Contract
Exhibit
10.48
THIS
WARRANT AND THE SECURITIES ISSUABLE UPON THE EXERCISE HEREOF HAVE NOT BEEN
REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED, OR ANY STATE SECURITIES
LAWS. THEY MAY NOT BE SOLD, OFFERED FOR SALE, TRANSFERRED, PLEDGED OR
HYPOTHECATED IN THE ABSENCE OF A REGISTRATION STATEMENT IN EFFECT WITH RESPECT
TO THE SECURITIES UNDER SUCH ACT AND ANY APPLICABLE STATE SECURITIES LAW OR
PURSUANT TO RULE 144 OR AN OPINION OF COUNSEL SATISFACTORY TO THE PARTNERSHIP
THAT SUCH REGISTRATION IS NOT REQUIRED.
Date
of Issuance
|
Void
after
|
|
April
13, 2006
|
April
13, 20011
|
TRULITE,
INC.
WARRANT
TO PURCHASE SHARES OF COMMON STOCK
This
Warrant is issued to [SHAREHOLDER], an [INDIVIDUAL OR ENTITY], or [HIS, HER
OR
ITS] assigns (the “Holder”)
by
Trulite, Inc., a Delaware corporation (the “Company”).
1.
Purchase
of Shares.
c) |
Number
of Shares.
Subject to the terms and conditions set forth herein, the Holder
is
entitled, upon surrender of this Warrant at the principal office
of the
Company (or at such other place as the Company shall notify the Holder
in
writing), to purchase from the Company up to [NUMBER OF SHARES] [(NUMBER)]
fully paid and nonassessable shares of the Company’s common stock, par
value $0.0001 per share (the “Common
Stock”).
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d) |
Exercise
Price.
The exercise price for the shares of Common Stock issuable pursuant
to
this Section 1 (the “Shares”) shall be Three Dollars ($3.00) per share
(the “Exercise Price”). The Shares and the Exercise Price shall be subject
to adjustment pursuant to Section 10
hereof.
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2. Exercise
Period. This Warrant shall be exercisable, in whole or in part, during the
term commencing on the date hereof and ending at 5:00 p.m. CST on April 13,
20011 (the “Exercise Period”); provided, however, that this Warrant shall no
longer be exercisable and become null and void upon the consummation of any
“Termination Event” defined as (a) the closing of the sale, transfer or
other disposition of all or substantially all of the Company’s assets,
(b) the consummation of the merger or consolidation of the Company with or
into another entity (except a merger or consolidation in which the holders
of
Company’ Common Stock immediately prior to such merger or consolidation continue
to hold at least 50% of the equity interest of the Company or the surviving
or
acquiring entity), (c) the closing of the transfer (whether by merger,
consolidation or otherwise), in one transaction or a series of related
transactions, to a person or group of affiliated persons (other than an
underwriter of the Company’s securities), of the Company’s securities if, after
such closing, such person or group of affiliated persons would hold more than
50% of the outstanding Common Stock of the Company, or (e) a liquidation,
dissolution or winding up of the Company; provided, however, that a transaction
shall not constitute a Termination Event if its sole purpose is to change the
state of the Company’s organization or to create a holding company that will be
owned in substantially the same proportions by the persons who held the
Company’s securities immediately prior to such transaction.
3. | Method of Exercise. |
d) |
While
this Warrant remains outstanding and exercisable in accordance with
Section 2 above, the Holder may exercise, in whole or in part, the
purchase rights evidenced hereby. Such exercise shall be effected
by:
|
(i) |
the
surrender of the Warrant, together with a duly executed copy of the
Notice
of Exercise attached hereto, to the Secretary of the Company at its
principal office (or at such other place as the Company shall notify
the
Holder in writing); and
|
(ii) |
the
payment to the Company of an amount equal to the aggregate Exercise
Price
for the number of Shares being
purchased.
|
e) |
Each
exercise of this Warrant shall be deemed to have been effected immediately
prior to the close of business on the day on which this Warrant is
surrendered to the Company as provided in Section 3(a) above. At
such
time, the person or persons in whose name or names any certificate
for the
Shares shall be issuable upon such exercise as provided in Section
3(c)
below shall be deemed to have become the holder or holders of record
of
the Shares represented by such
certificate.
|
f) |
As
soon as practicable after the exercise of this Warrant in whole or
in part
the Company at its expense will cause to be issued in the name of,
and
delivered to, the Holder, or as such Holder (upon payment by such
Holder
of any applicable transfer taxes) may
direct:
|
(i) |
a
certificate or certificates for the number of Shares to which such
Holder
shall be entitled, and
|
(ii) |
in
case such exercise is in part only, a new warrant or warrants (dated
the
date hereof) of like tenor, calling in the aggregate on the face
or faces
thereof for the number of Shares equal to the number of such Shares
described in this Warrant minus the number of such Shares purchased
by the
Holder upon all exercises made in accordance with Section 3(a) above
or
Section 5 below.
