Contract
Exhibit 4.1
Warrant No. [2007- ]
THIS SECURITY AND ANY SHARES ISSUED UPON THE EXERCISE OR CONVERSION OF THIS SECURITY HAVE NOT BEEN
REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “SECURITIES ACT”), AND, ACCORDINGLY,
MAY NOT BE OFFERED OR SOLD EXCEPT PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT UNDER THE
SECURITIES ACT OR PURSUANT TO AN AVAILABLE EXEMPTION FROM, OR IN A TRANSACTION NOT SUBJECT TO, THE
REGISTRATION REQUIREMENTS OF THE SECURITIES ACT AND IN COMPLIANCE WITH APPLICABLE STATE SECURITIES
LAWS OR BLUE SKY LAWS.
IRIDEX CORPORATION
COMMON STOCK PURCHASE WARRANT
IRIDEX Corporation (the “Company”), having its principal office as of the date hereof
at 0000 Xxxxx Xxxxx Xxxxxx, Xxxxxxxx Xxxx, Xxxxxxxxxx 00000, hereby certifies that, for value
received, [BlueLine Partners] or its registered assigns, is entitled, subject to the terms and
conditions set forth below, to purchase from the Company at any time on or from time to time after
August 31, 2007 and before 5:00 P.M., California time on the Expiration Date (defined below), [ ] fully paid and non-assessable shares of Common Stock (as defined below), at the initial
Purchase Price per share (as defined below) of $0.01. The number of such shares of Common Stock
and the Purchase Price per share are subject to adjustment as provided in Section 5.
The Company agreed to issue warrants, including this Warrant, to purchase an aggregate of Six
Hundred Thousand (600,000) shares of Common Stock (subject to adjustment as provided in Section 5)
in connection with the issuance by the Company to the Holders of an aggregate of Five Hundred
Thousand (500,000) Units.
As used herein the following terms, unless the context otherwise requires, have the following
respective meanings:
“Aggregate Purchase Price” has the meaning set forth in Section 3.1.
“Blue Sky Laws” means any state securities or “blue sky” laws.
“Board of Directors” means the board of directors of the Company.
“Business Day” means any day other than Saturday, Sunday or other day on which
commercial banks in California are authorized or required by law to remain closed.
“Company” includes the Company and any corporation which shall succeed to or assume
the obligations of the Company hereunder. The term “corporation” shall include an
association, joint stock company, business trust, limited liability company or other similar
organization.
“Common Stock” means the Company’s Common Stock, $0.01 par value per share, authorized
as of the date hereof, and any stock of any class or classes (however designated) hereafter
authorized upon reclassification thereof, which, if the Board of Directors declares any dividends
or distributions, has the right to participate in the distribution of earnings and assets of the
Company after the payment of dividends or other distributions on any shares of capital stock of the
Company entitled to a preference and in the voting for the election of directors of the Company.
“Convertible Securities” means (i) options to purchase or rights to subscribe for
Common Stock, (ii) securities by their terms convertible into or exchangeable for Common Stock or
(iii) options to purchase or rights to subscribe for such convertible or exchangeable securities.
“Exchange Act” means the Securities Exchange Act of 1934 as the same shall be in
effect at the time.
“Expiration Date” means December 31, 2007.
“Holder” means any record owner of Warrants or Underlying Securities.
“Investor Rights Agreement” has the meaning set forth in Section 1.
“Market Price” means with respect to any securities at any date (i) if the principal
trading market for such securities is Nasdaq, as defined below, or another exchange, the average of
the closing sale prices per share for the last ten previous trading days in which a sale was
reported, as officially reported on any consolidated tape, (ii) if the principal market for such
securities is the over-the-counter market, the average of the closing sale prices per share on the
last ten previous trading days in which a sale was reported as set forth by the over the counter
bulletin board or, (iii) if the security is not listed on another exchange or the over the counter
bulletin board, the average of the closing sale prices per share on the last ten previous trading
days in which a sale was reported as set forth in the National Quotation Bureau sheet listing such
securities for such days. Notwithstanding the foregoing, if there is no reported closing sale
price, as the case may be, reported on any of the ten trading days preceding the event requiring a
determination of Market Price hereunder, then the Market Price shall be the average of the high bid
and asked prices for the last ten previous trading days in which a sale was reported; and if there
is no reported high bid and asked prices, as the case may be, reported on any of the ten trading
days preceding the event requiring a determination of Market Price hereunder, then the Market Price
shall be determined in good faith by resolution of the Board of Directors.
“Nasdaq” means the Nasdaq Capital Market or Nasdaq Global Market.
“Notice” has the meaning set forth in Section 20.
“Original Issue Date” means August 31, 2007.
-2-
“Other Securities” refers to any stock (other than Common Stock) and other securities
of the Company or any other Person (corporate or otherwise) which the Holders of the Warrants at
any time shall be entitled to receive, or shall have received, upon the exercise of the Warrants,
in lieu of or in addition to Common Stock, or which at any time shall be issuable or shall have
been issued in exchange for or in replacement of Common Stock or Other Securities pursuant to
Section 5 or 6.
“Person” means any individual, sole proprietorship, partnership, corporation, limited
liability company, business trust, unincorporated association, joint stock corporation, trust,
joint venture or other entity, any university or similar institution, or any government or any
agency or instrumentality or political subdivision thereof.
“Purchase Agreement” means the Securities Purchase Agreement dated as of August 31,
2007, among the Company and the Purchasers.
“Purchase Price per share” means $0.01 per share, as may be adjusted from time to time
in accordance with Section 5 or 6.
“Purchaser” has the meaning set forth in the Purchase Agreement.
“registered” and “registration” refer to a registration effected by filing a
registration statement in compliance with the Securities Act, to permit the disposition of
Underlying Securities issued or issuable upon the exercise of Warrants, and any post-effective
amendments and supplements filed or required to be filed to permit any such disposition.
“Securities Act” means the Securities Act of 1933 as the same shall be in effect at
the time.
“Underlying Securities” means any Common Stock or Other Securities issued or issuable
upon exercise of Warrants.
“Units” has the meaning set forth in the Purchase Agreement.
“Warrant” means, as applicable, (i) the Warrants dated as of the date hereof,
originally issued by the Company pursuant to the Purchase Agreement, of which this Warrant is one,
evidencing rights to purchase up to an aggregate of Six Hundred Thousand (600,000) shares of Common
Stock, and all Warrants issued upon transfer, division or combination of, or in substitution for,
any thereof (all Warrants shall at all times be identical as to terms and conditions and date,
except as to the number of shares of Common Stock for which they may be exercised) or (ii) each
right as set forth in this Warrant to purchase one share of Common Stock, as adjusted from time to
time in accordance with Section 5 or 6.
1. Registration. The Holder shall have the rights to registration of Underlying
Securities issuable upon exercise of the Warrants that are set forth in the Investor Rights
Agreement, dated the Original Issue Date, among the Company and each of the Purchasers (the
“Investor Rights Agreement”).
-3-
2. Sale Without Registration. If, at the time of any transfer or surrender for
exchange of a Warrant or of Underlying Securities previously issued upon the exercise of Warrants,
such Warrant or Underlying Securities shall not be registered under the Securities Act, the Company
may require, as a condition of allowing such transfer or exchange, that the Holder or transferee of
such Warrant or Underlying Securities, as the case may be, furnish to the Company an opinion of
counsel, reasonably satisfactory to the Company, to the effect that such transfer or exchange may
be made without registration under the Securities Act and without registration or qualification
under any applicable Blue Sky Laws, provided that nothing contained in this Section 2 shall relieve
(a) the Company from complying with the Investor Rights Agreement or (b) the Holder from its
obligations under the Purchase Agreement.
3. Exercise of Warrant.
3.1 Exercise in Full. Subject to the provisions hereof, this Warrant may be exercised
in full by the Holder hereof by surrender of this Warrant, with the form of subscription at the end
hereof duly executed by such Holder, to the Company at its principal office set forth in Section 20
of this Warrant (or such other location as the Company from time to time may advise the Holder in
writing), accompanied by payment, in cash or by certified or official bank check payable to the
order of the Company, in the amount obtained (the “Aggregate Purchase Price”) by
multiplying (a) the number of shares of Common Stock then issuable upon exercise of this Warrant by
(b) the Purchase Price per share on the date of such exercise.
3.2 Partial Exercise. Subject to the provisions hereof, at any time following
approval by the Nasdaq of an Additional Listing Application with respect to the shares of Common
Stock into which this Warrant may be converted, this Warrant may be exercised in part by surrender
of this Warrant in the manner and at the place provided in Section 3.1 except that the amount
payable by the Holder upon any partial exercise shall be the amount obtained by multiplying (a) the
number of shares of Common Stock designated by the Holder in the subscription at the end hereof by
(b) the Purchase Price per share on the date of such exercise. Upon any such partial exercise, the
Company at its expense shall forthwith issue and deliver to or upon the order of the Holder hereof
a new Warrant or Warrants of like tenor, in the name of the Holder hereof or as such Holder (upon
payment by such Holder of any applicable transfer taxes and subject to the provisions of Section 2)
may request, calling in the aggregate on the face or faces thereof for the number of shares of
Common Stock equal to the number of such shares issuable prior to such partial exercise of this
Warrant minus the number of such shares designated by the Holder in the subscription at the end
hereof.
3.3 Company to Reaffirm Obligations. The Company shall, at the time of any exercise
of this Warrant, upon the request of the Holder hereof, acknowledge in writing its continuing
obligation to afford to such Holder any rights (including, without limitation, any right to
registration of the Underlying Securities, if any) to which such Holder shall continue to be
entitled after such exercise in accordance with the provisions of this Warrant; provided,
however, that if the Holder of this Warrant shall fail to make any such request, such
failure shall not affect the continuing obligation of the Company to afford such Holder any such
rights.
-4-
3.4 Certain Exercises. If an exercise of this Warrant is to be made in connection
with a registered public offering or sale of the Company, such exercise may, at the election of the
Holder, be conditioned on the consummation of the public offering or sale of the Company, in which
case such exercise shall not be deemed effective until the consummation of such transaction.
3.5 Conversion Right. In lieu of exercising this Warrant as specified in Section 3.1
and Section 3.2, the Holder may convert this Warrant, in whole or in part, into the number of
shares of Common Stock determined by dividing (a) the aggregate fair market value of the Common
Stock or the Other Securities issuable upon exercise of this Warrant minus the Aggregate Purchase
Price of such shares by (b) the current Market Price. Such conversion shall be effected by
surrender of this Warrant, with the form of subscription at the end hereof duly executed by such
Xxxxxx, to the Company at its principal office set forth at the head of this Warrant (or such other
location as the Company from time to time may advise the Holder in writing).
4. Delivery of Stock Certificates on Exercise. As soon as practicable after the
exercise of this Warrant in full or in part, and in any event within three Business Days
thereafter, the Company at its own expense (including the payment by it of any applicable issue
taxes) shall cause to be issued in the name of and delivered to the Holder hereof, or as such
Holder (upon payment by such Holder of any applicable transfer taxes and subject to the provisions
of Section 2) may direct, a certificate or certificates for the number of fully paid and
non-assessable shares of Common Stock or Other Securities to which such Holder shall be entitled
upon such exercise, plus, in lieu of any fractional share to which such Holder would otherwise be
entitled, cash equal to such fraction multiplied by the then current Market Price of one full
share.
5. Adjustment for Dividends.
(a) In case at any time or from time to time after the Original Issue Date, the Company shall
at any time declare or pay a dividend upon its Common Stock payable in shares of Common Stock, the
number of shares of Common Stock acquirable upon exercise hereof shall be increased by the number
of shares that would have been issued pursuant to such dividend with respect to the shares
acquirable hereunder as of the record date for such dividend.
(b) If the number of shares of Common Stock outstanding at any time after the Original Issue
Date is decreased by a combination or reverse stock split of the outstanding shares of Common
Stock, the Purchase Price per share shall be increased and the number of shares of Common Stock
acquirable upon exercise hereof shall be decreased, in each case in proportion to such decrease.
If the number of shares of Common Stock outstanding at any time after the Original Issue Date is
increased by a forward stock split of the outstanding shares of Common Stock or otherwise, the
number of shares of Common Stock acquirable upon exercise hereof shall be increased by the number
of shares that would have been issued had this Warrant been fully exercised as of the date of such
forward stock split or other transaction resulting in an increase in the outstanding shares of
Common Stock and the Purchase Price per share shall be decreased in proportion to such increase.
