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) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:____________________________ Holder’s Address:____________________________
Appears in 2 contracts
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) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:____________________________ Holder’s Address:: ____________________________
Appears in 2 contracts
Samples: It Tech Packaging, Inc., Lianluo Smart LTD
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) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:______: ______________________ Holder’s Address:: ____________________________
Appears in 1 contract
Samples: Blue Water Vaccines Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply the required information. Do not use this form to purchase sharesexercise for Warrant Shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: ___________________________________________ (Please Print) Holder’s Address: ___________________________________________ (Please Print) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:____________________________ Holder’s Address:____________________________
Appears in 1 contract
Samples: Digirad Corp
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) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:_____________________________________ Holder’s Address:______________________________________
Appears in 1 contract
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: ____________________________________________ Phone Number: Email Address: (Please Print) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:__: __________________________ Holder’s Address:: ____________________________
Appears in 1 contract
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply the 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) Phone NumberDated: ________________, 20__ Holder’s Signature: ____________________________________________________________ Email Holder’s Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:____________________________ Holder’s Address:____________________________
Appears in 1 contract
Samples: Saint James CO
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: :________________________________________________ Address:______________________________________________ (Please Print) Address: Dated:__________________________________________, 200__ (Please Print) Phone Number: Holder’s Signature:___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:____________________________ Holder’s Address:______________________________________________
Appears in 1 contract
Samples: CrowdGather, Inc.
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) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:__________: __________________ Holder’s Address:: ____________________________
Appears in 1 contract
Samples: Intelligent Bio Solutions Inc.
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: ________________________exercise___________________ (Please Print) Address: ___________________________________________ (Please Print) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:______________________________ Holder’s Address:_______________________________
Appears in 1 contract
Samples: SONDORS Inc.
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) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:: _____________________________ Holder’s Address:: ______________________________
Appears in 1 contract
Samples: Recruiter.com Group, Inc.
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) Phone NumberDated: ___________ , 20_ Holder’s Signature: ____________________________________________________________ Email Holder’s Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:____________________________ Holder’s Address:____________________________
Appears in 1 contract
Samples: Bone Biologics, Corp.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase sharesWarrant ADS, Warrant Shares or Pre-Funded Warrants.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: Phone Number: (Please Print) Email Address: Dated: _______________ __, ______ Holder’s Signature: ___________________________________________ (Please Print) Holder’s Address: ___________________________________________ (Please Print) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:____________________________ Holder’s Address:____________________________
Appears in 1 contract
Samples: ASLAN Pharmaceuticals LTD
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: ___________________________________________ Phone Number: Email Address: (Please Print) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:_____: _______________________ Holder’s Address:: ____________________________
Appears in 1 contract
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) Phone Number: ___________:________________________________ Email Address: ___________:________________________________ Dated: _______________ __, _________ Holder’s Signature:______________________________ Holder’s Address:______________________________
Appears in 1 contract
Samples: Scorpius Holdings, Inc.
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: ___________________________________________ Name: (Please Print) Address: ___________________________________________ Phone Number: Email Address: (Please Print) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:____________________________ Holder’s Address:____________________________
Appears in 1 contract
Samples: MingZhu Logistics Holdings LTD
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: ___________________________________________ Name: (Please Print) Address: ___________________________________________ (Please Print) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:____________________________ Holder’s Address:____________________________
Appears in 1 contract
Samples: Revelation Biosciences, Inc.
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: whose address is _______________________________________________________________ (Please Print) Phone NumberDated: _____________________________________________________ Email Holder's Signature: ________________________________________ Holder's Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:____________________________ Holder’s Address:____________________________
Appears in 1 contract
Samples: Targeted Genetics Corp /Wa/
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: ______________________________________, _____ (Please Print) Phone NumberHolder’s Signature: ___________________________________________ Email Holder’s Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:____________________________ Holder’s Address:____________________________
Appears in 1 contract
Samples: S&W Seed Co
ASSIGNMENT FORM. (To assign all or a portion of the foregoing Warrant, subject to compliance with section 4.3 hereof, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, all or a portion of the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Portion of Warrant Being Assigned: (Please Print) Dated: _______ 201__ Holder’s Signature: ___________________________________________ (Please Print) Holder’s Address: ___________________________________________ (Please Print) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:____________________________ Holder’s Address:____________________________
Appears in 1 contract
Samples: CareView Communications Inc
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) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:_________: ___________________ Holder’s Address:: ____________________________
Appears in 1 contract
Samples: Revelation Biosciences, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to exercise the Warrant to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to to: Name: ___________________________________________ (Please Print) Address: ___________________________________________ (Please Print) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:: ____________________________ Holder’s Address:: _____________________________ Series C Common Stock Purchase Warrant
Appears in 1 contract
Samples: Calidi Biotherapeutics, Inc.
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) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: ________________________________________ (Please Print) Holder’s Address: ___________________________________________ (Please Print) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:____________________________ Holder’s Address:____________________________
Appears in 1 contract
Samples: Lexaria Bioscience Corp.