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7. |
Registration
Matters.
|
e) |
Company
Registration.
|
i. |
Registration.
If (but without any obligation to do so) the Company proposes to
register
(including for this purpose a registration effected by the Company
for
stockholders other than Investor) any of its stock or other securities
under the Securities Act of 1933, as amended (the “Act”) in connection
with the public offering of such securities (other than a registration
relating solely to the sale of securities of participants in a Company
stock plan, a registration relating to a corporate reorganization
or
transaction under Rule 145 of the Act, a registration on any form
that does not include substantially the same information as would
be
required to be included in a registration statement covering the
sale of
the Purchased Shares, or a registration in which the only Common
Stock
being registered is Common Stock issuable upon conversion of debt
securities that are also being registered), the Company shall, at
such
time, promptly give Investor written notice of such registration.
Upon the
written request of Investor given within twenty (20) days after mailing
of
such notice by the Company in accordance with Section 12, the Company
shall, subject to the provisions of Section 4(c), use all
commercially reasonable efforts to cause to be registered under the
Act
all of the Purchased Shares that Investor requests to be
registered.
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ii. |
Right
to Terminate Registration.
The Company shall have the right to terminate or withdraw any registration
initiated by it under this Section 4 prior to the effectiveness of
such registration whether or not Investor has elected to include
securities in such registration. The expenses of such withdrawn
registration shall be borne by the Company in accordance with Section
4(c)
hereof.
|
iii. |
Underwriting
Requirements.
In connection with any offering involving an underwriting of shares
of the
Company’s capital stock, the Company shall not be required under this
Section 4 to include any of the Investor’s securities in such
underwriting unless they accept the terms of the underwriting as
agreed
upon between the Company and the underwriters selected by the Company
(or
by other persons entitled to select the underwriters) and enter into
an
underwriting agreement in customary form with such underwriters,
and then
only in such quantity as the underwriters determine in their sole
discretion will not jeopardize the success of the offering by the
Company.
If the total amount of securities, including Purchased Shares, requested
by stockholders to be included in such offering exceeds the amount
of
securities sold other than by the Company that the underwriters determine
in their sole discretion is compatible with the success of the offering,
then the Company shall be required to include in the offering only
that
number of such securities, including Purchased Shares, that the
underwriters determine in their sole discretion will not jeopardize
the
success of the offering. In no event shall any Purchased Shares be
excluded from such offering unless all other stockholders’ securities have
been first excluded. In the event that the underwriters determine
that
less than all of the Purchased Shares requested to be registered
can be
included in such offering, then the Purchased Shares that are included
in
such offering shall be apportioned pro rata among Investor and other
selling parties based on the number of shares of Common Stock held
by
Investor and all other selling parties or in such other proportions
as
shall mutually be agreed to by Investor and all other selling
parties.
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f) |
Information
from Investor.
It shall be a condition precedent to the obligations of the Company
to
take any action pursuant to this Section 1 with respect to the
registration of Purchased Shares of any selling Investor that such
Investor shall furnish to the Company such information regarding
itself,
the Purchased Shares held by it, and the intended method of disposition
of
such securities as shall be reasonably required to effect the registration
of such Investor’s Purchased
Shares.
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g) |
Expenses
of Registration.
All expenses other than underwriting discounts and commissions incurred
in
connection with registrations, filings or qualifications pursuant
to
Section 4, including (without limitation) all registration, filing
and
qualification fees, printers’ and accounting fees, and fees and
disbursements of counsel for the Company shall be borne by the
Company.
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h) |
Indemnification.
To the extent permitted by law, Investor will indemnify and hold
harmless
the Company, each of its directors, each of its officers who has
signed
the registration statement, each person, if any, who controls the
Company
within the meaning of the Act, legal counsel and accountants for
the
Company, any underwriter, any other party selling securities in such
registration statement and any controlling person of any such underwriter
against any losses, claims, damages or liabilities (joint or several)
to
which any of the foregoing persons may become subject, under the
Act, the
1934 Act, any state securities laws or any rule or regulation promulgated
under the Act, the 1934 Act or any state securities laws, insofar
as such
losses, claims, damages or liabilities (or actions in respect thereto)
arise out of or are based upon any Violation (defined below), in
each case
to the extent (and only to the extent) that such Violation occurs
in
reliance upon and in conformity with written information furnished
by
Investor expressly for use in connection with such registration;
and
Investor will reimburse any person intended to be indemnified pursuant
to
this subsection 4(d) for any legal or other expenses reasonably incurred
by such person in connection with investigating or defending any
such
loss, claim, damage, liability or action as such expenses are incurred;
provided, however, that the indemnity agreement contained in this
subsection 4(d) shall not apply to amounts paid in settlement of any
such loss, claim, damage, liability or action if such settlement
is
effected without the consent of Investor (which consent shall not
be
unreasonably withheld), and provided that in no event shall any indemnity
under this subsection 4(d) exceed the gross proceeds from the
offering received by Investor. For purposes of this section 4(d),
“Violation”
shall mean any of the following statements, omissions or violations
(i) any untrue statement or alleged untrue statement of a material
fact contained in such registration statement, including any preliminary
prospectus or final prospectus contained therein or any amendments
or
supplements thereto, (ii) the omission or alleged omission to state
in such registration statement a material fact required to be stated
therein, or necessary to make the statements therein not misleading,
or
(iii) any violation or alleged violation by the Company of the Act,
the 1934 Act, any state securities laws or any rule or regulation
promulgated under the Act, the 1934 Act or any state securities
laws.
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8. |
Representations
and Warranties of the Company.
In connection with the transactions provided for herein, the Company
hereby represents and warrants to the Holder
that:
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d) |
Organization,
Good Standing, and Qualification.
The Company is a corporation duly organized, validly existing, and
in good
standing under the laws of the State of Delaware and has all requisite
corporate power and authority to carry on its business as now conducted.
The Company is duly qualified to transact business and is in good
standing
in each jurisdiction in which the failure to so qualify would have
a
material adverse effect on its business or
properties.
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e) |
Authorization.
Except as may be limited by applicable bankruptcy, insolvency,
reorganization or similar laws relating to or affecting the enforcement
of
creditors’ rights, all corporate action has been taken on the part of the
Company, its officers, directors, and stockholders necessary for
the
authorization, execution and delivery of this Warrant. The Company
has
taken all corporate action required to make all the obligations of
the
Company reflected in the provisions of this Warrant the valid and
enforceable obligations they purport to be. The issuance of this
Warrant
will not be subject to preemptive rights of any stockholders of the
Company. The Company has authorized sufficient shares of Common Stock
to
allow for the exercise of this
Warrant.
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f) |
Valid
Issuance of Common Stock.
The Shares, when issued, sold, and delivered in accordance with the
terms
of the Warrants for the consideration expressed therein, will be
duly and
validly issued, fully paid and nonassessable and, based in part upon
the
representations and warranties of the Holders in this Warrant, will
be
issued in compliance with all applicable federal and state securities
laws.
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9. |
Representations
and Warranties of the Holder.
In connection with the transactions provided for herein, the Holder
hereby
represents and warrants to the Company
that:
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i) |
Authorization.
Holder represents that [HE, SHE OR IT] has full power and authority
to
enter into this Warrant. This Warrant constitutes the Holder’s valid and
legally binding obligation, enforceable in accordance with its terms,
except as may be limited by (i) applicable bankruptcy, insolvency,
reorganization, or similar laws relating to or affecting the enforcement
of creditors’ rights and (ii) laws relating to the availability of
specific performance, injunctive relief or other equitable
remedies.
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j) |
Purchase
Entirely for Own Account.
The Holder acknowledges that this Warrant is entered into by the
Holder in
reliance upon such Holder’s representation to the Company that the Warrant
and the Shares (collectively, the “Securities”) will be acquired for
investment for the Holder’s own account, not as a nominee or agent, and
not with a view to the resale or distribution of any part thereof,
and
that the Holder has no present intention of selling, granting any
participation in or otherwise distributing the same. By acknowledging
this
Warrant, the Holder further represents that the Holder does not have
any
contract, undertaking, agreement, or arrangement with any person
to sell,
transfer or grant participations to such person or to any third person,
with respect to the Securities.