-5-
(c) Upon each adjustment to the Purchase Price per share, the Holder of this Warrant shall
thereafter be entitled to purchase, at the Purchase Price per share resulting from such adjustment, the number of shares of Common Stock obtained by multiplying the Purchase
Price per share in effect immediately prior to such adjustment by the number of shares of Common
Stock purchasable pursuant hereto immediately prior to such adjustment, and dividing the product
thereof by the Purchase Price per share resulting from such adjustment.
6. Reorganization, Consolidation, Merger. In case the Company after the Original
Issue Date shall (a) effect a reorganization, (b) consolidate with or merge into any other Person,
or (c) transfer all or substantially all of its properties or assets to any other Person under any
plan or arrangement contemplating the dissolution of the Company, then, in each such case, the
Holder of this Warrant, upon the exercise hereof as provided in Section 3 at any time after the
consummation of such reorganization, consolidation or merger or the effective date of such
dissolution, as the case may be, shall be entitled to receive (and the Company or its successors or
assigns shall be entitled to deliver), in lieu of the Underlying Securities issuable upon such
exercise prior to such consummation or such effective date, the stock and other securities and
property (including cash) to which such Holder would have been entitled upon such consummation or
in connection with such dissolution, as the case may be, if such Holder had so exercised this
Warrant immediately prior thereto. Upon receipt of such stock and other securities and property
(including cash), if any, the rights of the Holder under this Warrant shall terminate and cease and
this Warrant shall expire and be of no force and effect. In any such case, the Company (or its
successors or assigns) shall be entitled to make appropriate adjustments in the application of the
provisions of this Warrant with respect to the rights and interests of the Holder after such
reorganization, merger, consolidation or dissolution. The Company shall not effect any such
reorganization, consolidation, merger or dissolution, unless prior to or simultaneously with the
consummation thereof, the successor corporation resulting from such consolidation or merger or the
corporation purchasing such assets shall confirm or assume, by written instrument, the obligation
to deliver to each Holder the shares of stock, cash, other securities or assets to which, in
accordance with the foregoing provisions, each Holder may be entitled to and all other obligations
of the Company under this Warrant.
7. Further Assurances; Reports. The Company shall take all such action as may be
necessary or appropriate in order that the Company may validly and legally issue fully paid and
non-assessable shares of Underlying Securities upon the exercise of all Warrants from time to time
outstanding. For so long as the Holder holds this Warrant, the Company shall deliver to the Holder
contemporaneously with delivery to the holders of Common Stock, a copy of each report of the
Company delivered to such holders.
8. Certificate as to Adjustments. In each case of any adjustment or readjustment in
the Underlying Securities, the Company shall, at its expense, promptly cause its Chief Financial
Officer to compute such adjustment or readjustment in accordance with the terms of this Warrant and
prepare a certificate setting forth such adjustment or readjustment and showing in detail the facts
upon which such adjustment or readjustment is based, and the number of shares of Common Stock or
Other Securities outstanding or deemed to be outstanding. The Company shall forthwith mail a copy
of each such certificate to the Holder.
-6-
9. Notices of Record Date. In the event of:
(a) any taking by the Company of a record of its stockholders for the purpose of determining
the stockholders thereof who are entitled to receive any dividend or other distribution (other than
a quarterly dividend payable solely in cash), or any right to subscribe for, purchase or otherwise
acquire any shares of stock of any class or any other securities or property, or to receive any
other right, or for the purpose of determining stockholders who are entitled to vote in connection
with any proposed capital reorganization of the Company, any reclassification or recapitalization
of the capital stock of the Company or any transfer of all or substantially all the assets of the
Company to or consolidation or merger of the Company with or into any other Person, or
(b) any voluntary or involuntary dissolution, liquidation or winding-up of the Company,
then and in each such event the Company shall mail or cause to be mailed to each Holder of a
Warrant a notice specifying (i) the date on which any such record is to be taken for the purpose of
such dividend, distribution or right, and stating the amount and character of such dividend,
distribution or right and (ii) the date on which any such reorganization, reclassification,
recapitalization, transfer, consolidation, merger, dissolution, liquidation or winding-up is to
take place, and the time, if any, as of which the Holders of record of Underlying Securities shall
be entitled to exchange their shares of Underlying Securities for securities or other property
deliverable upon such reorganization, reclassification, recapitalization, transfer, consolidation,
merger, dissolution, liquidation or winding-up. Such notice shall be mailed at least 20 days prior
to the date therein specified.
10. Reservation of Stock Issuable on Exercise of Warrants. The Company shall at all
times reserve and keep available, solely for issuance and delivery upon the exercise of the
Warrants, all shares of Common Stock (or Other Securities) from time to time issuable upon the
exercise of the Warrants.
11. Listing on Securities Exchanges; Registration; Issuance of Certain Securities. In
furtherance and not in limitation of any other provision of this Warrant, if the Company at any
time shall list any Common Stock (or Other Securities) on any national securities exchange or
Nasdaq, the Company shall, at its expense, simultaneously list the Underlying Securities from time
to time issuable upon the exercise of the Warrants on such exchange or Nasdaq, upon official notice
of issuance.
12. Exchange of Warrants. Subject to the provisions of Section 2, upon surrender for
exchange of this Warrant, properly endorsed, to the Company, as soon as practicable (and in any
event within three Business Days) the Company at its own expense shall issue and deliver to or upon
the order of the Holder thereof a new Warrant or Warrants of like tenor, in the name of such Holder
or as such Holder (upon payment by such Holder of any applicable transfer taxes) may direct,
calling in the aggregate on the face or faces thereof for the number of shares of Common Stock
called for on the face of this Warrant so surrendered.
-7-
13. Replacement of Warrants. Upon receipt of evidence reasonably satisfactory to the
Company of the loss, theft, destruction or mutilation of this Warrant and, in the case of any such
loss, theft or destruction, upon delivery of an indemnity agreement or other collateral
reasonably satisfactory in form and amount to the Company and its transfer agent or, in the case of
any such mutilation, upon surrender and cancellation of this Warrant, the Company at its expense
shall execute and deliver, in lieu thereof, a new Warrant of like tenor.
14. Warrant Agent. The Company may, by written notice to each Holder of a Warrant,
appoint an agent for the purpose of issuing Common Stock (or Other Securities) upon the exercise of
the Warrants pursuant to Section 3, exchanging Warrants pursuant to Section 12, and replacing
Warrants pursuant to Section 13, or any of the foregoing, and thereafter any such issuance,
exchange or replacement, as the case may be, shall be made at such office by such agent.
15. Remedies; Enforcement Expenses. The Company stipulates that the remedies at law
of the Holder of this Warrant in the event of any default or threatened default by the Company in
the performance of or compliance with any of the terms of this Warrant may not be adequate, and
that such terms may be specifically enforced by a decree for the specific performance of any
agreement contained herein or by an injunction that may be sought against a violation of any of the
terms hereof or otherwise. The Company agrees to pay all costs and expenses of enforcement of this
Warrant in the event of any default or threatened default by the Company in the performance of or
compliance with any of the terms of this Warrant, including, without limitation, reasonable
attorneys’ fees and expenses.
16. No Rights as Stockholder. This Warrant does not entitle the Holder hereof to any
voting rights or other rights as a stockholder of the Company prior to the exercise hereof.
17. Negotiability. Subject to Section 2, this Warrant is issued upon the following
terms, to all of which each Holder or owner hereof by the taking hereof consents and agrees that:
(a) subject to the provisions of this Warrant and the Purchase Agreement, title to this
Warrant may be transferred by endorsement (by the Holder hereof executing the form of assignment at
the end hereof); and
(b) until this Warrant is transferred on the books of the Company, the Company may treat the
registered Holder hereof as the absolute owner hereof for all purposes, notwithstanding any notice
to the contrary.
18. Governing Law; Jurisdiction. This Warrant shall be governed by and construed in
accordance with the laws of the State of California without regard to principles of conflicts of
law. Each of the Holder and the Company hereby irrevocably consents and submits to the
jurisdiction of any California State or United States Federal Court sitting in the State of
California, County of Santa Xxxxx, over any action or proceeding arising out of or relating to this
Warrant and irrevocably consents to the service of any and all process in any such action or
proceeding in the manner for the giving of notices at its address specified in Section 20. Each of
the Holder and the Company further waives any objection to venue in the State of California, County
of Santa Xxxxx and any objection to
-8-
an action or proceeding in such state and county on the basis
of forum non conveniens. Each of the Holder and the Company also waives any right to trial by
jury.
19. Headings. The headings of the sections of this Warrant are for convenience and
shall not by themselves determine the interpretation of this Warrant.
