Please issue a certificate or certificates representing said ______ shares in the name of the undersigned or in such other name or names as are specified below: -------------------------------- (Name) -------------------------------- (Address)
Please issue a certificate or certificates representing said shares in the name of the undersigned or in such other name or names as are specified below: Name: Address:
Please issue a certificate or certificates representing said shares of Stock in the name of the undersigned: Name: ---------------------------------- Address: ---------------------------------- ---------------------------------- ----------------------------------
Please issue a certificate or certificates representing said shares of the Common Stock in the name of the undersigned or in such other name as is specified below.
Please issue a certificate or certificates representing said shares of Warrant Stock in the name of the undersigned or in such other name as is specified below: ---------------------------------------- (Name) ---------------------------------------- (Address) ------------------------- ---------------------------------------- (Date) (Name of Warrant Holder) By: ------------------------------------ Title: ---------------------------------- Attachment 2 INVESTMENT REPRESENTATION STATEMENT Shares of the Securities (as defined in the attached Warrant) of TELOCITY, INC. In connection with the purchase of the above-listed securities, the undersigned hereby represents to Telocity, Inc. (the "Company") as follows:
Please issue a certificate representing the shares of the Preferred Stock in the name of the Holder or in such other name as is specified below: Names: Address:
Please issue a certificate representing the Warrant Shares in the name of the Holder and deliver the certificate to the address set forth below.
Please issue a certificate representing the shares of Common Stock in the name of the Holder or in such other name as is specified below: Name: Address: Taxpayer I.D.: Oxford Finance Corporation By: Name: Title: Date:
Please issue a certificate or certificates representing said shares in the name of the undersigned or in such other name as is specified below: --------------------- (Name) --------------------- --------------------- --------------------- (Address) and, if such shares of Common Stock shall not include all of the shares of Common Stock issuable as provided in this Warrant, that a new Warrant of like tenor and date for the balance of the shares of Common Stock issuable hereunder be delivered to the undersigned. (Delete following paragraph if not applicable:) [Holder hereby represents to you that it has sold or has current plans to resell all of such Common Shares received upon this exercise of this Warrant, solely in accordance with the terms of the Registration Statement filed with the U.S. Securities and Exchange Commission by the Company covering such Common Shares as described under the section entitled "Plan of Distribution" therein.] ------------------------------------- (Name of Registered Owner) ------------------------------------- (Signature of Registered Owner) ------------------------------------- (Street Address) ------------------------------------- (State) (Zip Code) NOTICE: The signature on this subscription must correspond with the name as written upon the face of the Warrant in every particular, without alteration or enlargement or any change whatsoever. EXHIBIT B ASSIGNMENT FORM FOR VALUE RECEIVED the undersigned registered owner of this Warrant for the purchase of shares of common stock of NexMed, Inc. hereby sells, assigns and transfers unto the Assignee named below all of the rights of the undersigned under this Warrant, with respect to the number of shares of common stock set forth below: --------------------------------------- --------------------------------------- --------------------------------------- (Name and Address of Assignee) --------------------------------------- (Number of Shares of Common Stock) and does hereby irrevocably constitute and appoint ____________ attorney-in-fact to register such transfer on the books of the Company, maintained for the purpose, with full power of substitution in the premises. Dated:________________________________ -------------------------------------- (Print Name and Title) -------------------------------------- (Signature) -------------------------------------- (Witness)
Please issue a certificate or certificates representing said shares of Common Stock in the name of the undersigned or in such other names as is specified below and issue to the undersigned a new Warrant representing the balance of the attached Warrant to the extent not exercised in full: --------------------------------------- (Name) --------------------------------------- (Address) --------------------------- -------------------------------- (Date) (Name of Warrant Holder) By: ------------------------------ Title: --------------------------- (name of purchaser, and title and signature of authorized person) EXHIBIT B TO COMMON STOCK PURCHASE WARRANT, DATED [DATE] INVESTMENT REPRESENTATION STATEMENT Date:_________________, 199__ ________ Shares of Common Stock of Martek Biosciences Corporation In connection with the purchase of the above-listed securities pursuant to exercise of the warrant referred to herein, the undersigned (the "Holder") hereby represents to Martek Biosciences Corporation (the "Company") as follows:
