
Company for any reason other than death, Total and Permanent Disability, or discharge by the
Company without Cause, the Options terminate in their entirety, regardless of whether the Options
are vested, immediately upon the Optionee’s termination of employment or other service
relationship.
(b) Termination by the Company Without Cause. In the event the Optionee’s employment
or other service relationship is terminated by the Company without Cause, (i) the unvested Options,
after giving effect to the provisions of Section 2 of this Agreement, terminate immediately upon
such cessation, and (ii) the vested Options remain exercisable during the 90-day period following
such cessation, but in no event after the Expiration Date. Unless sooner terminated, the vested
Options terminate upon the expiration of such 90-day period.
(c) Disability of Optionee. Notwithstanding the provisions of Section 4(a) above, if
the Optionee ceases to be employed by, or in a service relationship with, the Company as a result
of the Optionee’s Total and Permanent Disability, (i) the unvested Options, after giving effect to
the provisions of Section 2 of this Agreement, terminate immediately upon such cessation, and
(ii) the vested Options remain exercisable during the six-month period following such cessation,
but in no event after the
Expiration Date. Unless sooner terminated, the vested Options terminate upon the expiration
of such six-month period.
(d) Death of Optionee. If the Optionee dies prior to the expiration or other
termination of the Options, (i) the unvested Options, after giving effect to the provisions of
Section 2 of this Agreement, terminate immediately upon the Optionee’s death, and (ii) the vested
Options remain exercisable during the six-month period following the Optionee’s death, but in no
event after the Expiration Date, by the Optionee’s executor, personal representative, or the
person(s) to whom the Options are transferred by will or the laws of descent and distribution.
Unless sooner terminated, the vested Options terminate upon the expiration of such six-month
period.
(e) Misconduct. Notwithstanding anything to the contrary in this Agreement, the
Options terminate in their entirety, regardless of whether the Options are vested, immediately upon
the Optionee’s discharge of employment or other service relationship for Cause or upon the
Optionee’s commission of any of the following acts during any period following the cessation of
employment or other service relationship during which the Options otherwise would be exercisable:
(i) fraud on or misappropriation of any funds or property of the Company, or (ii) breach by the
Optionee of any provision of any employment, non-disclosure, non-competition, non-solicitation,
assignment of inventions, or other similar agreement executed by the Optionee for the benefit of
the Company, as determined by the Administrator, which determination will be conclusive.
5. Nontransferability of Options. These Options are nontransferable otherwise than by
will or the laws of descent and distribution and during the lifetime of the Optionee, the Options
may be exercised only by the Optionee or, during the period the Optionee is under a legal
disability, by the Optionee’s guardian or legal representative. Except as provided above, the
Options may not be assigned, transferred, pledged, hypothecated or disposed of in any way (whether
by operation of law or otherwise) and shall not be subject to execution, attachment or similar
process.
6. Nonstatutory Nature of the Options. The Options are not intended to
qualify as incentive stock options within the meaning of Code section 422, and this Agreement shall
be so construed. The Optionee acknowledges that, upon exercise of the Options, the Optionee will
recognize taxable income in an amount equal to the excess of the then Fair Market Value of the
Option Shares over the Exercise Price and must comply with the provisions of Section 7 of this
Agreement with respect to any tax withholding obligations that arise as a result of such exercise.
7. Withholding of Taxes. At the time the Options are exercised, in whole or in part,
or at any time thereafter as requested by the Company, the Optionee hereby authorizes withholding
from payroll or any other payment of any kind due the Optionee and otherwise agrees to make
adequate provision for foreign, federal, state and local taxes required by law to be withheld, if
any, which arise in connection with the Options. The Company may require the Optionee to make a
cash payment to cover any withholding tax obligation as a condition of exercise of the Options or
issuance of share certificates representing Option Shares.
The Administrator may, in its sole discretion, permit the Optionee to satisfy, in whole or in
part, any withholding tax obligation which may arise in connection with the Options either by
electing to have the Company withhold from the shares to be issued upon exercise that number of
shares, or by electing to deliver to the Company already-owned shares, in either case having a Fair
Market Value not in excess of the amount necessary to satisfy the statutory minimum withholding
amount due.