20. Notices. Any notice or other communication required or permitted to be given
hereunder (each a “Notice”) shall be given in writing and shall be made by personal
delivery or sent by courier or certified or registered first-class mail (postage pre-paid),
addressed to a party at its address shown below or at such other address as such party may
designate by three days’ advance Notice to the other party.
Any Notice to the Holder shall be sent to the address for such Xxxxxx set forth on books and
records of the Company.
Any Notice to the Company shall be sent to:
IRIDEX Corporation
0000 Xxxxx Xxxxx Xxxxxx
Xxxxxxxx Xxxx, Xxxxxxxxxx 00000
Attention: Chief Financial Officer
0000 Xxxxx Xxxxx Xxxxxx
Xxxxxxxx Xxxx, Xxxxxxxxxx 00000
Attention: Chief Financial Officer
Each Notice shall be deemed given and effective upon receipt (or refusal of receipt).
21. Severability. Whenever possible, each provision of this Warrant shall be
interpreted in such a manner as to be effective and valid under applicable law, but if any
provision of this Warrant shall be deemed prohibited or invalid under such applicable law, such
provision shall be ineffective to the extent of such prohibition or invalidity, and such
prohibition or invalidity shall not invalidate the remainder of such provision or any other
provision of this Warrant.
22. Amendments and Waivers. Any provision of this Warrant may be amended and the
observance of any provision of this Warrant may be waived (either generally or in a particular
instance and either retroactively or prospectively), only with the written consent of the Company
and the Holder of the Warrant.
23. Construction. Words (including capitalized terms defined herein) in the singular
shall be held to include the plural and vice versa as the context requires. The words
“herein”, “hereinafter”, “hereunder” and words of similar import used in
this Warrant shall, unless otherwise stated, refer to this Warrant as a whole and not to any
particular provision of this Warrant. All references to “$” in this Warrant and the other
agreements contemplated hereby shall refer to United States dollars (unless otherwise specified
expressly). Any reference to any gender includes the other genders.
[signature page follows]
-9-
IN WITNESS WHEREOF, the Company has caused this Warrant to be signed by its duly authorized
officer as of August 31, 2007.
IRIDEX Corporation |
||||
By: | ||||
Name: | Xxxxx X. Xxxxxxxx | |||
Title: | President and Chief Executive Officer |
FORM OF SUBSCRIPTION
(To be signed only upon exercise of Warrant)
To: IRIDEX Corporation
The undersigned, the Holder of the within Warrant, hereby irrevocably elects to exercise the
purchase right represented by such Warrant for, and to purchase
thereunder, * shares of Common
Stock of IRIDEX Corporation, and herewith makes payment of $ and requests that the
certificates for such shares be issued in the name of, and delivered to, , whose
address is .
The undersigned, the Holder of the within Warrant, hereby irrevocably elects to convert the
attached Warrant into shares in the manner specified in such Warrant. This conversion is exercised
with respect to of the shares covered by such Warrant.
[Strike paragraph above that does not apply.]
The undersigned represents that the undersigned is acquiring such securities for its own
account for investment and not with a view to or for sale in connection with any distribution
thereof (except for any resale pursuant to, and in accordance with a valid registration statement
effective under the Securities Act of 1933).
Dated:
(Signature must conform in all respects to the | ||||
name of the Holder as specified on the face of the Warrant) | ||||
(Address) | ||||
* | Insert here the number of shares called for on the face of the Warrant (or, in the case of a partial exercise, the portion thereof as to which the Warrant is being exercised). |
FORM OF ASSIGNMENT
(To be signed by the Holder only upon transfer of Warrant)
For value received, the undersigned hereby sells, assigns and transfers unto the
right represented by the within Warrant to purchase shares
of Common Stock of IRIDEX Corporation to which the within Warrant relates, and hereby does
irrevocably constitute and appoint Attorney to transfer such right on the
books of IRIDEX Corporation with full power of substitution in the premises. The Warrant being
transferred hereby is one of the Warrants issued by IRIDEX Corporation as of August 31, 2007 to
purchase an aggregate of 600,000 shares of Common Stock.
Dated: _______________
(Signature must conform in all respects to name | ||||
of Holder as specified on the face of the Warrant) | ||||
(Address) | ||||
Signature guaranteed by a bank or trust | ||||
company having its principal office in New York City or by a Member Firm of the New York Stock Exchange or American Stock Exchange | ||||