ASSIGNMENT FORM. (To assign the foregoing Warrant, subject to compliance with section 4.3 hereof, 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) Phone NumberAddress:_________________________________________________________________________________________________ (Please Print) Dated: , 20 Holder’s Signature: ___________________________________________________ Email Holder’s Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:____________________________ Holder’s Address:____________________________
Appears in 1 contract
Samples: Securities Purchase Agreement (Acadia Pharmaceuticals Inc)
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to exercise the Warrant to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: ___________________________________________ (Please Print) Address: ___________________________________________ Phone Number: Email Address: (Please Print) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:: _____________________________________ Holder’s Address:: _____________________________________
Appears in 1 contract
Samples: Opgen Inc
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to exercise the Warrant to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address: (Please Print) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: ___________________________________________ (Please Print) Holder’s Address: ___________________________________________ (Please Print) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:____________________________ Holder’s Address:____________________________
Appears in 1 contract
Samples: Ensysce Biosciences, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to exercise the Warrant to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to to: Name: ___________________________________________ (Please Print) Address: ___________________________________________ (Please Print) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:____________________________ Holder’s Address:_____________________________ Placement Agent Common Stock Purchase Warrant
Appears in 1 contract
Samples: Calidi Biotherapeutics, Inc.
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) Phone Number: Email Address: Dated: _______________ __, ______ Holder’s Signature: ______________________________________________________________ (Please Print) Holder’s Address: ___________________________________________ (Please Print) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:____________________________ Holder’s Address:____________________________
Appears in 1 contract
Samples: Dermata Therapeutics, Inc.
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) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:____________________________ Holder’s Address:: ____________________________
Appears in 1 contract
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) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:____________________________ : Holder’s Address:____________________________
Appears in 1 contract
Samples: Modular Medical, Inc.
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) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:________: ____________________ Holder’s Address:: ____________________________
Appears in 1 contract
Samples: BiondVax Pharmaceuticals Ltd.
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) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:____________________________ Holder’s Address:: ____________________________
Appears in 1 contract
Samples: Purchase Agreement (Aditxt, Inc.)
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: Phone Number:Email Address: (Please Print)___________________________________________ (Please Print) Address: ___________________________________________ (Please Print) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:________: ____________________ Holder’s Address:: ____________________________
Appears in 1 contract
Samples: Terran Orbital Corp
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) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:: ______________________________ Holder’s Address:: ______________________________
Appears in 1 contract
Samples: Dermata Therapeutics, Inc.
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) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:___________: _________________ Holder’s Address:: ____________________________
Appears in 1 contract
Samples: RenovoRx, Inc.
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) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:____: ________________________ Holder’s Address:: ____________________________
Appears in 1 contract
Samples: Aditxt, Inc.
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) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:____________________________ : Holder’s Address:____________________________
Appears in 1 contract
Samples: Top Ships Inc.
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) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _______20__ Holder’s 's Signature:____________________________ Holder’s 's Address:______________________________
Appears in 1 contract
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: ___________________________________________ Phone Number: Email Address: (Please Print) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:: _______________________________________ Holder’s Address:: _______________________________________
Appears in 1 contract
Samples: Top Ships Inc.
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: ___________________________________________ Phone Number: E-mail Address: (Please Print) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:____________________________ Holder’s Address:____________________________
Appears in 1 contract
Samples: Locafy LTD
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: __________________________________ (Please Print) Holder’s Address: ___________________________________________ (Please Print) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:____________________________ Holder’s Address:____________________________
Appears in 1 contract
Samples: Long Island Iced Tea Corp.
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) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:______: ______________________ Holder’s Address:: ____________________________
Appears in 1 contract
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: ___________________________________________ Phone Number: (Please Print) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:___: _________________________ Holder’s Address:: ____________________________
Appears in 1 contract
Samples: Integrated Ventures, Inc.
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) Phone Number: _________________________ Email Address: ___________________________ Email DWAC Account Number: Dated: _______________ __, ______ Holder’s Signature: __________________________ Holder’s Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:____________________________ Holder’s Address:____________________________
Appears in 1 contract
Samples: Athenex, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVEDFor Value Received, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: ____________________________________________________________________________________________ (Please Print) Address: ___________________________________________ (Please Print) Phone Number: ________________________________________________ Email (Please Print) Dated: _________________ Holder’s Signature: __________________________________________ Holder’s Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:____________________________ Holder’s Address:____________________________
Appears in 1 contract
Samples: Yinlips Technology, Inc.
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to exercise the Warrant to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: ___________________________________________ (Please Print) Address: ___________________________________________ (Please Print) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:_____________________________ Holder’s Address:: _____________________________
Appears in 1 contract
Samples: Toughbuilt Industries, Inc
ASSIGNMENT FORM. (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to exercise the Warrant to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to to: Name: ___________________________________________ (Please Print) Address: ___________________________________________ (Please Print) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:: _____________________________ Holder’s Address:: _____________________________ Series A Common Stock Purchase Warrant
Appears in 1 contract
Samples: Calidi Biotherapeutics, Inc.
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: ___________________________________________ Phone Number: Email Address: (Please Print) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:____________________________ Holder’s Address:____________________________
Appears in 1 contract
Samples: Aethlon Medical Inc
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) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:____________________________ Holder’s Address:: ____________________________
Appears in 1 contract
Samples: Versus Systems Inc.
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) Phone Number: ___________________________________________ Email Address: ___________________________________________ Dated: _______________ __, _________ Holder’s Signature:___________: _________________ Holder’s Address:: ____________________________
Appears in 1 contract
Samples: Digital Caddies, Inc.