Investment Representation Statement and Market. Stand-Off Agreement. Assignee has executed, and delivers herewith, an Investment Representation Statement and Market Stand-Off Agreement in a form substantially similar to the form attached to the Warrant Terms as Exhibit B-1. Assignor and Assignee are signing this Assignment Form on the date first set forth above. The Assignor may be required to provide evidence of authority and other documentation upon request by Computershare Inc. and Computershare Trust Company, N.A., the Warrant Agent with respect to the Warrants, including but not limited to, a signature guarantee from an eligible guarantor institution participating in a signature guarantee program approved by the Securities Transfer Association. ASSIGNOR ASSIGNEE (Print name of Assignor) (Print name of Assignee) (Signature of Assignor) (Signature of Assignee) (Print name of signatory, if applicable) (Print name of signatory, if applicable) (Print title of signatory, if applicable) (Print title of signatory, if applicable) Address: Address:
Appears in 2 contracts
Samples: Warrant Agreement (NEXGENT Inc.), Warrant Agreement (M&m Media, Inc.)
Investment Representation Statement and Market. Stand-Off Agreement. Assignee has executed, and delivers herewith, an Investment Representation Statement and Market Stand-Off Agreement in a form substantially similar to the form attached to the Warrant Terms as Exhibit B-1. Assignor and Assignee are signing this Assignment Form on the date first set forth above. The Assignor may be required to provide evidence of authority and other documentation upon request by Computershare Inc. and Computershare Trust Company, N.A., the Warrant Agent with respect to the Warrants, including but not limited to, a signature guarantee from an eligible guarantor institution participating in a signature guarantee program approved by the Securities Transfer Association. ASSIGNOR ASSIGNEE (Print name of Assignor) (Print name of the Assignee) (Signature of Assignor) (Signature of Assignee) (Print name of signatory, if applicable) (Print name of signatory, if applicable) (Print title of signatory, if applicable) (Print title of signatory, if applicable) Address: Address:
Appears in 2 contracts
Samples: Warrant Agreement (Crush Capital Inc.), Warrant Agreement (Crush Capital Inc.)