EXHIBIT 4.09
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STOCK OPTION EXERCISE NOTICE AND AGREEMENT
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Instructions: Login to Options Online to see vested shares. Call your
broker to place your sell order. Complete and sign this Agreement and
fax to Stock Administration at 000-000-0000, or deliver to 000
Xxxxxxxx, 0xx Xxxxx, Xxxxxxx Xxxx, XX 00000. Call 000-000-0000 or 650-
556-5335 with questions.
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I hereby elect to purchase the number of shares of Series A Common Stock of AT
HOME CORPORATION the "Company") as set forth below:
Name: _________________________ Other Broker:______________________
Address: __________________________ Contact name:______________________
__________________________ Contact Phone Number:______________
----- Account Number:____________________
Broker:----- Xxxxxxx Xxxxx
----- PaineWebber
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Option Option Option Shares Option
Number Date Type ** Exercised Price
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** FOR U.S. TAXPAYERS, THE IRS REQUIRES TAX WITHHOLDING ON THE EXERCISE OF A
"NQ" OR NON-QUALIFIED OPTION OPTION (28% FEDERAL, APPLICABLE STATE & LOCAL, 6.2%
SOCIAL SECURITY to the yearly maximum & 1.45% MEDICARE).
Delivery of Purchase Price. Participant hereby delivers to the Company the
Purchase Price, to the extent permitted in the Option Agreement (the "Option
Agreement") as follows (check as applicable and complete):
[_____] in cash (by check) in the amount of $_________________, receipt of
which is acknowledged by the Company
[_____] through a "same-day-sale" commitment, from Participant and the Broker
named above, or;
[_____] through a "margin" commitment, from Participant and the Broker named
above.
Tax Consequences. PARTICIPANT UNDERSTANDS THAT PARTICIPANT MAY SUFFER ADVERSE
TAX CONSEQUENCES AS A RESULT OF PARTICIPANT'S PURCHASE OR DISPOSITION OF THE
SHARES. PARTICIPANT REPRESENTS THAT PARTICIPANT HAS CONSULTED WITH ANY TAX
CONSULTANT(S) PARTICIPANT DEEMS ADVISABLE IN CONNECTION WITH THE PURCHASE OR
DISPOSITION OF THE SHARES AND THAT PARTICIPANT IS NOT RELYING ON THE COMPANY FOR
ANY TAX ADVISE.
Entire Agreement. The Plan and Option Agreement are incorporated herein by
reference, and participant hereby acknowledges receipt thereof. This Exercise
Agreement, the Plan and the Option Agreement constitute the entire agreement and
understanding of the parties and supercede in their entirety all prior
understandings and agreements of the Company and Participant with respect to the
subject matter hereof, and are governed by California law except for that body
of law pertaining to choice of law or conflict of law.
Duplicate Trades. Participant understands that if they place a sell order for
the same block of shares with more than one broker and both orders are executed,
that both transactions will be cancelled and participant will be held solely
responsible for any brokerage charges, bank fees, interest and any and all costs
associated with the cancellation of the orders.
Signature of Participant Date
