ISSUE TO Sample Clauses

ISSUE TO. (NAME) -------------------------------------------------------------------------------- (ADDRESS, INCLUDING ZIP CODE) -------------------------------------------------------------------------------- (SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER) DELIVER TO: --------------------------------------------------------------------- (NAME) -------------------------------------------------------------------------------- (ADDRESS, INCLUDING ZIP CODE) If the number of shares of Common Stock purchased hereby is less than the number of shares of Common Stock covered by the Warrant, the undersigned requests that a new Warrant representing the number of shares of Common Stock not so purchased be issued and delivered as follows:
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ISSUE TO. (NAME OF HOLDER) -------------------------------------------------------------------------------- (ADDRESS, INCLUDING ZIP CODE) DELIVER TO: -------------------------------------------------------------------- (NAME OF HOLDER) -------------------------------------------------------------------------------- (ADDRESS, INCLUDING ZIP CODE) Dated: , 200 [NAME OF HOLDER] ------------ - By ------------------------------------- Name: Title: EXHIBIT B to Common Stock Purchase Warrant [FORM OF] ASSIGNMENT FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers unto the Assignee named below all of the rights of the undersigned to purchase Common Stock, par value $__________ per share ("Common Stock") of XANODYNE PHARMACEUTICALS, INC. represented by the Warrant, with respect to the number of shares of Common Stock set forth below: Name of Assignee Address No. of Shares ---------------- ------- ------------- and does hereby irrevocably constitute and appoint ___________ Attorney to make such transfer on the books of XANODYNE PHARMACEUTICALS, INC. maintained for that purpose, with full power of substitution in the premises. Dated: , 200 [NAME OF HOLDER] ------------ - By: ------------------------------------ Name: Title: EXHIBIT C to Common Stock Purchase Warrant
ISSUE TO. (NAME OF HOLDER) -------------------------------------------------------------------------------- (ADDRESS, INCLUDING ZIP CODE) DELIVER TO: --------------------------------------------------------------------- (NAME OF HOLDER) -------------------------------------------------------------------------------- (ADDRESS, INCLUDING ZIP CODE) Dated: , 20 [NAME OF HOLDER] -------------- --- By: --------------------------------- Name: Title
ISSUE TO. Check here if after the Liquidity Event and requesting delivery by Deposit/Withdrawal at Custodian as follows: DTC Participant: DTC Number: Account Number: Date: _____________ __, Name of Registered Holder By: Name: Title: Tax ID:____________________________ E-mail Address:_____________________ EXHIBIT B ASSIGNMENT FORM (To assign the foregoing Warrant, execute this form and supply required information. Do not use this form to purchase shares.) FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to Name: (Please Print) Address (Please Print) Phone Number: Email Address: Dated: , Holder’s Signature: Holder’s Address: Appendix C NEITHER THIS SECURITY NOR THE SECURITIES FOR WHICH THIS SECURITY IS EXERCISABLE HAVE BEEN REGISTERED WITH THE SECURITIES AND EXCHANGE COMMISSION OR THE SECURITIES COMMISSION OF ANY STATE IN RELIANCE UPON AN EXEMPTION FROM REGISTRATION UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “SECURITIES ACT”), AND, ACCORDINGLY, MAY NOT BE OFFERED OR SOLD EXCEPT PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT UNDER THE SECURITIES ACT OR PURSUANT TO AN AVAILABLE EXEMPTION FROM, OR IN A TRANSACTION NOT SUBJECT TO, THE REGISTRATION REQUIREMENTS OF THE SECURITIES ACT AND IN ACCORDANCE WITH APPLICABLE STATE SECURITIES LAWS. THIS SECURITY AND THE SECURITIES ISSUABLE UPON EXERCISE OF THIS SECURITY MAY BE PLEDGED IN CONNECTION WITH A BONA FIDE MARGIN ACCOUNT OR OTHER LOAN SECURED BY SUCH SECURITIES. COMMON STOCK PURCHASE WARRANT SINGLEPOINT, INC. Initial Exercise Date: April 21, 2022 THIS COMMON STOCK PURCHASE WARRANT (the “Warrant”) certifies that, for value received, Target Capital 10 LLC or its assigns (the “Holder”) is entitled, upon the terms and subject to the limitations on exercise and the conditions hereinafter set forth, at any time on or after the date hereof (the “Initial Exercise Date”) and on or prior to 5:00 p.m. (New York City time) on April 21, 2025 (the “Termination Date”) but not thereafter, to subscribe for and purchase from SINGLEPOINT, INC., a Nevada corporation (the “Company”), up to 50% of the number of shares of Common Stock issuable under the Note or following an Event of Default, up to 75% of the number of shares of Common Stock issuable under the Note (as subject to adjustment hereunder, the “Warrant Shares”). For purposes of calculating the number of Warrant Shares issuable hereunder only, the number of shares of Common Stock issuable under the Note shall be deemed to equal (x)...
ISSUE TO. (NAME OF HOLDER) (ADDRESS, INCLUDING ZIP CODE) DELIVER TO: --------------------------------------------------------------------- (NAME OF HOLDER) (ADDRESS, INCLUDING ZIP CODE) Dated: _____________, 20__ [NAME OF HOLDER] By ---------------------------- Name: Title: EXHIBIT B to Common Stock Purchase Warrant FORM OF ASSIGNMENT FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers unto the Assignee named below all of the rights of the undersigned to purchase Common Stock, par value $0.01 per share ("Common Stock") of GENERAL DATACOMM INDUSTRIES, INC. represented by the Warrant, with respect to the number of shares of Common Stock set forth below: Name of Assignee Address No. of Shares ---------------- ------- ------------- and does hereby irrevocably constitute and appoint ________ Attorney to make such transfer on the books of the Corporation maintained for that purpose, with full power of substitution in the premises. Dated: _______________, 20__ [NAME OF HOLDER]
ISSUE TO. (NAME) -------------------------------------------------------------------------------- (ADDRESS, INCLUDING ZIP CODE) -------------------------------------------------------------------------------- (SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER) DELIVER TO: --------------------------------------------------------------------- (NAME) -------------------------------------------------------------------------------- (ADDRESS, INCLUDING ZIP CODE) If the number of Series C Shares purchased (and/or reduced) hereby is less than the number of Series C Shares covered by the Warrant, the undersigned requests that a new Warrant representing the number of Series C Shares not so purchased (or reduced) be issued and delivered as follows:
ISSUE TO. Xxx Xxxxx one hundred (100) shares of nonqualified preferred stock of Auto Specialty (the "Xxx Xxxxx Auto Specialty Preferred Stock"); and
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ISSUE TO. (NAME OF HOLDER) -------------------------------------------------------------------------------- (ADDRESS, INCLUDING ZIP CODE) DELIVER TO: -------------------------------------------------------------------- (NAME OF HOLDER) -------------------------------------------------------------------------------- (ADDRESS, INCLUDING ZIP CODE) Dated: [NAME OF HOLDER] -------------- By ------------------------- Name: Title: __________________, as transfer agent and registrar of the Common Stock, is hereby authorized and directed to issue the above number of shares of Common Stock in the name of the above referenced entity or person and to deliver the certificates representing such shares using an overnight delivery service.
ISSUE TO. (NAME) ------------------------------------------------------------------------------- ADDRESS, INCLUDING ZIP CODE) ------------------------------------------------------------------------------- (SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER) DELIVER TO -------------------------------------------------------------------- (NAME) at --------------------------------------------------------------------------- (ADDRESS, INCLUDING ZIP CODE) Date: ---------------------- ---------------------- Signature (Signature must conform in all respects to name of holder as specified on the face of the Warrant Certificate.)
ISSUE TO. (NAME) ------------------------------------------------------------------------------- (ADDRESS, INCLUDING ZIP CODE) ------------------------------------------------------------------------------- (SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER) DELIVER TO: -------------------------------------------------------------------- (NAME) ------------------------------------------------------------------------------- (ADDRESS, INCLUDING ZIP CODE) If the number of Series C Shares purchased (and/or reduced) hereby is less than the number of Series C Shares covered by the Warrant, the undersigned requests that a new Warrant representing the number of Series C Shares not so purchased (or reduced) be issued and delivered as follows:
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