Common use of per Unit Clause in Contracts

per Unit. Each Class A Unit consists of one share of common stock and one-half of one warrant (each whole warrant, a “Warrant”). Eligible Purchasers of the Class B Units are those Purchasers that invest at least $50,000 in this Offering and have participated in a prior Company offering during the Period (as defined herein) and either, (i) invested at least $200,000 in a prior Company offering during the Period (as defined herein), or (ii) invest at least 25% of the amount such Purchaser invested in a prior Company offering during the Period in this Offering. Each Class B Unit consists of one share of common stock and one Warrant. The Purchaser agrees to be bound by the terms and conditions set forth in the attached “Terms and Conditions of Purchase for Units” including without limitation the representations, warranties and covenants set forth in the applicable schedules attached thereto. The Purchaser further agrees, without limitation, that each of the Company and Xxxxxxx Investment Company, LLC (the “Placement Agent”) may rely upon the Purchaser’s representations, warranties and covenants contained in such documents. “Period” shall mean any time between December 1, 2013 and May 1, 2015. Please complete and sign the Accredited Investor Certificate – Exhibit A and the Selling Shareholder Questionnaire– Exhibit C SUBSCRIPTION AND PURCHASER INFORMATION Please print all information (other than signatures), as applicable, in the space provided below Number of Class A Units: ____________________________________x $1.10 ___________________________________________________ (Name of Purchaser) Number of Class B Units: ____________________________________x $1.10 = Account Reference (if applicable): ________________________ By: ________________________________________________ Authorized Signature Aggregate Purchase Price: _____________________________ (the “Purchase Price”) ___________________________________________________ (Official Capacity or Title – if the Purchaser is not an individual) ___________________________________________________ (Name of individual whose signature appears above if different than the name of the Purchaser printed above.) ___________________________________________________ (Purchaser’s Address, including Municipality and Province) ___________________________________________________ S.I.N. or Taxation Account of Purchaser ___________________________________________________ (Telephone Number) (Email Address) If the Purchaser is signing as agent for a principal (beneficial purchaser) and is not purchasing as trustee or agent for accounts fully managed by it, complete the following: ___________________________________________________ (Name of Principal) ___________________________________________________ (Principal’s Address) ___________________________________________________ Account Registration Information: ___________________________________________________ (Name) ___________________________________________________ (Account Reference, if applicable) ___________________________________________________ (Address, including Postal Code) Delivery Instructions as set forth below: ___________________________________________________ (Name) ___________________________________________________ (Account Reference, if applicable) ___________________________________________________ (Address) ___________________________________________________ (Contact Name) (Telephone Number) PURCHASE AGREEMENT FOR UNITS OF ANTRIABIO, INC. (a Delaware corporation)

Appears in 1 contract

Samples: Purchase Agreement (AntriaBio, Inc.)

