FORM OF ELECTION TO PURCHASE Sample Clauses

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Rights Certificate.) TO: ONEIDA LTD. The undersigned hereby irrevocably elects to exercise _________ Rights represented by this Rights Certificate to purchase the Units of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other Person or other property which may be issuable upon the exercise of the Rights) and requests that certificates for such Units be issued in the name of and delivered to: _______________________________________________________________________________ (Please print name and address) _______________________________________________________________________________ Please insert social security or other identifying number: If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: _______________________________________________________________________________ (Please print name and address) _______________________________________________________________________________ Please insert social security or other identifying number:
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FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Rights Certificate.) To: INTERPHASE CORPORATION The undersigned hereby irrevocably elects to exercise ____________ Rights represented by this Rights Certificate to purchase the shares of Common Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of and delivered to: Please insert social security or other identifying number ---------------------------- -------------------------------------------------------------------------------- (Please print name and address) -------------------------------------------------------------------------------- If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ---------------------------- -------------------------------------------------------------------------------- (Please print name and address) -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- Dated: , --------------------- ----- ----------------------------------------- Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:
FORM OF ELECTION TO PURCHASE. The undersigned hereby irrevocably elects to exercise of the Class A Warrants evidenced by the attached Warrant Certificate to purchase Warrant Shares, and herewith tenders (or is concurrently tendering) payment in the amount of $1.00 for each such Warrant Share in an amount determined in accordance with the terms of the Class A Warrant Agreement. The undersigned requests that a certificate representing such Warrant Shares be registered in the name of , a Person who is not a U.S. Person as that term is defined in Rule 902 of Regulation S, and whose address is: ______________________ and that such certificate be delivered to ________________, not a U.S. Person, and whose address is:___________________. If said number of Class A Warrants is less than the number of Class A Warrants evidenced by the Warrant Certificate, as calculated pursuant to the Class A Warrant Agreement, the undersigned requests that a new Warrant Certificate evidencing the number of Class A Warrants evidenced by this Warrant Certificate that are not being exercised be registered in the name of _________________, not a U.S. Person and whose address is: ______________________ and that such Warrant Certificate be delivered to _____________________, not a U.S. Person and whose address is: ______________________ Dated: Name of Holder of Warrant Certificate: ______________________ By: ______________________ (Please Print Name and Title, if applicable) ______________________ Address: ______________________ Signature: ______________________ Note: The above signature must correspond with the name as written in the first sentence of the attached Warrant Certificate in every particular, without alteration or enlargement or any change whatever, and if the certificate evidencing the Warrant Shares or any Warrant Certificate representing Class A Warrants not exercised is to be registered in a name other than that in which this Warrant Certificate is registered, the signature above must be guaranteed.
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Rights Certificate.)
FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Rights Certificate.) To:______________________ The undersigned hereby irrevocably elects to exercise Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person or such other property which may be issuable upon the exercise of the Rights) and requests that certificates for such shares (or such other securities of the Company or of any other person or such other property as may be issuable upon the exercise of the Rights) be issued in the name of and delivered to: (Please print name and address) Please insert social security or other identifying number: If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: (Please print name and address) Please insert social security or other identifying number: Dated _____________, ______. Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:
FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Certificate.) TO:_________________ The undersigned hereby irrevocably elects to exercise _________________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certificates for such share(s) be issued in the following name: Please insert social security or other identifying number: _______________________ ________________________________________________________________________________ (Please print name and address) _______________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: _______________________ ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ Dated: ________________, ____ _______________________________________ Signature (Signature must conform in all respects to name of holder as specified on the fact of this Rights Certificate) EXHIBIT C TO RIGHTS AGREEMENT FORM OF SECOND AMENDED CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF X. X. XXXXXX COMPANY, INC. Pursuant to Section 151 of the Delaware General Corporation Law X. X. Penney Company, Inc., a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFY:
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.)
FORM OF ELECTION TO PURCHASE. (To be Executed by the Holder if he Desires to Exercise the Warrants Evidenced by the Warrant Certificate) To CanArgo Energy Corporation: [The undersigned hereby irrevocably elects to exercise ( ) Warrants, evidenced by the within Warrant Certificate for, and to purchase thereunder, ( ) full shares of Common Stock issuable upon exercise of said Warrants and delivery of $ and payment of any applicable taxes. OR [The undersigned hereby irrevocably elects to convert ( ) Warrants, evidenced by the within Warrant Certificate, and to acquire Warrant Shares pursuant to theNet Issue Conversion” provision in Section 4 thereof, and, upon payment of any applicable taxes, to acquire Warrant Shares thereunder.] The undersigned hereby warrants and represents that he/it is an “accredited investor” as defined under Rule 501(a) of the Securities Act of 1933, as amended and accordingly the Warrants being exercised and the securities deliverable upon exercise thereof have been registered under the Act or are exempt from registration thereunder. Please register the certificates for such share as follows: Please insert taxpayer identification Or social security number (if any) . (Please print name) (Please print address) If said number of Warrants shall not be all the Warrants evidenced by the within Warrant Certificate, the undersigned requests that a new Warrant Certificate evidencing the Warrants not so exercised be registered in the name of the undersigned at the following address and deliver the Certificate to that address: (Please print address) (SIGNATURES CONTINUED ON FOLLOWING PAGE) Dated: Signature: .
FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Rights Certificate.) To: O'REILLY AUTOMOTIVE, INC.: The undersigned hereby irrevocably elects to exercise __________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of and delivered to: Please insert social security or other identifying number (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number (Please print name and address) Dated: _______________,__ Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:
FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Rights Certificate.) TO:_________________ The undersigned hereby irrevocably elects to exercise _________________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certificates for such share(s) be issued in the following name: Please insert social security or other identifying number:_________________ Please insert name and address:____________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number:_________________ ________________________________________________________________________________ ________________________________________________________________________________ Please insert name and address:_________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Dated: ______________, ______ __________________________________________ Signature (Signature must conform in all respects to name of holder as specified on the fact of this Rights Certificate) EXHIBIT C TO RIGHTS AGREEMENT CERTIFICATE OF DESIGNATIONS FORM OF CERTIFICATE OF DESIGNATIONS OF SERIES A JUNIOR PARTICIPATING PREFERRED STOCK OF GEOWORKS CORPORATION Pursuant to Section 151 of the Delaware General Corporation Law Geoworks Corporation, a company organized and existing under the laws of the State of Delaware (the "Company"), DOES HEREBY CERTIFY: