INSTRUCTIONS FOR REGISTRATION OF SECURITIES. Name: (Print in Block Letters) Address:
INSTRUCTIONS FOR REGISTRATION OF SECURITIES. Name ------------------------------------------------------------------------ (Print in Block Letters) Address ------------------------------------------------------------------------ Form to be used to assign Purchase Option:
INSTRUCTIONS FOR REGISTRATION OF SECURITIES. Name:_______________________________________________________ (Print in Block Letters) Address: _____________________________________________________
INSTRUCTIONS FOR REGISTRATION OF SECURITIES. Name:_______________________________________________________ (Print in Block Letters) Address: _____________________________________________________ NOTICE: The signature to this form must correspond with the name as written upon the face of the Purchase Warrant without alteration or enlargement or any change whatsoever, and must be guaranteed by a bank, other than a savings bank, or by a trust company or by a firm having membership on a registered national securities exchange. EXHIBIT B Form to be used to assign Purchase Warrant: ASSIGNMENT (To be executed by the registered Holder to effect a transfer of the within Purchase Warrant): FOR VALUE RECEIVED, _______________________________ does hereby sell, assign and transfer unto the right to purchase __________ shares of Common Stock, Neuraxis, Inc., a Delaware corporation (the “Company”), evidenced by the Purchase Warrant and does hereby authorize the Company to transfer such right on the books of the Company. Dated:______, 20____ Signature: _______________________________________ Signature Guaranteed
INSTRUCTIONS FOR REGISTRATION OF SECURITIES. Name: (Print in Block Letters) Address: NOTICE: The signature to this form must correspond with the name as written upon the face of the Purchase Warrant without alteration or enlargement or any change whatsoever, and must be guaranteed by a bank, other than a savings bank, or by a trust company or by a firm having membership on a registered national securities exchange. EXHIBIT B TO PURCHASE WARRANT Form to be used to assign Purchase Warrant: (To be executed by the registered Holder to effect a transfer of the within Purchase Warrant): FOR VALUE RECEIVED, ___________________________ does hereby sell, assign and transfer unto __________________ the right to purchase shares of Soliton, Inc., a Delaware corporation (the “Company”), evidenced by the Purchase Warrant and does hereby authorize the Company to transfer such right on the books of the Company. Dated: ____________, 20__ Signature NOTICE: The signature to this form must correspond with the name as written upon the face of the within Purchase Warrant without alteration or enlargement or any change whatsoever. EXHIBIT B Form of Lock-Up Agreement Boustead Securities, LLC 0 Xxxxxxx, Xxxxx 000 Xxxxxx, XX 00000 Re: Soliton, Inc. – Lock-Up Agreement Ladies and Gentlemen: The undersigned, a holder of shares of common stock, $0.001 par value (“Shares”), or rights to acquire Shares, of Soliton, Inc., a Delaware corporation (the “Company”), understands that Boustead Securities, LLC, acting as a representative (the “Representative”) of the several underwriters in the Public Offering (“Underwriters”), proposes to enter into an underwriting agreement (the “Underwriting Agreement”) with the Company providing for the public offering (the “Public Offering”) of Shares of the Company. To induce the Underwriters to continue their efforts in connection with the Public Offering, and for other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the undersigned hereby agrees for the benefit of the Company and the Representative that, without the Representative’s prior written consent, the undersigned will not, during the period commencing on the date hereof and ending 12 months following the closing date of the Public Offering (the “Initial Lock-Up Period”), directly or indirectly (1) offer, pledge, assign, encumber, announce the intention to sell, sell, contract to sell, sell any option or contract to purchase, purchase any option or contract to sell, grant any option, right or wa...
INSTRUCTIONS FOR REGISTRATION OF SECURITIES. Name --------------------------------------------------------------- (please typewrite or print in block letters) Address ------------------------------------------------------------ Signature ---------------------------------------------------------- ASSIGNMENT FORM FOR VALUE RECEIVED, ____________________________________________________________ hereby sells, assigns and transfers unto Name____________________________________________________________________________ (please typewrite or print in block letters) Address_________________________________________________________________________ The right to purchase ___________ shares of Common Stock as represented by this Warrant to the extent of _______________ shares of Common Stock as to which such right is exercisable and does hereby irrevocably constitute and appoint ____________________, attorney, to transfer the same on the books of the Company with full power of substitution in the premises. -------------------------------- Signature Dated: ________________, 2000
INSTRUCTIONS FOR REGISTRATION OF SECURITIES. Name --------------------------------------------------------------------------- (Print in Block Letters) Address ------------------------------------------------------------------------ NOTICE: The signature to this form must correspond with the name as written upon the face of the within Warrant in every particular without alteration or enlargement or any change whatsoever, and must be guaranteed by a bank, other than a savings bank, or by a trust company or by a firm having membership on a registered national securities exchange. Form to be used to assign Warrant: ASSIGNMENT (To be executed by the registered Holder to effect a transfer of the within Warrant): FOR VALUE RECEIVED, ________________________________ does hereby sell, assign and transfer unto __________________________ the right to purchase ____________ shares of Common Stock of SmartServ Online, Inc. (the "Company") evidenced by the within Warrant and does hereby authorize the Company to transfer such right on the books of the Company. Dated:___________________ -------------------------- Signature -------------------------- Signature Guaranteed NOTICE: The signature to this form must correspond with the name as written upon the face of the within Warrant in every particular without alteration or enlargement or any change whatsoever, and must be guaranteed by a bank, other than a savings bank, or by a trust company or by a firm having membership on a registered national securities exchange.
INSTRUCTIONS FOR REGISTRATION OF SECURITIES. Name_____________________________________________________________ (Print in Block Letters) Address__________________________________________________________ NOTICE: The signature to this form must correspond with the name as written upon the face of the within Purchase Option in every particular without alteration or enlargement or any change whatsoever, and must be guaranteed by a bank, other than a savings bank, or by a trust company or by a firm having membership on a registered national securities exchange. Form to be used to assign Purchase Option:
INSTRUCTIONS FOR REGISTRATION OF SECURITIES. Name (Print in Block Letters) Address NOTICE: The signature to this form must correspond with the name as written upon the face of the within Warrant in every particular without alteration or enlargement or any change whatsoever, and must be guaranteed by a bank, other than a savings bank, or by a trust company or by a firm having membership on a registered national securities exchange. Form to be used to assign Warrant: ASSIGNMENT (To be executed by the registered Holder to effect a transfer of the within Warrant): FOR VALUE RECEIVED, Aesop Financial Corporation does hereby sells, assigns and transfers unto Xxxxxxx Partners, Ltd. the right to purchase up to 1,190,000 shares of Common Stock of Integrated Healthcare Systems, Inc. (the "Company") evidenced by the within Warrant and does hereby authorize the Company to transfer such right on the books of the Company. Dated: as of October 31, 1997 Signature Aesop Financial Corporation By: /s/ Xxxxxx X. Xxxxxxxx --------------------------------- Xxxxxx X. Xxxxxxxx, President Signature Guaranteed SIGNATURE GUARANTEED MEDALLION GUARANTEED CITIBANK N.A. - NED /s/ Xxxx Xxxxxxxxxx ------------------------------------- Xxxx Xxxxxxxxxx Assistant Vice President Branch #002 Madison/42nd Street NOTICE: The signature to this form must correspond with the name as written upon the face of the within Warrant in every particular without alteration or enlargement or any change whatsoever, and must be guaranteed by a bank, other than a savings bank, or by a trust company or by a firm having membership on a registered national securities exchange.
INSTRUCTIONS FOR REGISTRATION OF SECURITIES. Name: (Print in Block Letters) Address: NOTICE: The signature to this form must correspond with the name as written upon the face of the Purchase Warrant without alteration or enlargement or any change whatsoever, and must be guaranteed by a bank, other than a savings bank, or by a trust company or by a firm having membership on a registered national securities exchange. EXHIBIT B Form to be used to assign Purchase Warrant: (To be executed by the registered Holder to effect a transfer of the within Purchase Warrant): FOR VALUE RECEIVED, does hereby sell, assign and transfer unto the right to purchase shares of Adomani, Inc., a Delaware corporation (the “Company”), evidenced by the Purchase Warrant and does hereby authorize the Company to transfer such right on the books of the Company. Dated: , 20 Signature NOTICE: The signature to this form must correspond with the name as written upon the face of the within Purchase Warrant without alteration or enlargement or any change whatsoever. EXHIBIT B Form of Lock-Up Agreement Exhibit C Patent Applications