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per Unit. Each Class A Unit consists of one common share in the capital of common stock the Corporation (a "Common Share") and one-half of one Common Share purchase warrant (each whole Common Share purchase warrant, a "Warrant"). Eligible Purchasers Each Warrant will entitle the holder thereof to purchase one Common Share (a "Warrant Share") at a price of $1.25 (the "Exercise Price") for a period of thirty (30) months following the Closing Date (as hereinafter defined); provided that, if at any time the closing trading price of the Class B Units are those Purchasers that invest at least Common Shares for any 20 consecutive trading days exceeds $50,000 in this Offering and have participated in a prior Company offering during 2.50, the Period (as defined herein) and either, (i) invested at least $200,000 in a prior Company offering during Corporation may accelerate the Period (as defined herein), or (ii) invest at least 25% expiry date of the amount Warrants by giving notice to the holders thereof and in such Purchaser invested in a prior Company offering during case the Period in this Offering. Each Class B Unit consists of one share of common stock and one WarrantWarrants will expire on the 30th calendar day after the date on which such notice is deemed to have been received by such holders. The Purchaser Subscriber agrees to be bound by the terms and conditions set forth in the attached "Terms and Conditions of Purchase Subscription for Units" including without limitation the representations, warranties and covenants set forth in the applicable schedules attached thereto. The Purchaser Subscriber further agrees, without limitation, that each of the Company Corporation and Xxxxxxx Investment Company, LLC the Agent (the “Placement Agent”as hereinafter defined) may rely upon the Purchaser’s Subscriber's representations, warranties and covenants contained in such documents. “Period” shall mean any time between December 1, 2013 and May 1, 2015. Please complete and sign the Accredited Investor Certificate – Exhibit A and the Selling Shareholder Questionnaire– Exhibit C SUBSCRIPTION AND PURCHASER SUBSCRIBER INFORMATION Please print all information (other than signaturesSignatures), as applicable, in the space provided below Name of Subscriber Number of Class A Units: ____________________________________x X $1.10 _______________0.90 = Account Reference (if applicable): ____________________________________ (Name of Purchaser) Number of Class B UnitsAggregate Subscription Price: ____________________________________x $1.10 = Account Reference (if applicable): ________________________ By: ________________________________________________ Authorized Signature Aggregate Purchase Price: _____________________________ (the “Purchase Subscription Price”) ___________________________________________________ Authorized Signature (Official Capacity or Title - if the Purchaser Subscriber is not an individual) ___________________________________________________ (Name of individual whose signature appears above if different than the name of the Purchaser printed above.) ___________________________________________________ (Purchaser’s Address, including Municipality and Province) ___________________________________________________ S.I.N. or Taxation Account of Purchaser ___________________________________________________ (Telephone Number) (Email Address) If the Purchaser Subscriber is signing as agent for a principal (beneficial purchaser) and is not purchasing as a trustee or agent for accounts account fully managed by it, complete the following: ___________________________________________________ (Name of individual whose signature appears above if different than the name of the Subscriber printed above.) (Name of Principal) ___________________________________________________ (Subscriber’s Address, including Municipality and Province) (Principal’s Address) ___________________________________________________ Account Registration Information: ___________________________________________________ (Name) ___________________________________________________ (Account Reference, if applicable) ___________________________________________________ (Address, including Postal Code) Delivery Instructions as set forth below: ___________________________________________________ (Name) ___________________________________________________ (Account Reference, if applicable) ___________________________________________________ (Address) ___________________________________________________ (Contact Name) (Telephone Number) PURCHASE AGREEMENT FOR UNITS OF ANTRIABIO, INC. (a Delaware corporationEmail Address)