8. Adjustments for Corporate Transactions and Other Events.
(a) Stock Dividend, Stock Split and Reverse Stock Split. Upon a stock dividend of, or
stock split or reverse stock split affecting, the Common Stock, the number of shares covered by and
the exercise price and other terms of the Options, shall, without further action of the Board, be
adjusted to reflect such event unless the Board determines, at the time it approves such stock
dividend, stock split or reverse stock split, that no such adjustment shall be made. The
Administrator may make adjustments, in its discretion, to address the treatment of fractional
shares and fractional cents that arise with respect to the Options as a result of the stock
dividend, stock split or reverse stock split.
(b) Non-Change in Control Transactions. Except with respect to the transactions set
forth in Section 8(a), in the event of any change affecting the Common Stock, the Company or its
capitalization, by reason of a spin-off, split-up, dividend, recapitalization, merger,
consolidation or share exchange, other than any such change that is part of a transaction resulting
in a Change in Control, the Administrator, in its discretion and without the consent of the
Optionee, shall make any adjustments in the Options, including but not limited to reducing the
number, kind and price of securities subject to the Options.
(c) Change in Control Transactions. In the event of any transaction resulting in a
Change in Control, the Options will terminate upon the effective time of any such Change in Control
unless provision is made in connection with the transaction in the sole discretion of the parties
thereto for the continuation or assumption of the Options, or the substitution of the Options with
new options of the surviving or successor entity or a parent thereof. In the event of such
termination, the Employee will be permitted, for a period of at least 10 days prior to the
effective time of the Change in Control, to exercise all of the Options that are then exercisable
or will become exercisable upon or prior to the effective time of the Change in Control; provided,
however, that any such exercise of any Options that become exercisable as a result of the Change in
Control shall be deemed to occur immediately prior to the effective time of such Change in Control.
(d) Adjustments for Unusual Events. The Administrator is authorized to make, in its
discretion and without the consent of the Optionee, adjustments in the terms and conditions of, and
the criteria included in, the Options in recognition of unusual or nonrecurring events affecting
the Company, or the financial statements of the Company or any Affiliate, or of changes in
applicable laws, regulations, or accounting principles, whenever the Administrator determines that
such adjustments are appropriate in order to prevent dilution or enlargement of the benefits or
potential benefits intended to be made available under the Options or the Plan.
(e) Binding Nature of Adjustments. Adjustments under this Section 8 will be made by
the Administrator, whose determination as to what adjustments, if any, will be made and the extent
thereof will be final, binding and conclusive. No fractional shares will be issued pursuant to the
Options on account of any such adjustments. The terms and conditions of this Agreement shall apply
with equal force to any additional and/or substitute securities received by the Optionee pursuant
to this Section 8 in exchange for, or by virtue of the Optionee’s ownership of, the Options or the
Option Shares, except as otherwise determined by the Administrator.
9. Confidential Information. In consideration of the Options granted to the Optionee
pursuant to this Agreement, the Optionee agrees and covenants that, except as specifically
authorized by the Company, the Optionee will keep confidential any trade secrets or confidential or
proprietary information of the Company which are now or which hereafter may become known to the
Optionee as a
result of the Optionee’s employment by or other service relationship with the Company, and
shall not at any time, directly or indirectly, disclose any such information to any person, firm,
Company or other entity, or use the same in any way other than in connection with the business of
the Company, at all times during and after the Optionee’s employment or other service relationship.
The provisions of this Section 9 shall not narrow or otherwise limit the obligations and
responsibilities of the Optionee set forth in any agreement of similar import entered into between
the Optionee and the Company.
10. Non-Guarantee of Employment or Service Relationship. Nothing in the Plan or this
Agreement shall alter the at-will or other employment status or other service relationship of the
Optionee, nor be construed as a contract of employment or service relationship between the Company
and the Optionee, or as a contractual right of Optionee to continue in the employ of, or in a
service relationship with, the Company for any period of time, or as a limitation of the right of
the Company to discharge the Optionee at any time with or without cause or notice and whether or
not such discharge results in the failure of any Options to vest or any other adverse effect on the
Optionee’s interests under the Plan.
11. No Rights as a Stockholder. The Optionee shall not have any of the rights of a
stockholder with respect to the Option Shares until such shares have been issued to him or her upon
the due exercise of the Options. No adjustment shall be made for dividends or distributions or
other rights for which the record date is prior to the date such shares are issued.
12. The Company’s Rights. The existence of the Options shall not affect in any way
the right or power of the Company or its stockholders to make or authorize any or all adjustments,
recapitalizations, reorganizations or other changes in the Company’s capital structure or its
business, or any merger or consolidation of the Company, or any issue of bonds, debentures,
preferred or other stocks with preference ahead of or convertible into, or otherwise affecting the
Common Stock or the rights thereof, or the dissolution or liquidation of the Company, or any sale
or transfer of all or any part of the Company’s assets or business, or any other corporate act or
proceeding, whether of a similar character or otherwise.
13. Optionee. Whenever the word “Optionee” is used in any provision of this Agreement
under circumstances where the provision should logically be construed, as determined by the
Administrator, to apply to the estate, personal representative, or beneficiary to whom the Options
may be transferred by will or by the laws of descent and distribution, or another permitted
transferee, the word “Optionee” shall be deemed to include such person.
14. Notices. All notices and other communications made or given pursuant to this
Agreement shall be in writing and shall be sufficiently made or given if hand delivered or mailed
by certified mail, addressed to the Optionee at the address contained in the records of the
Company, or addressed to the Administrator, care of the Company for the attention of its Corporate
Secretary at its principal office or, if the receiving party consents in advance, transmitted and
received via telecopy or via such other electronic transmission mechanism as may be available to
the parties.
15. Entire Agreement. This Agreement contains the entire agreement between the
parties with respect to the Options granted hereunder. Any oral or written agreements,
representations, warranties, written inducements, or other communications made prior to the
execution of this Agreement with respect to the Options granted hereunder shall be void and
ineffective for all purposes.
16. Amendment. This Agreement may be amended from time to time by the Administrator
in its discretion; provided, however, that this Agreement may not be modified in a
manner that would
have a materially adverse effect on the Options or Option Shares as determined in the
discretion of the Administrator, except as provided in the Plan or in a written document signed by
each of the parties hereto.
17. Conformity with Plan. This Agreement is intended to conform in all respects with,
and is subject to all applicable provisions of, the Plan. Inconsistencies between this Agreement
and the Plan shall be resolved in accordance with the terms of the Plan. In the event of any
ambiguity in this Agreement or any matters as to which this Agreement is silent, the Plan shall
govern. A copy of the Plan is available upon request to the Administrator.
18. Governing Law. The validity, construction and effect of this Agreement, and of any
determinations or decisions made by the Administrator relating to this Agreement, and the rights of
any and all persons having or claiming to have any interest under this Agreement, shall be
determined exclusively in accordance with the laws of the State of Maryland, without regard to its
provisions concerning the applicability of laws of other jurisdictions. Any suit with respect
hereto will be brought in the federal or state courts in the districts which include the city and
state in which the principal offices of the Company are located, and the Optionee hereby agrees and
submits to the personal jurisdiction and venue thereof.
19. Section 409A. This Agreement and the Options granted hereunder are intended to
comply with, or otherwise be exempt from, Section 409A of the Code. Nothing in the Plan or this
Agreement shall be construed as including any feature for the deferral of compensation other than
the deferral of recognition of income until the exercise of the Options. Should any provision of
the Plan or this Agreement be found not to comply with, or otherwise be exempt from, the provisions
of Section 409A of the Code, it may be modified and given effect, in the sole discretion of the
Administrator and without requiring the Optionee’s consent, in such manner as the Administrator
determines to be necessary or appropriate to comply with, or to effectuate an exemption from,
Section 409A of the Code. The foregoing, however, shall not be construed as a guarantee by the
Company of any particular tax effect to the Optionee.
20. Electronic Delivery of Documents. The Optionee (i) consents to the electronic
delivery of this Agreement, all information with respect to the Plan and the Options, and any
reports of the Company provided generally to the Company’s stockholders; (ii) acknowledges that the
Optionee may receive from the Company a paper copy of any documents delivered electronically at no
cost to the Optionee by contacting the Company by telephone or in writing; (iii) further
acknowledges that the Optionee may revoke his or her consent to the electronic delivery of
documents at any time by notifying the Company of such revoked consent by telephone, postal service
or electronic mail; and (iv) further acknowledges that the Optionee understands that he or she is
not required to consent to electronic delivery of documents.
