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: Sintx Technologies, Inc., Sintx Technologies, 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 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 shares~~exercise 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

Samples: Common Stock Purchase Warrant (CohBar, 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: Common Share Purchase (NLS Pharmaceutics Ltd.)

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 Number~~Dated: ________________, 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 Number~~Dated: ___________ , 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 ~~shares~~Warrant 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

Samples: Common Stock Purchase Warrant (NeoVolta 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: 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 Number~~Dated: _____________________________________________________ ~~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 Number~~Holder’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 Number~~Address:_________________________________________________________________________________________________ (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

Samples: Common Stock Purchase Warrant (CohBar, 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: 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

Samples: Securities Purchase Agreement (Aradigm 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: ______________________________________~~____~~_ 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

Samples: Hall of Fame Resort & Entertainment 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: ~~_____~~______________________________________ (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 RECEIVED~~For 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.

Common use of ASSIGNMENT FORM Clause in Contracts