Appears in 1 contract

Samples: Polymet Mining Corp

per Unit. Each Class A Unit consists shall consist of one (1) share of common stock of the Corporation (a "COMMON SHARE") and one-half (1/2) Common Share purchase warrant of one warrant the Corporation (each whole warrant, a “Warrant”"WARRANT"). Eligible Purchasers Each one (1) whole Warrant shall entitle the holder to acquire one (1) Common Share (a "WARRANT SHARE") at a price equal to CAD$2.65 per Warrant Share for a period of eighteen (18) months from the date of issue of the Class B Units are those Purchasers that invest at least $50,000 in this Offering and have participated in a prior Company offering during the Period (as defined herein) and either, (i) invested at least $200,000 in a prior Company offering during the Period (as defined herein), or (ii) invest at least 25% of the amount such Purchaser invested in a prior Company offering during the Period in this Offering. Each Class B Unit consists of one share of common stock and one WarrantWarrants. The Purchaser Subscriber agrees to be bound by the attached terms and conditions set forth in of subscription (the attached “Terms "TERMS AND CONDITIONS") and Conditions of Purchase for Units” including without limitation agrees that the Corporation and its agents and attorneys may rely upon the representations, warranties and covenants set forth contained therein and in the applicable schedules attached theretoSubscriber Certificate (as hereinafter defined). The Purchaser further agreesThis subscription, without limitation, that each plus the Terms and Conditions of the Company completed and Xxxxxxx Investment Companyexecuted Subscriber Certificate, LLC (are collectively referred to as the “Placement Agent”) may rely upon "SUBSCRIPTION AGREEMENT" or the Purchaser’s representations, warranties and covenants contained in such documents. “Period” shall mean any time between December 1, 2013 and May 1, 2015. Please complete and sign the Accredited Investor Certificate – Exhibit A and the Selling Shareholder Questionnaire– Exhibit C "AGREEMENT." SUBSCRIPTION AND PURCHASER SUBSCRIBER INFORMATION Please print all information (other than signatures), as applicable, in the space provided below XXXXXXX, XXXXX & CO. Number of Class A Units*: ____________________________________x $1.10 ___________________________________________________ 1,437,829 ------------------------------------- ------------------- (Name of PurchaserSubscriber) Number of Class B UnitsShare Price: ____________________________________x $1.10 = X CAD $ 2.20 Account Reference (if applicable): ________________________ ------------ ---- Aggregate Subscription Price: USD $ 3,250,000 -------------------------- By: ________________________________________________ /S/ XXXXXX XXXXXXXXXX (the "SUBSCRIPTION PRICE") -------------------------------- Authorized Signature Aggregate Purchase Price: _____________________________ (the “Purchase Price”) ___________________________________________________ ------------------------------------- IF THE SUBSCRIBER IS SIGNING AS (Official Capacity or Title - if the Purchaser AGENT FOR A PRINCIPAL (BENEFICIAL Subscriber is not an individual) ___________________________________________________ PURCHASER) AND IS NOT PURCHASING AS TRUSTEE OR AGENT FOR ACCOUNTS FULLY MANAGED BY IT, COMPLETE THE FOLLOWING AND ENSURE THAT THAT APPLICABLE EXHIBIT(S) ARE COMPLETED ON BEHALF OF SUCH PRINCIPAL: ------------------------------------- (Name of individual whose signature appears above if different than the ------------------------------------ name of the Purchaser Subscriber printed above.) ___________________________________________________ (Purchaser’s Name of Principal) 00 XXXXX XXXXXX ------------------------------------ ------------------------------------- (Principal's Address) (Subscriber's Address, including Municipality and ProvinceXxxxx) ___________________________________________________ S.I.N. or Taxation Account of Purchaser ___________________________________________________ XXX XXXX, XXX XXXX 00000 ------------------------------------- (000)000-0000 XXXXXX.XXXXXXXXXX@XX.XXX ------------------------------------------ (Telephone Number) (Email Address) If *Calculated based on a fixed exchange rate of US$1.00 = CAD$ .9733 (which is the Purchaser is signing noon buying rate as agent for a principal (beneficial purchaser) and is not purchasing as trustee or agent for accounts fully managed reported by it, complete the following: ___________________________________________________ (Name Federal Reserve Bank of Principal) ___________________________________________________ (Principal’s Address) ___________________________________________________ Account Registration Information: ___________________________________________________ (Name) ___________________________________________________ (Account Reference, if applicable) ___________________________________________________ (Address, including Postal Code) Delivery Instructions as set forth below: ___________________________________________________ (Name) ___________________________________________________ (Account Reference, if applicable) ___________________________________________________ (Address) ___________________________________________________ (Contact Name) (Telephone Number) PURCHASE AGREEMENT FOR UNITS OF ANTRIABIO, INC. (a Delaware corporationNew York on the Closing Date)

Appears in 1 contract

Samples: Terms And (Pacific Energy Resources LTD)

per Unit. Each Class A Unit consists of one share Common Share (as hereinafter defined) and one Warrant (as hereinafter defined). This offer of common stock and one-half Units is part of one warrant an offering of up to 1,081,081 Units (each whole warrant, a the WarrantOffering”). Eligible Purchasers of the Class B Units are those Purchasers that invest at least $50,000 in this Offering and have participated in a prior Company offering during the Period (as defined herein) and either, (i) invested at least $200,000 in a prior Company offering during the Period (as defined herein), or (ii) invest at least 25% of the amount such Purchaser invested in a prior Company offering during the Period in this Offering. Each Class B Unit consists of one share of common stock and one Warrant. The Purchaser Subscriber agrees to be bound by the terms and conditions set forth in the attached “Terms and Conditions of Purchase Subscription for Units” including without limitation the representations, warranties and covenants set forth in the applicable schedules attached thereto. The Purchaser Subscriber further agrees, without limitation, that each of the Company and Xxxxxxx Investment Company, LLC Inc. (the “Placement Agent”) may rely upon the PurchaserSubscriber’s representations, warranties and covenants contained in such documents. “Period” shall mean any time between December 1, 2013 and May 1, 2015. Please complete and sign the Accredited Investor Certificate – Exhibit A and the Selling Shareholder Questionnaire– Exhibit C SUBSCRIPTION AND PURCHASER SUBSCRIBER INFORMATION Please print all information (other than signatures), as applicable, in the space provided below Number of Class A Units: ______________________________________ x $1.10 ___________________________________________________ 1.85 (Name of PurchaserSubscriber) Number of Class B Units: ____________________________________x $1.10 = Account Reference (if applicable): ______________________________ By: _________________________________________________________________________ Authorized Signature Aggregate Purchase Subscription Price: _______________________________________ (the “Purchase Subscription Price”) Authorized Signature ____________________________________________________ (Official Capacity or Title – if the Purchaser Subscriber is not an individual) _____________________________________________________ (Name of individual whose signature appears above if different than the name of the Purchaser subscriber printed above.) ____________________________________________________ (PurchaserSubscriber’s Address, including Municipality and Province) ____________________________________________________ S.I.N. or Taxation Account of Purchaser Subscriber ____________________________________________________ (Telephone Number) (Email Address) If the Purchaser Subscriber is signing as agent for a principal (beneficial purchaser) and is not purchasing as trustee or agent for accounts fully managed by it, complete the following: ____________________________________________________ (Name of Principal) ____________________________________________________ (Principal’s Address) ___________________________________________________ Account Registration Information: ____________________________________________________ (Name) ____________________________________________________ (Account Reference, if applicable) ____________________________________________________ (Address, including Postal Code) Delivery Instructions as set forth below: ___________________________________________________ (Name) ___________________________________________________ (Account Reference, if applicable) ___________________________________________________ (Address) ___________________________________________________ (Contact Name) (Telephone Number) PURCHASE SUBSCRIPTION AGREEMENT FOR UNITS OF ANTRIABIO, INC. (a Delaware corporation)

Appears in 1 contract

Samples: Subscription Agreement (AntriaBio, Inc.)

per Unit. Each Class A Unit consists of one common share in the capital of common stock the Corporation (a “Common Share”) and one-half of one Common Share purchase warrant (each whole warrant, a “Warrant”). Eligible Purchasers Each Warrant will entitle the holder thereof to purchase one Common Share (a “Warrant Share”) at a price of $0.60 during the first year following the Closing Date (as hereinafter defined) $0.80 during the second year following the Closing Date and $1.00 during the third year following the Closing Date (the “Exercise Price”); provided that, in respect of the Class B Units are those Purchasers that invest at least $50,000 in this Offering and have participated in a prior Company offering during third year the Period (as defined herein) and either, (i) invested at least $200,000 in a prior Company offering during the Period (as defined herein), or (ii) invest at least 25% exercise of the amount such Purchaser invested in a prior Company offering during Warrant is conditional upon the Period in this Offering. Each Class B Unit consists of one share of common stock and one WarrantCorporation achieving Tier 1 status on the TSX Venture Exchange within the first two years following the Closing Date. The Purchaser Subscriber agrees to be bound by the terms and conditions set forth in the attached “Terms and Conditions of Purchase Subscription for Units” including without limitation the representations, warranties and covenants set forth in the applicable schedules attached thereto. The Purchaser Subscriber further agrees, without limitation, that each of the Company Corporation and Xxxxxxx Investment Company, LLC the Agents (the “Placement Agent”as hereinafter defined) may rely upon the PurchaserSubscriber’s representations, warranties and covenants contained in such documents. “Period” shall mean any time between December 1, 2013 and May 1, 2015. Please complete and sign the Accredited Investor Certificate – Exhibit A and the Selling Shareholder Questionnaire– Exhibit C SUBSCRIPTION AND PURCHASER INFORMATION Please print all information (other than signatures), as applicable, in the space provided below Number of Class A Units: Units X CDN$0.50 ____________________________________x $1.10 __ = (Name of Subscriber) Aggregate Subscription Price: _____________________ ______________________________________ (Name of Purchaserthe “Subscription Price”) Number of Class B UnitsAccount Reference (if applicable) If the Subscriber is signing as agent for a principal Per: ____________________________________x $1.10 = Account Reference _ (if applicable): ________________________ By“Beneficial Purchaser”) and is not a trust company or Authorized Signature portfolio manager, in either case, purchasing as trustee or agent for accounts fully managed by it, complete the following: ________________________________________________ Authorized Signature Aggregate Purchase Price: _____________________________ (the “Purchase Price”) ___________________________________________________ (Official Capacity or of Title – if the Purchaser Subscriber is not an individual) ___________________________________________________ (Name of individual whose signature appears above if different than the name of the Purchaser printed above.) ___________________________________________________ (Purchaser’s Address, including Municipality and Province) ___________________________________________________ S.I.N. or Taxation Account of Purchaser ___________________________________________________ (Telephone Number) (Email Address) If the Purchaser is signing as agent for a principal (beneficial purchaser) and is not purchasing as trustee or agent for accounts fully managed by it, complete the following: ___________________________________________________ (Name of Principal) ______________________________________ (Name of individual whose signature appears above if different that the name of the subscriber printed _____________________________________ above.) (Principal’s 's Address) ______________________________________ _____________________________________ Account Registration Information: (Subscriber’s Address) (Fax (Fax Number) Number) ______________________________________ _____________________________________ (Telephone Number) (Email Address) (Telephone Number) (Email Address) Registered Shareholder Information (if different from Delivery Instructions as set forth below: Subscriber): ______________________________________ _____________________________________ (Name) (Name) ______________________________________ _____________________________________ (Account Reference, if applicable) (Account Reference, if applicable) ______________________________________ ______________________________________ (Address, including Postal Code) Delivery Instructions (Address) (Contact Name) (Telephone Number) The Corporation hereby accepts the subscription for Units as set forth below: on the face page of this Subscription Agreement on the terms and conditions contained in the Subscription Agreement (including all applicable schedules) this ___ day of ___________________________________________________ (Name) ___________________________________________________ (Account Reference, if applicable) ___________________________________________________ (Address) ___________________________________________________ (Contact Name) (Telephone Number) PURCHASE AGREEMENT FOR UNITS OF ANTRIABIO, 2006. ROCKWELL VENTURES INC. (a Delaware corporation)Per: Authorized Signing Officer TERMS AND CONDITIONS OF SUBSCRIPTION FOR UNITS