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k) |
Disclosure
of Information.
The Holder acknowledges that [HE, SHE or IT] has received all the
information it considers necessary or appropriate for deciding whether
to
acquire the Securities. The Holder further represents that [HE, SHE
or IT]
has had an opportunity to ask questions and receive answers from
the
Company regarding the terms and conditions of the offering of the
Securities.
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l) |
Investment
Experience.
The Holder is an investor in securities of companies in the development
stage and acknowledges that [HE, SHE or IT] is able to fend for [HIMSELF,
HERSELF or ITSELF], can bear the economic risk of [HIS, HER OR ITS]
investment, and has such knowledge and experience in financial or
business
matters that [HE, SHE or IT] is capable of evaluating the merits
and risks
of the investment in the Securities. If other than an individual,
the
Holder also represents [HE, SHE or IT] has not been organized solely
for
the purpose of acquiring the
Securities.
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m) |
Accredited
Investor.
The Holder is an “accredited investor” within the meaning of Rule 501 of
Regulation D, as presently in effect, as promulgated by the Securities
and
Exchange Commission (the “SEC”) under the
Act.
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n) |
Restricted
Securities.
The Holder understands that the Securities are characterized as
“restricted securities” under the federal securities laws inasmuch as they
are being acquired from the Company in a transaction not involving
a
public offering and that under such laws and applicable regulations
such
securities may be resold without registration under the Act, only
in
certain limited circumstances. In this connection, each Lender represents
that it is familiar with Rule 144, as presently in effect, as promulgated
by the SEC under the Act (“Rule 144”), and understands the resale
limitations imposed thereby and by the
Act.
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o) |
Further
Limitations on Disposition.
Without in any way limiting the representations set forth above,
the
Holder further agrees not to make any disposition of all or any portion
of
the Shares unless and until the transferee has agreed in writing
for the
benefit of the Company to be bound by the terms of this Warrant,
including, without limitation, this Section 6
and:
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i. |
there
is then in effect a registration statement under the Act covering
such
proposed disposition and such disposition is made in accordance with
such
registration statement; or
|
ii. |
the
Holder shall have notified the Company of the proposed disposition
and
shall have furnished the Company with a detailed statement of the
circumstances surrounding the proposed disposition, and if reasonably
requested by the Company, the Holder shall have furnished the Company
with
an opinion of counsel, reasonably satisfactory to the Company, that
such
disposition will not require registration of such shares under the
Act. It
is agreed that the Company will not require opinions of counsel for
transactions made pursuant to Rule 144 except in extraordinary
circumstances; or
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iii. |
if
other than an individual, the Holder shall not make any disposition
to any
of the Company’s competitors as such is reasonably in good faith
determined by the Company.
|
p) |
Legends.
It is understood that the Securities may bear the following
legend:
|
“THESE SECURITIES HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933,
AS
AMENDED. THEY MAY NOT BE SOLD, OFFERED FOR SALE, PLEDGED, HYPOTHECATED, OR
OTHERWISE TRANSFERRED EXCEPT PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT
UNDER THE SECURITIES ACT OF 1933, AS AMENDED, OR AN OPINION OF COUNSEL
SATISFACTORY TO THE COMPANY THAT REGISTRATION IS NOT REQUIRED UNDER SUCH ACT
OR
UNLESS SOLD PURSUANT TO RULE 144 UNDER SUCH ACT.”
7.
Covenants
of the Company.
c) |
Notices
of Record Date.
In the event of any taking by the Company of a record of the holders
of
any class of securities for the purpose of determining the holders
thereof
who are entitled to receive any dividend (other than a cash dividend
which
is the same as cash dividends paid in previous quarters and stock
dividends) or other distribution, the Company shall mail to the Holder,
at
least ten (10) days prior to such record date, a notice specifying
the
date on which any such record is to be taken for the purpose of such
dividend or distribution.
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d) |
Covenants
as to Exercise Shares.
The Company covenants and agrees that all Shares that may be issued
upon
the exercise of the rights represented by this Warrant will, upon
issuance
in accordance with the terms hereof, be validly issued and outstanding,
fully paid and nonassessable, and free from all taxes, liens and
charges
with respect to the issuance thereof. The Company further covenants
and
agrees that the Company will at all times during the Exercise Period,
have
authorized and reserved, free from preemptive rights, a sufficient number
of shares of Common Stock to provide for the exercise of the rights
represented by this Warrant. If at any time during the Exercise Period
the
number of authorized but unissued shares of Common Stock shall not
be
sufficient to permit exercise of this Warrant, the Company will take
such
corporate action as may, in the opinion of its counsel, be necessary
to
increase its authorized but unissued shares of Common Stock to such
number
of shares as shall be sufficient for such
purposes.
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8.
Adjustment
of Exercise Price and Number of Shares.
The
number and kind of Shares purchasable upon exercise of this Warrant and the
Exercise Price shall be subject to adjustment from time to time as
follows:
d) |
Subdivisions,
Combinations and Other Issuances.
If the Company shall at any time after the issuance but prior to
the
expiration of this Warrant subdivide its Common Stock, by split-up
or
otherwise, or combine its Common Stock, or issue additional shares
of its
Common Stock as a dividend with respect to any shares of its Common
Stock,
the number of Shares issuable on the exercise of this Warrant shall
forthwith be proportionately increased in the case of a subdivision
or
stock dividend, or proportionately decreased in the case of a combination.
Appropriate adjustments shall also be made to the Exercise Price
payable
per share, but the aggregate Exercise Price payable for the total
number
of Shares purchasable under this Warrant (as adjusted) shall remain
the
same. Any adjustment under this Section 8(a) shall become effective
at the close of business on the date the subdivision or combination
becomes effective, or as of the record date of such dividend, or
in the
event that no record date is fixed, upon the making of such
dividend.
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e) |
Reclassification,
Reorganization and Consolidation.
In case of any reclassification, capital reorganization or change
in the
capital stock of the Company (other than as a result of a subdivision,
combination or stock dividend provided for in Section 8(a) above),
then, as a condition of such reclassification, reorganization or
change,
lawful provision shall be made, and duly executed documents evidencing
the
same from the Company or its successor shall be delivered to the
Holder,
so that the Holder shall have the right at any time prior to the
expiration of this Warrant to purchase, at a total price equal to
that
payable upon the exercise of this Warrant, the kind and amount of
shares
of stock and other securities or property receivable in connection
with
such reclassification, reorganization or change by a holder of the
same
number and type of securities as were purchasable as Shares by the
Holder
immediately prior to such reclassification, reorganization or change.
In
any such case appropriate provisions shall be made with respect to
the
rights and interest of the Holder so that the provisions hereof shall
thereafter be applicable with respect to any shares of stock or other
securities or property deliverable upon exercise hereof, and appropriate
adjustments shall be made to the Exercise Price per Share payable
hereunder, provided the aggregate Exercise Price shall remain the
same.
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f) |
Notice
of Adjustment.
When any adjustment is required to be made in the number or kind
of shares
purchasable upon exercise of the Warrant, or in the Exercise Price,
the
Company shall promptly notify the Holder of such event and of the
number
of Shares or other securities or property thereafter purchasable
upon
exercise of this Warrant.
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17. |
Choice
of Law, Venue and Forum. This Agreement, the entire relationship
of the
parties hereto, and any litigation between the parties (whether grounded
in contract, tort, statute, law or equity) shall be governed by,
construed
in accordance with, and interpreted pursuant to the laws of the State
of
Texas, without giving effect to its choice of laws principles. Exclusive
venue for any litigation between the parties hereto shall be in Xxxxxx
County, Texas, and shall be brought in the State District Courts
of Xxxxxx
County, Texas, or in the United States District Court for the Southern
District of Texas, Houston Division. The parties hereto waive any
challenge to personal jurisdiction or venue (including without limitation
a challenge based on inconvenience) in Xxxxxx County, Texas, and
specifically consent to the jurisdiction of the State District Courts
of
Xxxxxx County and the United States District Court for the Southern
District of Texas, Houston
Division.
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18. |
Successors
and Assigns. The terms and provisions of this Warrant and the Purchase
Agreement shall inure to the benefit of, and be binding upon, the
Company
and the holders hereof and their respective successors and
assigns.
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19. |
Titles
and Subtitles. The titles and subtitles used in this Warrant are
used for
convenience only and are not to be considered in construing or
interpreting this Warrant.
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20. |
Notices.
All notices and other communications given or made pursuant hereto
shall
be in writing and shall be deemed effectively given: (a) upon personal
delivery to the party to be notified, (b) when sent by confirmed
electronic mail or facsimile if sent during normal business hours
of the
recipient, and if not so confirmed, then on the next business day,
(c)
five (5) days after having been sent by registered or certified mail,
return receipt requested, postage prepaid, or (d) one (1) day after
deposit with a nationally recognized overnight courier, specifying
next
day delivery, with written verification of receipt. All communications
shall be sent to the respective parties at the following addresses
(or at
such other addresses as shall be specified by notice given in accordance
with this Section 12):
|
If
to the
Company:
Trulite,
Inc.
0
Xxxxxxxx Xxxxx 0000
Xxxxxxx,
Xxxxx 00000
Attention:
Xxxx Xxxxxxx
If
to
Holder:
[SHAREHOLDER]
[ADDRESS]
[ADDRESS]
21. |
Finder’s
Fee.
Each party represents that it neither is or will be obligated for
any
finder’s fee or commission in connection with this transaction. The Holder
agrees to indemnify and to hold harmless the Company from any liability
for any commission or compensation in the nature of a finder’s fee (and
the costs and expenses of defending against such liability or asserted
liability) for which the Holder or any of [HIS, HER OR ITS] officers,
partners, employees or representatives is responsible. The Company
agrees
to indemnify and hold harmless the Holder from any liability for
any
commission or compensation in the nature of a finder’s fee (and the costs
and expenses of defending against such liability or asserted liability)
for which the Company or any of its officers, employees or representatives
is responsible.
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22. |
Expenses.
If any action at law or in equity is necessary to enforce or interpret
the
terms of this Warrant, the prevailing party shall be entitled to
reasonable attorneys’ fees, costs and necessary disbursements in addition
to any other relief to which such party may be
entitled.
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23. |
Entire
Agreement; Amendments and Waivers. This Warrant and any other documents
delivered pursuant hereto constitute the full and entire understanding
and
agreement between the parties with regard to the subjects hereof
and
thereof. Nonetheless, any term of this Warrant may be amended and
the
observance of any term of this Agreement may be waived (either generally
or in a particular instance and either retroactively or prospectively),
with the written consent of the Company and the Holder; or if this
Warrant
has been assigned in part, by the holders or rights to purchase a
majority
of the shares originally issuable pursuant to this
Warrant.
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24. |
Severability.
If any provision of this Warrant is held to be unenforceable under
applicable law, such provision shall be excluded from this Warrant
and the
balance of the Warrant shall be interpreted as if such provision
were so
excluded and shall be enforceable in accordance with its
terms.
|
[Signature
Page Follows]
IN
WITNESS WHEREOF, the parties have executed this Agreement as of the date first
above written.
COMPANY: | ||
Trulite, Inc. | ||
(a Delaware corporation) | ||
|
|
|
By: | ||
Xxxx Xxxxxxx, President |
Address: 0 Xxxxxxxx Xxxxx 0000 | ||
Xxxxxxx,
Xxxxx 00000
|
ACKNOWLEDGED
AND AGREED:
HOLDER:
[SHAREHOLDER]
By: ______________________________
[NAME
AND
TITLE (if Holder is an entity)]
Address:
[ADDRESS]
[ADDRESS]
NOTICE
OF EXERCISE
Trulite,
Inc.
Attention:
Corporate Secretary
The
undersigned hereby elects to purchase, pursuant to the provisions of the
Warrant, as follows:
_____________
shares of Common Stock pursuant to the terms of the attached Warrant, and
tenders herewith payment in cash of the Exercise Price of such Shares in full,
together with all applicable transfer taxes, if any.
The
undersigned hereby represents and warrants that Representations and Warranties
in Section 6 hereof are true and correct as of the date
hereof.
HOLDER: | |||||
Date: |
By:
|
||||
Address:
|
|||||
Name in which shares should be registered: | ||
ASSIGNMENT
FORM
(To
assign the foregoing Warrant, execute this form and supply required information.
Do not use this form to purchase shares.)
For
Value Received,
the
foregoing Warrant and all rights evidenced thereby are hereby assigned
to
Name: | ||
(Please
Print)
|
||
Address: | ||
(Please
Print)
|
Dated: | |||
Holder’s | |||
Signature: | |||
Holder’s | |||
Address: | |||
NOTE:
The
signature to this Assignment Form must correspond with the name as it appears
on
the face of the Warrant. Officers of corporations and those acting in a
fiduciary or other representative capacity should provide proper evidence of
authority to assign the foregoing Warrant.