21. No Future Entitlement. The Optionee acknowledges and agrees that: (i) the grant
of these Options is a one-time benefit which does not create any contractual or other right to
receive future grants of stock options, or compensation in lieu of stock options, even if stock
options have been granted repeatedly in the past; (ii) all determinations with respect to any such
future grants, including, but not limited to, the times when stock options shall be granted or
shall become exercisable, the maximum number of shares subject to each stock option, and the
purchase price, will be at the sole discretion of the Administrator; (iii) the value of these
Options is an extraordinary item of compensation which is outside the scope of the Optionee’s
employment contract, if any; (iv) the value of these Options is not part of normal or expected
compensation or salary for any purpose, including, but not limited to, calculating any
termination, severance, resignation, redundancy, end of service payments or similar payments,
or bonuses, long-service awards, pension or retirement benefits; (v) the vesting of these Options
ceases upon termination of employment with the Company or transfer of employment from the Company,
or other cessation of eligibility for any reason, except as may otherwise be explicitly provided in
this Agreement; (vi) if the underlying Common Stock does not increase in value, these Options will
have no value, nor does the Company guarantee any future value; and (vii) no claim or entitlement
to compensation or damages arises if these Options do not increase in value and the Optionee
irrevocably releases the Company from any such claim that does arise.
22. Personal Data. For the exclusive purpose of implementing, administering and
managing these Options, the Optionee consents to the collection, receipt, use, retention and
transfer, in electronic or other form, of the Optionee’s personal data by and among the Company and
its third party vendors. The Optionee understands that personal data (including but not limited
to, name, home address, telephone number, employee number, employment status, social security
number, tax identification number, date of birth, nationality, job and payroll location, data for
tax withholding purposes and shares awarded, cancelled, exercised, vested and unvested) may be
transferred to third parties assisting in the implementation, administration and management of
these Options and the Plan and the Optionee expressly authorizes such transfer as well as the
retention, use, and the subsequent transfer of the data by the recipient(s). The Optionee
understands that these recipients may be located in the Optionee’s home country or elsewhere, and
that the recipient’s country may have different data privacy laws and protections than the
Optionee’s home country. The Optionee understands that data will be held only as long as is
necessary to implement, administer and manage these Options. The Optionee understands that he or
she may, at any time, request a list with the names and addresses of any potential recipients of
the personal data, view data, request additional information about the storage and processing of
data, require any necessary amendments to data or refuse or withdraw the consents herein, in any
case without cost, by contacting in writing the Company’s Secretary. The Optionee understands,
however, that refusing or withdrawing the Optionee’s consent may affect the Optionee’s ability to
accept a stock option.
23. Headings. The headings in this Agreement are for reference purposes only and
shall not affect the meaning or interpretation of this Agreement.
Enclosure: Prospectus of the TeleCommunication Systems, Inc. Amended and Restated Stock Incentive
Plan
STOCK OPTION CERTIFICATE
[Date]
[Address]
Dear _________________:
Pursuant to the terms and conditions of the TeleCommunication Systems, Inc. Amended and Restated
Stock Incentive Plan (the “Plan”), you have been granted stock options to purchase [___] shares
(each an “Option,” collectively, the “Options”) of the Class A Common Stock, par value $0.01 per
share (the “Common Stock”) of TeleCommunication Systems, Inc. (the “Company”) as outlined below.
The Options are Nonstatutory Stock Options. This Certificate constitutes part of and is subject to
the terms and provisions of the attached Stock Option Agreement (the “Agreement”) which is
incorporated herein by reference.
Granted To: | _________________ | |||
(the ‘Employee’ for Incentive Stock Options, or the ‘Optionee’ for Nonstatutory Stock Options) | ||||
Grant Date: | «Grant_Date» | |||
Granted: | _________________ Options | |||
Xxxxx Xxxxx: | «Grant_Price_» per Option Total Cost to Exercise: «TotalCost_» | |||
Expiration Date: | The close of business on the last business day immediately preceding: | |||
_________________ | ||||
Vesting Schedule: | <Vesting Schedule Name> | |||
[___] on [___] | ||||
[___] on [___] | ||||
[___] on [___] | ||||
[___] on [___] | ||||
[___] on [___] |
By my signature below, I hereby acknowledge receipt of these Options granted on the date shown
above, which have been issued to me under the terms and conditions of the Agreement and the Plan.
I further acknowledge receipt of the Agreement and the Plan Prospectus and agree to be bound by all
of the terms and conditions of the Options, as evidenced in the Agreement and the Plan. I
understand that I must be an employee of, or otherwise providing service to TCS on the date I
exercise vested Options, unless otherwise provided in the Agreement or the Plan, and that I may
forfeit all unexercised Options, both vested and unvested, at the close of business on my last day
of employment or service with TCS as further described in the Agreement. I also consent to
electronic delivery, including via email or posting on the Company’s web site, of all future
notices or other information with respect to this grant, the Plan, and the Common Stock of the
Company.
Signature: ______________________________________
|
Date: ________________ |