SUBSCRIPTION FORM. (TO BE EXECUTED BY THE REGISTERED HOLDER IF HE DESIRES TO EXERCISE THE WARRANT) To: ICC WORLDWIDE, INC. The undersigned hereby exercises the right to purchase _________ shares of Common Stock, par value $.0001 per share, covered by the attached Warrant in accordance with the terms and conditions thereof, and herewith makes payment of the Warrant Price for such shares in full. Signature: Address: DATED: ___________________________ NOTICE OF EXERCISE OF COMMON STOCK WARRANT PURSUANT TO NET ISSUE ("CASHLESS") EXERCISE PROVISIONS Attention: Corporate Secretary ICC WORLDWIDE, INC. 0000 X. Xxxxx Xxxxxxx Corona del Mar, CA 92625 Aggregate Price of Warrant $ Aggregate Price Being Exercised $ Warrant Price (per Shares) Number of Shares of Common Stock to be Issued Under this Notice:______________ CASHLESS EXERCISE Gentlemen: The undersigned, registered holder of the Warrant to Purchase Common Stock delivered herewith ("Warrant") hereby irrevocably exercises such Warrant for, and purchases thereunder, shares of the Common Stock of ICC WORLDWIDE, INC., a Delaware corporation, as provided below. Capitalized terms used herein, unless otherwise defined herein, shall have the meanings given in the Warrant. The portion of the Aggregate Price (as hereinafter defined) to be applied toward the purchase of Common Stock pursuant to this Notice of Exercise is $__________, thereby leaving a remainder Aggregate Price (if any) equal to $__________. Such exercise shall be pursuant to the net issue exercise provisions of Section I. (b) of the Warrant; therefore, the holder makes no payment with this Notice of Exercise.
SUBSCRIPTION FORM. To Be Executed by the Registered Holder in Order to Exercise Warrants The undersigned Registered Holder hereby irrevocably elects to exercise Warrants represented by this Warrant Certificate, and to purchase the securities issuable upon the exercise of such Warrants, and requests that certificates for such securities shall be issued in name of PLEASE INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER (please print or type name and address) and be delivered to (please print or type name and address) and if such number of Warrants shall not be all the Warrants evidenced by this Warrant Certificate, that a new Warrant Certificate for the balance of such Warrants be registered in the name of, and delivered to, the Registered Holder at the address stated below.
SUBSCRIPTION FORM. To Be Executed by the Registered Holder in Order to Exercise Warrants The undersigned Registered Holder irrevocably elects to exercise ______________ Warrants represented by this Warrant Certificate, and to purchase the Common Stock issuable upon the exercise of such Warrants, and requests that Certificates for such shares shall be issued in the name of (PLEASE TYPE OR PRINT NAME AND ADDRESS) (SOCIAL SECURITY OR TAX IDENTIFICATION NUMBER) and be delivered to (PLEASE PRINT OR TYPE NAME AND ADDRESS) and, if such number of Warrants shall not be all the Warrants evidenced by this Warrant Certificate, that a new Warrant Certificate for the balance of such Warrants be registered in the name of, and delivered to, the Registered Holder at the address stated below: Dated: (SIGNATURE) (ADDRESS) (TAX IDENTIFICATION NUMBER)
SUBSCRIPTION FORM. To be Executed by the Holder of this Warrant if such Holder Desires to Exercise this Warrant in Whole or in Part: To: South Uintah Gas Properties, Inc. (the "Company") The undersigned ___________________________ (Social Security number _____________or taxpayer identification number of Subscriber: _________________________) hereby irrevocably elects to exercise the right of purchase represented by this Warrant for, and to purchase thereunder, ____________ shares of the Common Stock (the "Common Stock") provided for therein and tenders payment herewith to the order of the Company in the amount of $______________, such payment being made as provided on the face of this Warrant. The undersigned requests that certificates for such shares of Common Stock be issued as follows: Name: __________________________________________________________________________ Address: _______________________________________________________________________ ________________________________________________________________________________ Deliver to: ____________________________________________________________________ Address: _______________________________________________________________________ ________________________________________________________________________________ and, if such number of shares of Common Stock shall not be all the shares of Common Stock purchasable hereunder, that a new Warrant for the balance remaining of the shares of Common Stock purchasable under this Warrant be registered in the name of, and delivered to, the undersigned at the address stated above. Dated: ______________________