Appears in 1 contract

Samples: Rockwell Ventures Inc

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per Unit. Each Class A Unit consists is comprised of one share of common stock in the capital of the Issuer (each, a “Share”) and oneone non-half of one transferable common stock share purchase warrant (each whole warranteach, a “Warrant”). Eligible Purchasers Each Warrant shall entitle the holder thereof to acquire one additional Share (each, a “Warrant Share”) at a price of $0.20 per Warrant Share until 5:00 p.m. (Eastern time) on the date of expiration of the Class B Units are those Purchasers that invest at least $50,000 in this Offering and have participated in a prior Company offering during Warrant, which is two years following the Period (as defined herein) and either, (i) invested at least $200,000 in a prior Company offering during the Period Closing Date (as defined herein), or as set forth in the warrant certificate, a form of which is attached as Schedule “A” (ii) invest at least 25% of the amount such Purchaser invested in a prior Company offering during the Period in this Offering. Each Class B Unit consists of one share of common stock and one Warrant“Warrant Certificate”). The Purchaser Subscriber agrees to be bound by the terms and conditions set forth in the attached “Terms and Conditions of Purchase Subscription for Units” including without limitation the representations, warranties and covenants set forth in the applicable schedules attached thereto. The Purchaser further agrees, without limitation, that each of the Company and Xxxxxxx Investment Company, LLC (the “Placement Agent”) may rely upon the Purchaser’s representations, warranties and covenants contained in such documents. “Period” shall mean any time between December 1, 2013 and May 1, 2015. Please complete and sign the Accredited Investor Certificate – Exhibit A and the Selling Shareholder Questionnaire– Exhibit C SUBSCRIPTION AND PURCHASER INFORMATION Please print all information (other than signatures), as applicable, in the space provided below Number of Class A Units: Subscriber Information ____________________________________x $1.10 ________ Units to be Purchased Number of Units:x $0.20 (Name of Subscriber) = Account Reference (if applicable): ________________________ X___________________________________________ Aggregate Subscription Price: $ (the “Subscription Amount”) (Signature of Subscriber – if the Subscriber is an Individual) X___________________________________________ (Signature of Authorized Signatory – if the Subscriber is not an Individual) ____________________________________________ (Name and Title of PurchaserAuthorized Signatory – if the Subscriber is not an Individual) Number of Class B Units: ____________________________________x $1.10 = Account Reference (if applicable): ________________________ By: ________________________________________________ Authorized Signature Aggregate Purchase Price: _____________________________ (the “Purchase Price”) ___________________________________________________ (Official Capacity SIN, SSN, or Title – if other Tax Identification Number of the Purchaser is not an individualSubscriber) ___________________________________________________ (Name of individual whose signature appears above if different than the name of the Purchaser printed above.Subscriber’s Address, including city and province or state or residence) ___________________________________________________ (Purchaser’s Address, including Municipality and Province) ___________________________________________________ S.I.N. or Taxation Account of Purchaser ___________________________________________________ (Telephone Number) (Email Address) If the Purchaser is signing Please complete if purchasing as agent or trustee for a principal (beneficial purchaser) (a “Disclosed Principal”) and is not purchasing as trustee or agent for accounts fully managed by it, complete the following: ____. _______________________________________________ (Name of Disclosed Principal) ___________________________________________________ (Address of Disclosed Principal’s Address) ___________________________________________________ Account Registration Information: ___________________________________________________ (Name) ___________________________________________________ (Account Reference, if applicable) ___________________________________________________ (AddressSIN, including Postal Code) Delivery Instructions as set forth below: ___________________________________________________ (Name) ___________________________________________________ (Account ReferenceSSN, if applicable) ___________________________________________________ (Address) ___________________________________________________ (Contact Name) (Telephone Number) PURCHASE AGREEMENT FOR UNITS OF ANTRIABIO, INC. (a Delaware corporationor other Tax Identification Number of Disclosed Principal)

Appears in 1 contract

Samples: Private Placement Subscription Agreement (Online Disruptive Technologies, Inc.)

