Common use of FORM OF ELECTION TO PURCHASE Clause in Contracts

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:

Appears in 4 contracts

Samples: Rights Agreement (Cytrx Corp), Rights Agreement (Delek US Holdings, Inc.), Rights Agreement (Contango Oil & Gas Co)

AutoNDA by SimpleDocs

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:

Appears in 3 contracts

Samples: Shareholder Rights Agreement (Mimedx Group, Inc.), Stockholder Rights Agreement (Sandridge Energy Inc), Rights Agreement (Dakota Plains Holdings, Inc.)

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: *Medallion Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 3 contracts

Samples: Rights Agreement, Rights Agreement (Contango ORE, Inc.), Rights Agreement (Cloud Peak Energy Inc.)

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:

Appears in 3 contracts

Samples: Rights Agreement (Gastar Exploration Inc.), Rights Agreement (Gastar Exploration Inc.), Rights Agreement (Vaalco Energy Inc /De/)

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 Person 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 _____________Dated: , ______. Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 3 contracts

Samples: Rights Agreement (Double-Take Software, Inc.), Rights Agreement (Wabash National Corp /De), Rights Agreement (Wabash National Corp /De)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Rights Certificate.) To:______________________ : PHARMATHENE, 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 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: 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 print name and address) Please insert social security or other identifying number: Dated number (Please print name and address): Dated:_____________, ______. Signature ________________ Signature: ________________________________ Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 2 contracts

Samples: Section 382 Rights Agreement (Pharmathene, Inc), Section 382 Rights Agreement (Pharmathene, Inc)

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 Medallion Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 2 contracts

Samples: Rights Agreement (Nuverra Environmental Solutions, Inc.), Tax Benefits Preservation Plan (Bonanza Creek Energy, Inc.)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Rights Certificate.) ToTo American Medical Security Group, Inc.: The undersigned hereby irrevocably elects to exercise __________ Rights represented by this Rights Certificate to purchase the Preferred Shares 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:______________________ 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 :_____________, ______. ___ (Please print name and address) Dated: _______________,_____ ________________________________ Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 2 contracts

Samples: Rights Agreement (American Medical Security Group Inc), Rights Agreement (American Medical Security Group Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Rights Certificate.) To:___________: FRONTLINE CAPITAL GROUP: The undersigned hereby irrevocably elects to exercise ___________ 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 Person which may be issuable or such other assets which may be deliverable upon the exercise of the Rights) and requests that certificates for any 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 insert social security or other identifying number (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 insert social security or other identifying number (Please print name and address) Please insert social security or other identifying numberDated: Dated _______________, ______. _ Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 2 contracts

Samples: Rights Agreement (Frontline Capital Group), Rights Agreement (Frontline Capital Group)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Rights Certificate.) To:____________: INNOVATE CORP.: The undersigned hereby irrevocably elects to exercise __________ The undersigned hereby irrevocably elects to exercise Rights represented by this Rights Certificate to purchase the shares of Preferred Stock (or other securities or property) issuable upon the exercise of the such 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 of Preferred Stock (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 Rightssecurities) be issued in the name of and delivered to: Please insert social security or other identifying number (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 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) Please insert social security or other identifying numberDated: Dated ________________, ______. ____ _____________________________________ Signature (Signature must conform to holder specified on Rights Certificate) Signature Guaranteed: Certificate The undersigned hereby certifies Signature must be guaranteed by checking the appropriate boxes that:a bank, trust company, broker, dealer or other eligible institution participating in a recognized signature guarantee medallion program.

Appears in 2 contracts

Samples: Tax Benefits Preservation Plan (INNOVATE Corp.), Tax Benefits Preservation Plan (INNOVATE Corp.)

FORM OF ELECTION TO PURCHASE. (To be executed if by the registered holder if such holder desires to exercise Rights represented by the Rights evidenced by this Rights Certificate.) To: JP REALTY, INC. The undersigned hereby irrevocably elects to exercise ________________ Rights evidenced by this Rights Certificate to purchase the Units issuable upon the exercise of the Rights (or such other securities, cash or property of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such Units (or such other securities which may be issuable upon the exercise of the Rights) be issued in the name of and delivered to: Please insert social security or other identifying number:__________________________________ 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 name) (Please print address) Please insert social security or other identifying number: If such number of Rights shall not be all of 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:__________________________________ (Please print name) (Please print address) Dated: Dated ______________________________________, Signature: ______. Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking ____________________________ (Sign exactly as your name appears on the appropriate boxes that:other side of this Rights Certificate)

Appears in 2 contracts

Samples: Rights Agreement (Jp Realty Inc), Rights Agreement (Jp Realty Inc)

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 numberprint name and address: Dated _____________, ______. Signature Signature Guaranteed_____ Please insert social security or other identifying number: Certificate The undersigned hereby certifies by checking the appropriate boxes that:________________________

Appears in 2 contracts

Samples: Rights Agreement (Dominari Holdings Inc.), Rights Agreement (Aikido Pharma Inc.)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Rights Right Certificate.) To:_: PHARMACOPEIA, INC. The undersigned hereby irrevocably elects to exercise Rights represented by this Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of such 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 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 Right Certificate, a new Right Certificate for the balance remaining 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: _____________________ The undersigned hereby irrevocably elects to exercise Rights represented Signatures must be guaranteed by this Rights Certificate to purchase the shares a member firm of Preferred Stock issuable upon the exercise a registered United States national securities exchange, a member of the Rights (National Association of Securities Dealers, Inc., or such other securities of the Company a commercial bank or of any other person trust company having an office 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 correspondent 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 _____________, ______United States. Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 2 contracts

Samples: Rights Agreement (Pharmacopeia Inc), Rights Agreement (Pharmacopeia Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise the Rights represented by the Rights Certificate.) To:______________________ : PICO HOLDINGS, 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 or Person (as such other property term is defined in the Rights Agreement) 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 toto or that such shares be credited to the book-entry account of: (Please print name and address) Please insert social security or other identifying number: 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 print name and address) Please insert social security or other identifying numbernumber (Please print name and address): Dated: Dated _____________, ______. Signature Signature: Medallion Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Section 382 Rights Agreement (Pico Holdings Inc /New)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Rights Right Certificate.) To:______________________ To COGNEX CORPORATION: The undersigned hereby irrevocably elects to exercise Rights represented by this Rights Right 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 toof: Please insert social security or other identifying taxpayer number: _____________________________________________________________ (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 Right Certificate or if the Rights Certificateare being exercised pursuant to Section 11(a)(ii) of the Rights Agreement, a new Rights Right 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 taxpayer number: Dated _____________, ______. __________________________________________ (Please print name and address) Dated: , Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Shareholder Rights Agreement (Cognex Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Rights Certificate.) To:________: INSIGHT ENTERPRISES, INC: The undersigned hereby irrevocably elects to exercise ______________ 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 deliverable to: (Please print name and address) Please insert social security or other identifying number: 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 ___number ------------------------------------------------------------ Dated:__________, ______. _ ---------------------------- Signature Signature Guaranteed: ------------------------------ Signatures must be guaranteed by a member firm of a registered national stock exchange, a member of the National Association of Securities Dealers, Inc. or a commercial bank or trust company having an office or correspondent in the United States. 47 Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Insight Enterprises Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Rights Certificate.) To:_____________: MANATRON, INC. The undersigned hereby irrevocably elects to exercise _________ 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: ___________________________________ (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 print name and address) Please insert social security or other identifying number: Dated ___________________________________ (Please print name and address) B-8 Dated: ______________, 20______. _ Signature Signature Guaranteed: B-9 Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Manatron Inc)

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 Medallion Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Tax Benefits Preservation Plan (Universal Stainless & Alloy Products Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Rights Right Certificate.) To:______________________ : PHOSPHATE HOLDINGS, INC. The undersigned hereby irrevocably elects to exercise Rights represented by this Rights Right Certificate to purchase the shares of Preferred Stock Common Shares issuable upon the exercise of the Rights (or such other securities of the Company or of any other person or such other property Person 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: (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Rights Right Certificate, a new Rights Right 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 _____________(Please print name and address) Date: , ______. Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Phosphate Holdings, Inc.)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Rights Certificate.) To:: ICU MEDICAL, INC. The undersigned hereby irrevocably elects to exercise __________ Rights represented by this Rights Certificate to purchase the number of one-hundredths of a share of Preferred Stock issuable upon the exercise of such 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 number of one-hundredths of a share of Preferred Stock be issued in the name of and delivered to: Please insert social security or other identifying number: ______________________________ 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:___________

Appears in 1 contract

Samples: Rights Agreement (Icu Medical Inc/De)

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:

Appears in 1 contract

Samples: Rights Agreement (Myos Rens Technology Inc.)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Rights Certificate.) To:______________________ : TRENWICK GROUP LTD.: The undersigned hereby irrevocably elects to exercise ______ Rights represented by this Rights Certificate to purchase the shares of Series A Preferred Stock Shares 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 insert social security or other identifying number (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, 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) Please insert social security or other identifying numberDated: Dated _____________, 20______. _ Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Trenwick Group LTD)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Rights Certificate.) To:____________: AVIS BUDGET GROUP, INC. The undersigned hereby irrevocably elects to exercise __________ 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 insert social security or other identifying number (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 insert social security or other identifying number (Please print name and address) Please insert social security or other identifying numberDated: Dated _____________, __,__ ______. Signature _________________________ Signature: Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Avis Budget Group, Inc.)

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 _____________________ Dated:____________, ____ ___. __________________________ Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Arbitron Inc)

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 _____________Dated: , ______. Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Office Depot Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Rights Right Certificate.) To:____: bebe stores, inc. The undersigned hereby irrevocably elects to exercise __________________ The undersigned hereby irrevocably elects to exercise Rights represented by this Rights Right Certificate to purchase the shares of Series A Preferred Stock issuable upon the exercise of the such Rights (or such other securities or property of the Company or of any other person or such other property Person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares stock (or such other securities or property of the Company or of any other person or such other property as Person which may be issuable upon the exercise of the Rights) be issued in the name of and delivered (or to: , as the case may be): (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 Right Certificate, a new Rights Right 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) Please insert social security or other identifying numberDated: Dated _____________, ______. _ Signature Signature Medallion Guaranteed: Certificate Signatures must be guaranteed by an “eligible guarantor institution” as defined in Rule 17Ad-15 promulgated under the Securities Exchange Act of 1934, as amended, which is a member of a recognized Medallion Signature Guarantee Program. The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Sale Agreement (B. Riley Financial, Inc.)

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:

Appears in 1 contract

Samples: Rights Agreement (Genvec Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Rights Certificate.) To:______________________ TO: QUOTIENT TECHNOLOGY 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 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 Rightssecurities) be issued in the name of and delivered to: (Please print name and address) 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 securityor other identifying number: ______________________ (Please print name and address) Please insert social security or other identifying numberDated: Dated ______________, ______. _ Signature Signature Medallion Guaranteed: Certificate The undersigned hereby certifies Signatures must be guaranteed by checking an eligible institution participating in a recognized signature guarantee medallion program at a guarantee level acceptable to the appropriate boxes that:Rights Agent.

Appears in 1 contract

Samples: Tax Benefits Preservation Plan (Quotient Technology Inc.)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Rights Right Certificate.) To:_____________To AVANIR Pharmaceuticals, Inc.: The undersigned hereby irrevocably elects to exercise _________ The undersigned hereby irrevocably elects to exercise Rights represented by this Rights Right 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 toof: Please insert social security or other identifying taxpayer number: (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 Right Certificate or if the Rights Certificateare being exercised pursuant to Section 11(a)(ii) of the Rights Agreement, a new Rights Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying taxpayer number: (Please print name and address) Please insert social security or other identifying numberDated: Dated _________, ___ _____________, ___ Signature Signature Guaranteed: ______. Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:_______________

Appears in 1 contract

Samples: Stockholder Rights Agreement (Avanir Pharmaceuticals)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Rights Right Certificate.) To:_______________To SENSEI BIOTHERAPEUTICS, INC.: The undersigned hereby irrevocably elects to exercise _______ The undersigned hereby irrevocably elects to exercise Rights represented by this Rights Right 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 toof: Please insert social security or other identifying taxpayer number: __________________ (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 Right Certificate or if the Rights Certificateare being exercised pursuant to Section 11(a)(ii) of the Rights Agreement, a new Rights Right 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 taxpayer number: Dated _____________, _____ (Please print name and address) Dated: ______. ___, __ Signature Signature Medallion Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:______________________________

Appears in 1 contract

Samples: Stockholder Rights Agreement (Sensei Biotherapeutics, Inc.)

AutoNDA by SimpleDocs

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Rights Certificate.) To:______________________ : LIVEPERSON, 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 or such other property which that 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: (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 print name and address) Please insert social security or other identifying number: Dated (Please print name and address) Dated: _____________, ______. _ Signature Signature Guaranteed: Certificate The undersigned hereby certifies _________________________ Signature must be guaranteed by checking the appropriate boxes that:a bank, trust company, broker, dealer or other eligible institution participating in a recognized signature guarantee medallion program.

Appears in 1 contract

Samples: Tax Benefits Preservation Plan (Liveperson Inc)

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 Medallion Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Tax Benefits Preservation Plan (Edgio, Inc.)

FORM OF ELECTION TO PURCHASE. (To be executed if by the registered holder if such holder desires to exercise any or all of the Rights represented by the Rights this Right Certificate.) To:______________________ To Trident Microsystems, Inc.: The undersigned hereby irrevocably elects to exercise ( ) of the Rights represented by this Rights Right Certificate to purchase the shares of Preferred the Common Stock of the Company, or other securities or property issuable upon the exercise of said number of Rights pursuant to 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 Agreement. The undersigned hereby requests that certificates a certificate for any such shares (or securities and any 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 Name, address and address) Please insert social security or other identifying number: If such number of issuee) The undersigned hereby further requests that if said number of Rights shall not be all the Rights evidenced represented by this Rights Right Certificate, a new Rights Right Certificate for the remaining balance of such Rights shall be registered issued in the name of and delivered to: (Please print name Name, address and address) Please insert social security or other identifying numbernumber of issuee) Dated: Dated _____________, ______. Signature (Signature) Signature Guaranteed: 8 Form of Reverse Side of Right Certificate The undersigned hereby certifies by checking the appropriate boxes that:(continued)

Appears in 1 contract

Samples: Rights Agreement (Trident Microsystems Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if by the registered holder if such holder desires to exercise any or all of the Rights represented by the Rights this Right Certificate.) To:______________________ To Halozyme Therapeutics, Inc.: The undersigned hereby irrevocably elects to exercise ( ) of the Rights represented by this Rights Right Certificate to purchase the shares of Preferred the Common Stock of the Company, or other securities or property issuable upon the exercise of said number of Rights pursuant to 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 Agreement. The undersigned hereby requests that certificates a certificate for any such shares (or securities and any 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 Name, address and address) Please insert social security or other identifying number: If such number of issuee) The undersigned hereby further requests that if said number of Rights shall not be all the Rights evidenced represented by this Rights Right Certificate, a new Rights Right Certificate for the remaining balance of such Rights shall be registered issued in the name of and delivered to: (Please print name Name, address and address) Please insert social security or other identifying numbernumber of issuee) Dated: Dated _____________, ______. Signature (Signature) Signature Guaranteed: Form of Reverse Side of Right Certificate The undersigned hereby certifies by checking the appropriate boxes that:(continued)

Appears in 1 contract

Samples: Rights Agreement (Halozyme Therapeutics Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if by the registered holder if such holder desires to exercise any or all Rights represented evidenced by the Rights Certificate.) To:______________________ : Medical Staffing Network Holdings, Inc.: The undersigned hereby irrevocably elects to exercise ( ) Rights represented evidenced by this Rights Certificate to purchase the shares of Preferred Stock Shares issuable upon the exercise of the Rights (or such other securities of the Company or of any other person or such other property which that 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 toto or that such shares be credited to the book-entry account of: (Please print social security or other identifying number) (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) (Please print name and address) Dated: Dated _____________, ______. Signature Medallion Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Medical Staffing Network Holdings Inc)

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 Medallion Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Tax Benefits Preservation Plan (RiceBran Technologies)

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 Person 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 _____________, ______. __________________________________________ Dated: , Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Evergreen Energy Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented repre- sented by the Rights Certificate.) To:______________________ : SINA CORPORATION: The undersigned hereby irrevocably elects to exercise Rights represented by this Rights Certificate certificate to purchase the shares of Preferred Stock Ordinary Shares 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 insert social security or other identifying number (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 insert social security or other identifying number (Please print name and address) Please insert social security or other identifying numberDated: Dated _____________, __,____. _ Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Sina Corp)

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:

Appears in 1 contract

Samples: Rights Agreement (Freds Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Rights Certificate.) To:____________: DRIVE SHACK INC. The undersigned hereby irrevocably elects to exercise __________ 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 that 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 insert social security or other identifying number (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 insert social security or other identifying number (Please print name and address) Please insert social security or other identifying numberDated: Dated _____________, ,______. _ Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Tax Benefits Preservation Plan (Drive Shack Inc.)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Rights Certificate.) To:To INVESTORS TITLE COMPANY: The undersigned hereby irrevocably elects to exercise ______________________ 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 Corporation 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 insert social security or other identifying number (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 insert social security or other identifying number (Please print name and address) Please insert social security or other identifying numberDated: Dated _________________ ___, _____ (Signature) Signature Guaranteed: Certificate ______. Signature Signature Guaranteed: Certificate _____ The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Investors Title Co)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Rights Right Certificate.) To:____: Sinovac Biotech Ltd. The undersigned hereby irrevocably elects to exercise __________________ The undersigned hereby irrevocably elects to exercise Rights represented by this Rights Right Certificate to purchase the shares of Series A Preferred Stock Shares issuable upon the exercise of the such Rights (or such other securities or property of the Company or of any other person or such other property Person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares (or such other securities or property of the Company or of any other person or such other property as Person which may be issuable upon the exercise of the Rights) be issued in the name of and delivered (or to: , as the case may be): (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 Right Certificate, a new Rights Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert U.S. social security or other identifying number (Please print name and address) Please insert social security or other identifying numberDated: Dated _____________, ______. _ Signature Signature Medallion Guaranteed: Certificate Signatures must be guaranteed by an “eligible guarantor institution” as defined in Rule 17Ad-15 promulgated under the U.S. Securities Exchange Act of 1934, as amended, which is a member of a recognized Medallion Signature Guarantee Program. The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Sinovac Biotech LTD)

FORM OF ELECTION TO PURCHASE. (To be executed if by the registered holder if such holder desires to exercise any or all of the Rights represented by the Rights this Right Certificate.) To:______________________ To Jamba, Inc.: The undersigned hereby irrevocably elects to exercise ( ) of the Rights represented by this Rights Right Certificate to purchase the shares of Preferred the Common Stock of the Company, or other securities or property issuable upon the exercise of said number of Rights pursuant to 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 Agreement. The undersigned hereby requests that certificates a certificate for any such shares (or securities and any 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 Name, address and address) Please insert social security or other identifying number: If such number of issuee) The undersigned hereby further requests that if said number of Rights shall not be all the Rights evidenced represented by this Rights Right Certificate, a new Rights Right Certificate for the remaining balance of such Rights shall be registered issued in the name of and delivered to: (Please print name Name, address and address) Please insert social security or other identifying numbernumber of issuee) Dated: Dated _____________, ______. Signature (Signature) Signature Guaranteed: Form of Reverse Side of Right Certificate The undersigned hereby certifies by checking the appropriate boxes that:(continued)

Appears in 1 contract

Samples: Rights Agreement (Jamba, Inc.)