SUBSCRIPTION FORM. To Be Executed by the Registered Holder in Order to Exercise Warrants The undersigned Registered Holder hereby irrevocably elects to exercise Warrants represented by this Warrant Certificate, and to purchase the securities issuable upon the exercise of such Warrants, and requests that certificates for such securities shall be issued in the name of PLEASE INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER -------------------------------- -------------------------------- -------------------------------- (please print or type name and address) and be delivered to -------------------------------- -------------------------------- -------------------------------- (please print or type name and address) and if such number of Warrants shall not be all the Warrants evidenced by this Warrant Certificate, that a new Warrant Certificate for the balance of such Warrants be registered in the name of, and delivered to, the Registered Holder at the address stated below. Dated: X -------------------- -------------------- -------------------- -------------------- Address -------------------- Social Security or Taxpayer Identification Number ------------------- Signature Guaranteed
SUBSCRIPTION FORM. (To be Executed by the Optionee to Exercise the Rights to Purchase Stock evidenced by the foregoing Option) TO: MODAVOX, INC. The undersigned hereby exercises the right to purchase _______ shares of Common Stock covered by the attached Option in accordance with the terms and conditions thereof, and herewith makes payment of this Option Price of such shares in full. The undersigned represents and Options to you that the undersigned is acquiring such shares for the undersigned's own account with the intent of holding such shares for investment and without the intent of participating directly or indirectly in a distribution of such shares. _________________________________ By: _____________________________ Signature _________________________________ _________________________________ Address Dated: _________________.
SUBSCRIPTION FORM. To Be Executed by the Holder of This Warrant if Holder Desires to Exercise This Warrant in Whole or in Part: To: Telident, Inc. (the "Corporation") The undersigned ________________________________ Please insert Social Security or other identifying number of Subscriber: _______________________ hereby irrevocably elects to exercise the right of purchase represented by this Warrant for, and to purchase thereunder, _________ shares of the Common Stock provided for therein and tenders payment herewith to the order of the Corporation in the amount of $_______, such payment being made as provided on the face of this Warrant. The undersigned requests that certificates for such shares of Common Stock be issued as follows: Name:__________________________________________________ Address:_______________________________________________ Deliver to:____________________________________________ Address: _____________________________________________ and, if such number of shares of Common Stock shall not be all the shares of Common Stock purchasable hereunder, that a new Warrant for the balance remaining of the shares of Common Stock purchasable under this Warrant be registered in the name of, and delivered to, the undersigned at the address stated above. Dated: ___________ Signature ---------------------------------------- Note: The signature on this Subscription Form must correspond with the name as written upon the face of this Warrant in every particular, without alteration or enlargement or any change whatever. EXHIBIT 3 ESCROW AGREEMENT This Agreement is entered into this 23rd day of July, 1997, by and among Telident, Inc. (the "Issuer"), FAMCO III LIMITED LIABILITY COMPANY (the "Purchaser"), and Manchester Companies, Inc. (the "Escrow Agent").
SUBSCRIPTION FORM. To: ___________________ Date: ___________________ The undersigned hereby subscribes for __________ Common Shares covered by this Warrant. The certificate(s) for such Common Shares (if certificated) shall be issued in the name of the undersigned or as otherwise indicated below. The undersigned hereby represents and warrants that the undersigned is acquiring such ownership interest for its own account for investment purposes only, and not for resale or with a view to distribution of such ownership interest or any part thereof. Signature: Name of Registration: Mailing Address:
SUBSCRIPTION FORM. To: MYECHECK, INC. (the "Company") And to: The Directors Thereof. Pursuant to the Share Purchase Warrant made the day of , 2008 the undersigned hereby subscribes for and agrees to take up _______________ common shares without par value (the "Shares") in the capital of the Company, at a price of $ 4.00 (USD) per Share for the aggregate sum of $_______________ (the "Subscription Funds"), and encloses herewith a certified cheque, bank draft or money order payable to the Company in full payment of the Shares. The undersigned (the "Subscriber") hereby requests that upon receipt of the Subscription Funds by the Company:
SUBSCRIPTION FORM. (To Be Executed By The Registered Holder In Order To Exercise The Warrant) The undersigned hereby irrevocably elects to exercise the right to purchase __________shares of Common Stock of COMPLETE WELLNESS CENTERS, INC. covered by this Warrant according to the conditions hereof and herewith makes payment of the Exercise Price of such shares in full. -------------------------- Signature -------------------------- -------------------------- Address Dated: __________.
