Name of Firm. XXXXXX XXXXXXX /S/ XXXX XXXXX ---------------------------------------- ------------------------------------------------------- (Authorized Signature) Address: 0000 XXXXXX XX XXX XXXXXXXX Title: VICE PRESIDENT --------------------------------------------- ----------------------------------------------- Name: XXXX XXXXX ------------------------------------------------ Area Code and Telephone Number: (000) 000-0000 ------------------------------------------------------- -------------------------------------- (Please print or type) Date: 4/12/02 ------------------------------------------------- Exhibit B NAME OF ENTITY TYPE OF ENTITY -------------------------------------- ---------------------------------- K Capital Partners, LLC Delaware limited liability company Special K Capital Offshore Master Fund Cayman Islands limited partnership (U.S. Dollar), L.P. K Capital Offshore Master Fund Cayman Islands limited partnership (U.S. Dollar), L.P. Harwich Capital Partners, LLC Delaware limited liability company Xxxxxx Xxxxx Natural person Xxxxx Xxxxxx Natural person
Name of Firm. Enter full name of the employing firm (the firm where the employee will actually work).
Name of Firm. 3. Name of Staff:
Name of Firm. BY: Print Name : (Name of firm’s authorized party to enter into contract) Title: Firm’s Name & location ATTEST: Print Name: (Name of firm’s representative) Title: Firm’s Name & Location
Name of Firm. Telephone: Fax: Email:
Name of Firm. Firm’s Nominee Name(s) (if applicable): ____________________________________________________________________________ ___________________________________________________________________________________________________________
Name of Firm or Company reserves the right to determine the total number of trainees who can be accepted in any given period of time.
Name of Firm. Address: ------------------------------------------------------------- --------------------------------------------------------------------- Zip Code Area Code and Telephone Number: ---------------------------------------------------- --------------------------------------------------------------------- AUTHORIZED SIGNATURE --------------------------------------------------------------------- TITLE Name: ---------------------------------------------------------------- PLEASE TYPE OR PRINT Dated: ---------------------------------------------------------, 1998 ============================================================================== NOTE: DO NOT SEND WARRANT CERTIFICATES WITH THIS FORM. CERTIFICATES MUST BE SENT WITH THE LETTER OF TRANSMITTAL.