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:

Appears in 1 contract

Samples: Rights Agreement (Freds Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if by the registered holder if such holder desires to exercise any or all Rights represented evidenced by the Rights Certificate.) To:______________________ : Catalyst Pharmaceutical Partners, Inc.: The undersigned hereby irrevocably elects to exercise ( ) Rights represented evidenced by this Rights Certificate to purchase the shares of Preferred Stock Shares issuable upon the exercise of the Rights (or such other securities of the Company or of any other person or such other property which that 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 toto or that such shares be credited to the book-entry account of: (Please print social security or other identifying number) (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) (Please print name and address) Dated: Dated _____________, ______. Signature Medallion Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Catalyst Pharmaceutical Partners, Inc.)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Rights Certificate.) To:____________: INLAND STEEL INDUSTRIES, INC. The undersigned hereby irrevocably elects to exercise __________ 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 print 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 print social security or other identifying number: Dated ) Dated:_______________, 19__ ----------------------- Signature Signature Guaranteed:______. Signature Signature Guaranteed: ____________________ Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Inland Steel Industries Inc /De/)

FORM OF ELECTION TO PURCHASE. (To be executed if by the registered holder if such holder desires to exercise any or all Rights represented evidenced by the Rights Certificate.) To:______________________ : Xxxxxxx Industries, Inc.: The undersigned hereby irrevocably elects to exercise ( ) Rights represented evidenced by this Rights Certificate to purchase the shares of Preferred Stock Shares issuable upon the exercise of the Rights (or such other securities of the Company or of any other person or such other property which that 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 toto or that such shares be credited to the book-entry account of: (Please print social security or other identifying number) (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) (Please print name and address) Dated: Dated _____________, ______. 20 Signature (Signature must conform in all respects to the name of holder as written upon the face of this Right Certificate, without alternation or enlargement or any change whatsoever.) Medallion Signature Guaranteed*: Certificate The undersigned hereby certifies * Signature must be guaranteed by checking an “Eligible Guarantor Institution” pursuant to Rule 17Ad-15 of the appropriate boxes that:Securities Exchange Act of 1934, as amended.

Appears in 1 contract

Samples: Section 382 Rights Agreement (Schmitt Industries Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Rights Right Certificate.) To:______________________ : Transcept Pharmaceuticals, Inc. The undersigned hereby irrevocably elects to exercise Rights represented by this Rights Right Certificate to purchase the shares of Series A Preferred Stock issuable upon the exercise of the such Rights (or such other securities or property of the Company or of any other person or such other property Person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares stock (or such other securities or property of the Company or of any other person or such other property as Person which may be issuable upon the exercise of the Rights) be issued in the name of and delivered (or to: , as the case may be): (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 Right Certificate, a new Rights Right 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) Please insert social security or other identifying numberDated: Dated _____________, ______. Signature Signature Medallion Guaranteed: Certificate Signatures must be guaranteed by an “eligible guarantor institution” as defined in Rule 17Ad-15 promulgated under the Securities Exchange Act of 1934, as amended, which is a member of a recognized Medallion Signature Guarantee Program. The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Tax Benefit Preservation Plan (Transcept Pharmaceuticals Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Rights Right Certificate.) To:______________________ To La Jolla Pharmaceutical Company: The undersigned hereby irrevocably elects to exercise Rights represented by this Rights Right 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 toof: Please insert social security or other identifying taxpayer number: ______________________________________________________________ (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 Right Certificate or if the Rights Certificateare being exercised pursuant to Section 11(a)(ii) of the Rights Agreement, a new Rights Right 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 taxpayer number: Dated _____________, ______. ___________________________________________ (Please print name and address) Dated: , Signature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (La Jolla Pharmaceutical Co)

Draft better contracts in just 5 minutes Get the weekly Law Insider newsletter packed with expert videos, webinars, ebooks, and more!