per Unit. Each Class A Unit consists shall consist of one (1) share of common stock of the Corporation (a "COMMON SHARE") and one-half (1/2) Common Share purchase warrant of one warrant the Corporation (each whole warrant, a “Warrant”"WARRANT"). Eligible Purchasers Each one (1) whole Warrant shall entitle the holder to acquire one (1) Common Share (a "WARRANT SHARE") at a price equal to CAD$2.65 per Warrant Share for a period of eighteen (18) months from the date of issue of the Class B Units are those Purchasers that invest at least $50,000 in this Offering and have participated in a prior Company offering during the Period (as defined herein) and either, (i) invested at least $200,000 in a prior Company offering during the Period (as defined herein), or (ii) invest at least 25% of the amount such Purchaser invested in a prior Company offering during the Period in this Offering. Each Class B Unit consists of one share of common stock and one WarrantWarrants. The Purchaser Subscriber agrees to be bound by the attached terms and conditions set forth in of subscription (the attached “Terms "TERMS AND CONDITIONS") and Conditions of Purchase for Units” including without limitation agrees that the Corporation and its agents and attorneys may rely upon the representations, warranties and covenants set forth contained therein and in the applicable schedules attached theretoSubscriber Certificate (as hereinafter defined). The Purchaser further agreesThis subscription, without limitation, that each plus the Terms and Conditions of the Company completed and Xxxxxxx Investment Companyexecuted Subscriber Certificate, LLC (are collectively referred to as the “Placement Agent”) may rely upon "SUBSCRIPTION AGREEMENT" or the Purchaser’s representations, warranties and covenants contained in such documents. “Period” shall mean any time between December 1, 2013 and May 1, 2015. Please complete and sign the Accredited Investor Certificate – Exhibit A and the Selling Shareholder Questionnaire– Exhibit C "AGREEMENT." SUBSCRIPTION AND PURCHASER SUBSCRIBER INFORMATION Please print all information (other than signatures), as applicable, in the space provided below Number of Class A Units*: ____________________________________x $1.10 ___________________________________________________ -------------------------------------------------------------- ------------------------------------------ (Name of PurchaserSubscriber) Number of Class B UnitsShare Price: ____________________________________x $1.10 = X Account Reference (if applicable): ________________________ -------------------------------------- ---------------------------- Aggregate Subscription Price: By: ________________________________________________ ------------------------------ ----------------------------------------------------------- (the "SUBSCRIPTION PRICE") Authorized Signature Aggregate Purchase Price: _____________________________ (the “Purchase Price”) ___________________________________________________ -------------------------------------------------------------- IF THE SUBSCRIBER IS SIGNING AS AGENT FOR A PRINCIPAL (Official Capacity or Title - if the Purchaser Subscriber is not an (BENEFICIAL PURCHASER)AND IS NOTPURCHASING AS TRUSTEE OR individual) ___________________________________________________ AGENT FOR ACCOUNTS FULLY MANAGED BY IT, COMPLETE THE FOLLOWING AND ENSURE THAT THAT APPLICABLE EXHIBIT(S) ARE COMPLETED ON BEHALF OF SUCH PRINCIPAL: -------------------------------------------------------------- (Name of individual whose signature appears above if different than the name of the Purchaser Subscriber printed above.) ____________________________________________----------------------------------------------------------- (Name of Principal) -------------------------------------------------------------- (Subscriber's Address, including State) ----------------------------------------------------------- (Principal's Address) -------------------------------------------------------------- ----------------------------------------------------------- -------------------------------------------------------------- (Telephone Number) (Email Address) *Calculated based on a fixed exchange rate of US$1.00 = CAD$_______ (Purchaser’s Address, including Municipality and Province) ___________________________________________________ S.I.N. or Taxation Account which is the noon buying rate as reported by the Federal Reserve Bank of Purchaser ___________________________________________________ (Telephone Number) (Email Address) If New York on the Purchaser is signing as agent for a principal (beneficial purchaser) and is not purchasing as trustee or agent for accounts fully managed by it, complete the following: ___________________________________________________ (Name of Principal) ___________________________________________________ (Principal’s Address) ___________________________________________________ Account Registration Information: ___________________________________________________ (Name) ___________________________________________________ (Account Reference, if applicable) ___________________________________________________ (Address, including Postal Code) Delivery Instructions as set forth below: ___________________________________________________ (Name) ___________________________________________________ (Account Reference, if applicable) ___________________________________________________ (Address) ___________________________________________________ (Contact Name) (Telephone Number) PURCHASE AGREEMENT FOR UNITS OF ANTRIABIO, INC. (a Delaware corporationClosing Date)

Appears in 1 contract

Samples: Pacific Energy Resources LTD

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