Common use of Election to Convert Clause in Contracts

Election to Convert. To: Chemed Corporation The undersigned owner of this Security hereby irrevocably exercises the option to convert this Security, or the portion below designated, into Capital Stock of CHEMED CORPORATION in accordance with the terms of the Indenture referred to in this Security, and directs that the shares issuable and deliverable upon conversion, together with any check in payment for fractional shares, be issued in the name of and delivered to the undersigned, unless a different name has been indicated in the assignment below. If shares are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Date: , in whole __ Portions of Security to be converted ($27 or integral multiples thereof): $_________________ ----------------------------------- Signature (for conversion only) Plese Print or Typewrite Name and Address, Including Zip Code, and Social Security or Other Identifying Number ----------------------------------- ----------------------------------- ----------------------------------- Signature Guarantee:(5) ----------------------------------- -------- (5)(Signature must be guaranteed by an "eligible guarantor institution" that is, a bank, stockbroker, savings and loan association or credit union meeting the requirements of the Registrar, which requirements include membership or participation in the Securities Transfer Agents Medallion Program ("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.)

Appears in 2 contracts

Samples: Indenture (Chemed Corp), Indenture (Chemed Capital Trust)

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Election to Convert. To: Chemed Corporation The undersigned owner of this Security hereby irrevocably exercises the option to convert this Security, or the portion below designated, into Capital Stock of CHEMED CORPORATION in accordance with the terms of the Indenture referred to in this Security, and directs that the shares issuable and deliverable upon conversion, together with any check in payment for fractional shares, be issued in the name of and delivered to the undersigned, unless a different name has been indicated in the assignment below. If shares are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Date: , in whole __ Portions of Security to be converted ($27 - or integral multiples thereof): $________________ ________________________________________ ----------------------------------- Signature (for conversion only) Plese Please Print or Typewrite Name and Address, Including Zip Code, and Social Security or Other Identifying Number ----------------------------------- ----------------------------------- ----------------------------------- ________________________________________ ________________________________________ ________________________________________ Signature Guarantee:(5Guarantee: (5) ----------------------------------- -------- (5)(Signature must be guaranteed by an "eligible guarantor institution" that is, a bank, stockbroker, savings and loan association or credit union meeting the requirements of the Registrar, which requirements include membership or participation in the Securities Transfer Agents Medallion Program ("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.)________________________________________ --------

Appears in 2 contracts

Samples: Chemed Corp, Chemed Capital Trust

Election to Convert. To: Chemed Suiza Foods Corporation The undersigned owner of this Security hereby irrevocably exercises the option to convert this Security, or the portion below designated, into Capital Common Stock of CHEMED CORPORATION Suiza Foods Corporation in accordance with the terms of the Indenture referred to in this Security, and directs that the shares issuable and deliverable upon conversion, together with any check in payment for fractional shares, be issued in the name of and delivered to the undersigned, unless a different name has been indicated in the assignment below. If shares are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Any holder, upon the exercise of its conversion rights in accordance with the terms of the Indenture and the Security, agrees to be bound by the terms of the Registration Rights Agreement relating to the Common Stock issuable upon conversion of the Securities. Date: , --------------------------------- in whole ___ Portions of Security to be in part in part ___ converted ($27 50 or integral multiples thereof): $_________________ ----------------------------------- $ ---------------------------------- ------------------------------------ Signature (for conversion only) Plese Please Print or Typewrite Name and Address, Including Zip Code, and Social Security or Other Identifying Number ----------------------------------- ----------------------------------- ----------------------------------- ------------------------------------ ------------------------------------ ------------------------------------ Signature Guarantee:(5) ----------------------------------- -------- (5)(Signature Guarantee:* --------------- ------------------------- * Signature must be guaranteed by an "eligible guarantor institution" that is, a commercial bank, stockbroker, savings and loan association trust company or credit union meeting the requirements member firm of the Registrar, which requirements include membership or participation in the Securities Transfer Agents Medallion Program ("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 1934New York Stock Exchange.)

Appears in 1 contract

Samples: Suiza Foods Corp

Election to Convert. To: Chemed Corporation DT Industries, Inc. The undersigned owner of this Security hereby irrevocably exercises the option to convert this Security, or the portion below designated, into Capital Common Stock of CHEMED CORPORATION DT INDUSTRIES, INC. in accordance with the terms of the Indenture referred to in this Security, and directs that the shares issuable and deliverable upon conversion, together with any check in payment for fractional shares, be issued in the name of and delivered to the undersigned, unless a different name has been indicated in the assignment below. If shares are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Any holder, upon the exercise of its conversion rights in accordance with the terms of the Indenture and the Security, agrees to be bound by the terms of the Registration Rights Agreement relating to the Common Stock issuable upon conversion of the Securities. Date: , in whole __ Portions of Security to be converted ($27 50 or integral multiples thereof): $_________________ ----------------------------------- $ ---------------------- ----------------------------------------- Signature (for conversion only) Plese Please Print or Typewrite Name and Address, Including Zip Code, and Social Security or Other Identifying Number ----------------------------------- ----------------------------------- ----------------------------------- ----------------------------------------- ----------------------------------------- ----------------------------------------- Signature Guarantee:(5) ----------------------------------- -------- Guarantee: 5/ ----------------- ------------------- 5/ (5)(Signature Signature must be guaranteed by an "eligible guarantor institution" that is, a bank, stockbroker, savings and loan association or credit union meeting the requirements of the Registrar, which requirements include membership or participation in the Securities Transfer Agents Medallion Program ("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.)

Appears in 1 contract

Samples: Purchase Agreement (Dt Industries Inc)

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Election to Convert. To: Chemed The AES Corporation The undersigned owner of this Security Debenture hereby irrevocably exercises the option to convert this SecurityDebenture, or the portion below designated, into Capital Common Stock of CHEMED CORPORATION THE AES CORPORATION, in accordance with the terms of the Indenture referred to in this SecurityDebenture, and directs that the shares issuable and deliverable upon conversion, together with any check in payment for fractional shares, be issued in the name of and delivered to the undersigned, unless a different name has been indicated in the assignment below. If shares are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Date: _________, ____ in whole __ Portions of Security Debenture to be converted ($27 50 or integral multiples thereof): $_________________ ----------------------------------- ------------------------------- Signature (for conversion only) Plese Please Print or Typewrite Name and Address, Including Zip Code, and Social Security or Other Identifying Number ----------------------------------- ----------------------------------- ----------------------------------- ---------------------- ---------------------- ---------------------- Signature Guarantee:(5) ----------------------------------- -------- (5)(Signature Guarantee:1____ ------------------- 1 Signature must be guaranteed by an "eligible guarantor institution" that is, is a bank, stockbroker, savings and loan association or credit union meeting the requirements of the RegistrarConversion Agent, which requirements include membership or of participation in the Securities Transfer Agents Medallion Program ("STAMP") or such other "signature guarantee program" as may be determined by the Registrar Conversion Agent in addition to, or in substitution for, STAMP, all in accordance with the Securities and Exchange Act of 1934, as amended.)

Appears in 1 contract

Samples: Aes Trust Ii

Election to Convert. To: Chemed The Titan Corporation The undersigned owner of this Security hereby irrevocably exercises the option to convert this Security, or the portion below designated, into Capital Common Stock of CHEMED CORPORATION The Titan Corporation in accordance with the terms of the Indenture referred to in this Security, and directs that the shares issuable and deliverable upon conversion, together with any check in payment for fractional shares, be issued in the name of and delivered to the undersigned, unless a different name has been indicated in the assignment below. If shares are to be issued in the name of a person other than the undersigned, the undersigned will pay all transfer taxes payable with respect thereto. Any Holder, upon the exercise of its conversion rights in accordance with the terms of the Indenture and the Security, agrees to be bound by the terms of the Registration Rights Agreement relating to the Common Stock issuable upon conversion of the Securities. Date: , in whole __ Portions of Security to be converted ($27 50 or integral multiples thereof): $_________________ ----------------------------------- Signature (for conversion only) Plese Please Print or Typewrite Name and Address, Including Zip Code, and Social Security or Other Identifying Number ----------------------------------- ----------------------------------- ----------------------------------- Signature Guarantee:(5Guarantee:(6) ----------------------------------- -------- ---------------------------- --------------- (5)(Signature 6) (Signature must be guaranteed by an "eligible guarantor institution" that is, a bank, stockbroker, savings and loan association or credit union meeting the requirements of the Registrar, which requirements include membership or participation in the Securities Transfer Agents Medallion Program ("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.)

Appears in 1 contract

Samples: Indenture (Titan Corp)

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