Common use of Dated Clause in Contracts

Dated. Signed: -------------------------------- ---------------------------------- (Sign exactly as name appears on the other side of this Note) Signature Guarantee: ------------------------------------------------------------ TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ---------------------------- ----------------------------------------- NOTICE: To be executed by an executive officer OPTION OF HOLDER TO ELECT PURCHASE If you want to elect to have this Note purchased by the Company pursuant to Section 4.13 or Section 4.14 of the Indenture, check the appropriate box:

Appears in 1 contract

Samples: Covenants (Railworks Corp)

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Dated. Signed: -------------------------------- ---------------------------------- ------------------ ------------------------------------------ (Sign exactly as name appears on the other side of this NoteSecurity) Signature Guarantee: ------------------------------------------------------------ ----------------------------------------------------------- TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration requirements of the Securities Act provided by Rule 144A. 144A thereunder. Dated: ---------------------------- ----------------------------------------- NOTICE------------------ --------------------------------------------- Executive Officer Name: To be executed by an executive officer _______________________ Title: _______________________ FORM OF OPTION OF HOLDER TO ELECT PURCHASE If you want to elect to have this Note purchased by the Company pursuant to Section 4.13 4.14 or Section 4.14 4.15 of the Indenture, check the appropriate box:

Appears in 1 contract

Samples: Article Twelve (Discovery Zone Inc)

Dated. Signed: -------------------------------- ---------------------------------- --------- ------------------------------------------ (Sign exactly as name appears on the other side of this NoteSecurity) Signature Guarantee: ------------------------------------------------------------ ---------------------------------------------------------- Participant in a recognized Signature Guarantee Medallion Program (or other signature guarantor program reasonably acceptable to the Registrar) TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration requirements of the Securities Act provided by Rule 144A. 144A thereunder. Dated: ---------------------------- ----------------------------------------- NOTICE--------------- ------------------------------------------------ Executive Officer Name: To be executed by an executive officer ________________________ Title: ________________________ FORM OF OPTION OF HOLDER TO ELECT PURCHASE If you want to elect to have this Note purchased by the Company pursuant to Section 4.13 or Section 4.14 of the Indenture, check the appropriate box:

Appears in 1 contract

Samples: Registration Rights Agreement (New World Coffee Manhattan Bagel Inc)

Dated. Signed: -------------------------------- ---------------------------------- ------------------------ ------------------------------------ (Sign exactly as name appears on the other side of this NoteSecurity) Signature Guarantee: ------------------------------------------------------------ TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note Security for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ---------------------------- ----------------------------- ----------------------------------------- NOTICE: To be executed by an executive officer OPTION OF HOLDER TO ELECT PURCHASE If you want to elect to have this Note Security purchased by the Company pursuant to Section 4.13 4.12 or Section 4.14 4.13 of the Indenture, check the appropriate box:

Appears in 1 contract

Samples: Bway Corp

Dated. Signed: -------------------------------- ---------------------------------- ------------------ ------------------------ (Sign exactly as name appears on the other side of this NoteSecurity) Signature Guarantee: ------------------------------------------------------------ ----------------------------------------- TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ---------------------------- ----------------------------------------- ------------------ -------------------------------- NOTICE: To be executed by an executive officer 129 [OPTION OF HOLDER TO ELECT PURCHASE PURCHASE] If you want to elect to have this Note purchased by the Company pursuant to Section 4.13 4.15 or Section 4.14 4.16 of the Indenture, check the appropriate box:

Appears in 1 contract

Samples: McMS Inc

Dated. Signed: -------------------------------- ---------------------------------- -------------------- ----------------------------------------- (Sign exactly as name appears on the other side of this Note) Signature Guarantee: ------------------------------------------------------------ TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, amended and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ---------------------------- ----------------------------------------- -------------- ---------------------------------------------------- NOTICE: To be executed by an executive officer [OPTION OF HOLDER TO ELECT PURCHASE PURCHASE] If you want to elect to have this Note purchased by the Company pursuant to Section 4.13 4.14 or Section 4.14 4.15 of the Indenture, check the appropriate box:

Appears in 1 contract

Samples: Financing and Security Agreement (Kimberton Enterprises Inc)

Dated. Signed: -------------------------------- ---------------------------------- ---------------------------- ----------------------------- (Sign exactly as name appears on the other side of this NoteSecurity) Signature Guarantee: ------------------------------------------------------------ ----------------------------------------------------------- TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note Security for its own account or an account with respect to which it if exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ---------------------------- ----------------------------------------- ----------------------------- ------------------------------------- NOTICE: To be executed by an executive officer OPTION OF HOLDER TO ELECT PURCHASE If you want to elect to have this Note Security purchased by the Company pursuant to Section 4.13 4.9 or Section 4.14 4.19 of the Indenture, check the appropriate box:box below: [_] Section 4.9 (Change in Control) [_] Section 4.19 (Asset Sale) If you want to elect to have only part of the Security purchased by the Company pursuant to Section 4.9 or Section 4.19, state the amount you elect to have purchased: $_________ Date: Your Signature: ---------- ------------------------------ (Sign exactly as your name appears on the face of this Security)

Appears in 1 contract

Samples: SFW Holding Corp

Dated. Signed: ------------------------------ -------------------------------- ---------------------------------- (Sign exactly as name appears on the other side of this Note) Signature Guarantee: ------------------------------------------------------------ -------------------------------------- Participant in a recognized Signature Guarantee Medallion Program (or other signature guarantor program reasonably acceptable to the Trustee) TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company Issuers as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ---------------------------- ----------------------------------------- ------------------------------ ---------------------------------------- NOTICE: To be executed by an executive officer OPTION OF HOLDER TO ELECT PURCHASE If you want to elect to have this Note purchased by the Company Issuers pursuant to Section 4.09, Section 4.13 or Section 4.14 4.17 of the Indenture, check the appropriate box:

Appears in 1 contract

Samples: Stanley-Martin Communities, LLC

Dated. Signed: -------------------------------- ------------------------- ---------------------------------- (Sign exactly as name appears on the other side of this Note) Signature Guarantee: ------------------------------------------------------------ TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company Issuers as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ---------------------------- ----------------------------------------- NOTICE: To be executed by an executive officer OPTION OF HOLDER TO ELECT PURCHASE If you want to elect to have this Note purchased by the Company pursuant to Section 4.13 or Section 4.14 of the Indenture, check the appropriate box:-------------------------- -----------------------------------

Appears in 1 contract

Samples: Subordination Agreement (Universal City Development Partners LTD)

Dated. Signed: -------------------------------- ---------------------------------- -------------------------- --------------------------------- (Sign exactly as name appears on the other side of this NoteSecurity) Signature Guarantee: ------------------------------------------------------------ Participant in a recognized Signature Guarantee Medallion Program (or other signature guarantor program reasonably acceptable to the Trustee) TO BE COMPLETED BY PURCHASER IF (2a) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note Security for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ---------------------------- ----------------------------------------- --------------------- ------------------------------------ NOTICE: To be executed by an executive officer OPTION OF HOLDER TO ELECT PURCHASE If you want to elect to have this Note Security purchased by the Company pursuant to Section 4.13 Sections 4.16 or Section 4.14 4.17 of the Indenture, check the appropriate box:

Appears in 1 contract

Samples: Call Points Inc

Dated. Signed: -------------------------------- ---------------------------------- ---------------------- ----------------------------------- (Sign exactly as name appears on the other side of this NoteSecurity) Signature Guarantee: ------------------------------------------------------------ ----------------------------------------------------- TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note Security for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ---------------------------- ----------------------------------------- NOTICE: To be executed by an executive officer OPTION OF HOLDER SECURITYHOLDER TO ELECT PURCHASE If you want to elect to have all or any part of this Note Security purchased by the Company pursuant to Section 4.13 4.6 or Section 4.14 4.8 of the Indenture, Indenture check the appropriate box:

Appears in 1 contract

Samples: Indenture (H R Window Supply Inc)

Dated. Signed: -------------------------------- ---------------------------------- ------------------ ------------------------ (Sign exactly as name appears on the other side of this NoteSecurity) Signature Guarantee: ------------------------------------------------------------ ----------------------------------------- TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ---------------------------- ----------------------------------------- ------------------ -------------------------------- NOTICE: To be executed by an executive officer 143 [OPTION OF HOLDER TO ELECT PURCHASE PURCHASE] If you want to elect to have this Note purchased by the Company pursuant to Section 4.13 4.15 or Section 4.14 4.16 of the Indenture, check the appropriate box:

Appears in 1 contract

Samples: McMS Inc

Dated. Signed: -------------------------------- ---------------------------------- ------------------------- ------------------------------------ (Sign exactly as name appears on the other side of this NoteSecurity) Signature Guarantee: ------------------------------------------------------------ TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ---------------------------- ----------------------------------------- ------------------------- ------------------------------------ NOTICE: To be executed by an executive officer [OPTION OF HOLDER TO ELECT PURCHASE PURCHASE] If you want to elect to have this Note purchased by the Company pursuant to Section 4.13 4.15 or Section 4.14 4.16 of the Indenture, check the appropriate box:

Appears in 1 contract

Samples: Gaylord Container Corp /De/

Dated. Signed: -------------------------------- ---------------------------------- ------------------ ----------------------------------------- (Sign exactly as your name appears on the other side of this Note) Signature Guarantee: ------------------------------------------------------------ --------------------------------------------------------- TO BE COMPLETED BY PURCHASER IF BOX (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ---------------------------- ----------------------------------------- ----------------------------- ------------------------------------ NOTICE: To be executed by an executive officer [OPTION OF HOLDER TO ELECT PURCHASE PURCHASE] If you want to elect to have this Note purchased by the Company pursuant to Section 4.13 4.15 or Section 4.14 4.16 of the Indenture, check the appropriate box:

Appears in 1 contract

Samples: Hutchinson Products Corp

Dated. Signed: ------------------- -------------------------------- ---------------------------------- (Sign exactly as name appears on the other side of this Note) Signature Guarantee: ------------------------------------------------------------ ----------------------------------------------------------- Participant in a recognized Signature Guarantee Medallion Program (or other signature guarantor program reasonably acceptable to the Trustee) TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company Issuers as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ---------------------------- ----------------------------------------- ------------------- --------------------------------------- NOTICE: To be executed by an executive officer OPTION OF HOLDER TO ELECT PURCHASE If you want to elect to have this Note purchased by the Company Issuers pursuant to Section 4.13 4.09 or Section 4.14 4.13 of the Indenture, check the appropriate box:

Appears in 1 contract

Samples: Norcraft Companies Lp

Dated. Signed: -------------------------------- ---------------------------------- ------------------- -------------------------------------------- (Sign exactly as name appears on the other side of this NoteSecurity) Signature Guarantee: ------------------------------------------------------------ ----------------------------------------------------------- TO BE COMPLETED BY PURCHASER IF BOX (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ---------------------------- ----------------------------------------- --------------------------- ------------------------------------ NOTICE: To be executed by an executive officer [OPTION OF HOLDER TO ELECT PURCHASE PURCHASE] If you want to elect to have this Note purchased by the Company pursuant to Section 4.13 4.15 or Section 4.14 4.16 of the Indenture, check the appropriate box:

Appears in 1 contract

Samples: Hutchinson Products Corp

Dated. Signed: -------------------------------- ---------------------------------- ------------------------- ---------------------------- (Sign exactly as your name appears on the other side of this Note) Signature Guarantee: ------------------------------------------------------------ -------------------------- TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ---------------------------- ----------------------------------------- ______________________ _______________________________________________ NOTICE: To be executed by an executive officer [OPTION OF HOLDER TO ELECT PURCHASE PURCHASE] If you want to elect to have this Note purchased by the Company pursuant to Section 4.13 4.15, Section 4.16 or Section 4.14 4.23 of the Indenture, check the appropriate box:

Appears in 1 contract

Samples: Article Twelve Agreement (Golfsmith International Holdings Inc)

Dated. Signed: -------------------------------- ---------------------------------- ---------------------------- ------------------------------------- (Sign exactly as your name appears on the other side of this Note) Signature Guarantee: ------------------------------------------------------------ ----------------------------- TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ---------------------------- ----------------------------------------- -------------------------------------- NOTICE: To be executed by an executive officer A-10 106 [OPTION OF HOLDER TO ELECT PURCHASE PURCHASE] If you want to elect to have this Note purchased by the Company pursuant to Section 4.13 4.15 or Section 4.14 4.16 of the Indenture, check the appropriate box:

Appears in 1 contract

Samples: Icn Pharmaceuticals Inc

Dated. Signed: -------------------------------- ---------------------------------- --------------------------- --------------------------------- (Sign exactly as name appears on the other side of this NoteSecurity) Signature Guarantee: ------------------------------------------------------------ ------------------------------------------------- TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ---------------------------- ----------------------------------------- ----------------------- ---------------------------------------- NOTICE: To be executed by an executive officer [OPTION OF HOLDER TO ELECT PURCHASE PURCHASE] If you want to elect to have this Note purchased by the Company pursuant to Section 4.13 4.15 or Section 4.14 4.16 of the Indenture, check the appropriate box:

Appears in 1 contract

Samples: Coinmach Corp

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Dated. Signed: ---------------------------- -------------------------------- ---------------------------------- (Sign exactly as name appears on the other side of this NoteSecurity) Signature Guarantee: ------------------------------------------------------------ ---------------------------------------- TO BE COMPLETED BY PURCHASER IF (2( 2 ) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information informa tion regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's undersigned s foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ---------------------------- ----------------------------------------- ----------------------- ---------------------------------------------- NOTICE: To be executed by an executive officer [OPTION OF HOLDER TO ELECT PURCHASE PURCHASE] If you want to elect to have this Note purchased by the Company pursuant to Section 4.13 4.15 or Section 4.14 4.16 of the Indenture, check the appropriate box:

Appears in 1 contract

Samples: Collins & Aikman Floor Coverings Inc

Dated. Signed: -------------------------------- ---------------------------------- ------------------ ------------------------ (Sign exactly as name appears on the other side of this NoteSecurity) Signature Guarantee: ------------------------------------------------------------ ----------------------------------------- TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note Security for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ---------------------------- ----------------------------------------- ------------------ -------------------------------- NOTICE: To be executed by an executive officer OPTION OF HOLDER TO ELECT PURCHASE If you want to elect to have this Note Security purchased by the Company pursuant to Section 4.13 4.15 or Section 4.14 4.16 of the Indenture, check the appropriate box:

Appears in 1 contract

Samples: Indenture (Avado Brands Inc)

Dated. Signed: -------------------------------- ---------------------------------- ---------------------- ------------------------------------------ (Sign exactly as name appears on the other side of this Note) Signature Guarantee: ------------------------------------------------------------ --------------------------------------------------------- TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, amended and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ---------------------------- ----------------------------------------- ------------------ -------------------------------------------- NOTICE: To be executed by an executive officer [OPTION OF HOLDER TO ELECT PURCHASE PURCHASE] If you want to elect to have this Note purchased by the Company pursuant to Section 4.13 4.14 or Section 4.14 4.15 of the Indenture, check the appropriate box:

Appears in 1 contract

Samples: Indenture (Penn National Gaming Inc)

Dated. Signed: -------------------------------- ---------------------------------- ----------- --------------------------------------------- (Sign exactly as name appears on the other side of this NoteSecurity) Signature Guarantee: ------------------------------------------------------------ ---------------------------------------------------------- Participant in a recognized Signature Guarantee Medallion Program (or other signature guarantor program reasonably acceptable to the Registrar) TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration requirements of the Securities Act provided by Rule 144A. 144A thereunder. Dated: ---------------------------- ----------------------------------------- NOTICE--------------- -------------------------------------------------- Executive Officer Name: To be executed by an executive officer _______________________ Title: ______________________ FORM OF OPTION OF HOLDER TO ELECT PURCHASE If you want to elect to have this Note purchased by the Company pursuant to Section 4.13 or Section 4.14 of the Indenture, check the appropriate box:

Appears in 1 contract

Samples: Registration Rights Agreement (New World Coffee Manhattan Bagel Inc)

Dated. Signed: -------------------------------- ---------------------------------- -------------------------- ---------------------- (Sign exactly as name appears on the other side of this NoteSecurity) Signature Guarantee: ------------------------------------------------------------ ------------------------------------------- TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. DatedDate: ---------------------------- ----------------------------------------- ------------------------ ----------------------------- NOTICE: To be executed by an executive officer OPTION OF HOLDER TO ELECT PURCHASE If you want officer1 ---------------- 1 Only to elect to have this Note purchased by the Company pursuant to Section 4.13 or Section 4.14 of the Indenture, check the appropriate box:be included on Notes constituting Restricted Securities.

Appears in 1 contract

Samples: Indenture (Kaiser Aluminum Corp)

Dated. Signed: -------------------------------- ---------------------------------- ------------------ -------------------------------------------- (Sign exactly as your name appears on the other side of this Note) Signature Guarantee: ------------------------------------------------------------ Signatures must be guaranteed by an "eligible guarantor institution" meeting the requirements of the Registrar, which requirements on and after October 26, 1992 will include membership or participation in STAMP or such other "signature guarantee program" as may be determined by the Registrar in addition to, or in substitution for, STAMP, all in accordance with the Securities Exchange Act of 1934, as amended. TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, amended and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company Issuer as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ---------------------------- ----------------------------------------- ------------------- -------------------------------------------------- NOTICE: To be executed by an executive officer [OPTION OF HOLDER TO ELECT PURCHASE PURCHASE] If you want to elect to have this Note purchased by the Company Issuer pursuant to Section 4.13 4.11 or Section 4.14 4.12 of the this Indenture, check the appropriate box:

Appears in 1 contract

Samples: Mobile Field Office Co

Dated. Signed: -------------------------------- ---------------------------------- ------------------ ------------------------------------------ (Sign exactly as name appears on the other side of this NoteSecurity) Signature Guarantee: ------------------------------------------------------------ ----------------------------------------------------------- TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration requirements of the Securities Act provided by Rule 144A. 144A thereunder. Dated: ---------------------------- ----------------------------------------- NOTICE------------------ --------------------------------------------- Executive Officer Name: To be executed by an executive officer ________________________ Title: ________________________ FORM OF OPTION OF HOLDER TO ELECT PURCHASE If you want to elect to have this Note purchased by the Company pursuant to Section 4.13 4.14 or Section 4.14 4.15 of the Indenture, check the appropriate box:

Appears in 1 contract

Samples: Article Twelve (Discovery Zone Inc)

Dated. Signed: -------------------------------- ---------------------------------- Signed:----------------------------------------- (Sign exactly as name appears on the other side of this NoteSecurity) Signature Guarantee: ------------------------------------------------------------ Guarantee:------------------------------------------------------ Participant in a recognized Signature Guarantee Medallion Program (or other signature guarantor program reasonably acceptable to the Registrar) TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration requirements of the Securities Act provided by Rule 144A. 144A thereunder. Dated: ---------------------------- ----------------------------------------- NOTICEExecutive Officer Name: To be executed by an executive officer _______________________ Title: _______________________ FORM OF OPTION OF HOLDER TO ELECT PURCHASE If you want to elect to have this Note purchased by the Company pursuant to Section 4.13 or Section 4.14 of the Indenture, check the appropriate box:

Appears in 1 contract

Samples: Registration Rights Agreement (New World Coffee Manhattan Bagel Inc)

Dated. Signed: -------------------------------- ---------------------------------- ---------------------- ------------------------------ (Sign exactly as name appears on the other side of this Note) Signature Guarantee: ------------------------------------------------------------ ----------------------------------------------------- TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. DatedDate: ---------------------------- ----------------------------------------- ------------------------- ------------------------------------- NOTICE: To be executed by an executive officer OPTION OF HOLDER TO ELECT PURCHASE If you want to elect to have this Note purchased by the Company pursuant to Section 4.13 4.14 or Section 4.14 4.15 of the this Indenture, check the appropriate box:

Appears in 1 contract

Samples: Cambridge Industries Inc /De

Dated. Signed: -------------------------------- ---------------------------------- ------------------- ---------------------------------------------- (Sign exactly as name appears on the other side of this Note) Signature Guarantee: ------------------------------------------------------------ TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, amended and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ---------------------------- ----------------------------------------- --------------------- --------------------------------------- NOTICE: To be executed by an executive officer [OPTION OF HOLDER TO ELECT PURCHASE PURCHASE] If you want to elect to have this Note purchased by the Company pursuant to Section 4.13 4.14 or Section 4.14 4.15 of the Indenture, check the appropriate box:

Appears in 1 contract

Samples: Indenture (Penhall Co)

Dated. Signed: -------------------------------- ---------------------------------- --------------- -------------------------------------------------- (Sign exactly as name appears on the other side of this Note) Signature Guarantee: ------------------------------------------------------------ -------------------- TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, amended and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company Issuers as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ---------------------------- ----------------------------------------- ------------- ---------------------------------------- NOTICE: To be executed by an executive officer OPTION OF HOLDER TO ELECT PURCHASE If you want EXHIBIT C Form of Certificate To Be Delivered in Connection with Transfers to elect to have this Note purchased by the Company pursuant to Section 4.13 or Section 4.14 of the Indenture, check the appropriate boxNon-QIB Accredited Investors Ladies and Gentlemen:

Appears in 1 contract

Samples: Supplemental Indenture (Canadian Abraxas Petroleum LTD)

Dated. Signed: -------------------------------- ---------------------------------- -------------------- ------------------------------ (Sign exactly as name appears on the other side of this NoteSecurity) Signature Guarantee: ------------------------------------------------------------ ------------------------------------------------ TO BE COMPLETED BY PURCHASER IF (2) ABOVE IS CHECKED The undersigned represents and warrants that it is purchasing this Note Security for its own account or an account with respect to which it exercises sole investment discretion and that it and any such account is a "qualified institutional buyer" within the meaning of Rule 144A under the Securities Act of 1933, as amended, and is aware that the sale to it is being made in reliance on Rule 144A and acknowledges that it has received such information regarding the Company as the undersigned has requested pursuant to Rule 144A or has determined not to request such information and that it is aware that the transferor is relying upon the undersigned's foregoing representations in order to claim the exemption from registration provided by Rule 144A. Dated: ---------------------------- ----------------------------------------- -------------------- ------------------------------ NOTICE: To be executed by an executive officer OPTION OF HOLDER TO ELECT PURCHASE If you want to elect to have this Note Security purchased by the Company pursuant to Section 4.13 4.15 or Section 4.14 4.16 of the Indenture, check the appropriate box:

Appears in 1 contract

Samples: Building One Services Corp

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