Common use of Subscription Clause in Contracts

Subscription. The undersigned, ________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and purchase ____________________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICES, INC., covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:____________________ Signature_______________________ Address_________________________ ASSIGNMENT FOR VALUE RECEIVED, _________________________________ hereby sells, assigns and transfers unto _________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address_________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, _________________________________ hereby sells, assigns and transfers unto _________________________________ the right to purchase _________ shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICES, INC. by the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address_________________________

Appears in 6 contracts

Samples: Perma Fix Environmental Services Inc, Perma Fix Environmental Services Inc, Perma Fix Environmental Services Inc

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Subscription. The undersigned, ____________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees elects to subscribe for and purchase exercise the within Warrant to the extent of purchasing _____________________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICES, INC., covered by said Warrant, thereunder and hereby makes payment therefor of $_______________ by certified or official bank check in full at payment of the price per share provided by said Warrant pursuant to the terms of said Warrantexercise price therefor. Dated:_______________ Signature:______ Signature________________________ Address:_______________________________ ASSIGNMENT FOR VALUE RECEIVED, RECEIVED _______________________________________ hereby sells, assigns and transfers unto _____________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _____________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESProcept, INC. Inc. Dated:_______________ Signature:______ Signature_______________________ Address_________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, ___Address:______________________________ hereby sells, assigns and transfers unto PARTIAL ASSIGNMENT FOR VALUE RECEIVED __________________________ hereby assigns and transfers unto _________________________ the right to purchase __________ shares of the Common Stock Stock, no par value per share, of PERMA- FIX ENVIRONMENTAL SERVICES, INC. Procept Inc. covered by the foregoing Warrant, and a proportionate part of said Warrant and all the rights evidenced thereby, and does irrevocably constitute and appoint __________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESProcept, INC. Inc. Dated:____________________ Signature_______________________ Address:___________________________ Address:_____________________________

Appears in 6 contracts

Samples: Procept Inc, Procept Inc, Procept Inc

Subscription. The undersigned, ____________________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and purchase ____________________ shares of the Common Stock of PERMAPerma-FIX ENVIRONMENTAL SERVICESFix Environmental Services, INC., Inc. covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:_____: _______________ SignatureSignature __________________________ AddressAddress ____________________________ ASSIGNMENT FOR VALUE RECEIVED, _______________RECEIVED __________________ hereby sells, assigns and transfers unto _________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMAPerma-FIX ENVIRONMENTAL SERVICESFix Environmental Services, INC. Inc. Dated:_____: _______________ SignatureSignature __________________________ AddressAddress ____________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, ______________RECEIVED ___________________ hereby sells, assigns and transfers unto _________________________________ the right to purchase ___________ shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICESPerma-Fix Environmental Services, INC. Inc. by the foregoing Warrant, and a proportionate part of said Warrant and all the rights evidenced therebyhereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer that part of said Warrant on the books of PERMAPerma-FIX ENVIRONMENTAL SERVICESFix Environmental Services, INC. Inc. Dated:_____: _______________ Signature_______________________ AddressSignature __________________________ Address ____________________________

Appears in 5 contracts

Samples: Perma Fix Environmental Services Inc, Perma Fix Environmental Services Inc, Perma Fix Environmental Services Inc

Subscription. The undersigned, ,____________________________, pursuant to the provisions of the foregoing within Warrant, hereby agrees elects to subscribe exercise said Warrant for and purchase ____________________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICES, INC., EuroSite Power Inc. covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said within Warrant. DatedPrinted Name of Holder: Signature:____________________ Signature_______________________ Address_________________________ Title (if signing on behalf of the Holder): Address: Dated: FULL ASSIGNMENT FOR VALUE RECEIVED, ____________________________ hereby sells, assigns and transfers unto_________________________ the within Warrant and all rights evidenced thereby and does irrevocably constitute and appoint ___________________________, attorney, to transfer the said Warrant on the books of the within-named Company. ______________________________ Assignor Dated: ________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED _________________________ hereby sells, assigns and transfers unto _________________________________ that portion of the foregoing within Warrant and all the rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant thereby which will on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address_________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, _________________________________ hereby sells, assigns and transfers unto _________________________________ date hereof entitle the right holder to purchase __________ shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICES, INC. by the foregoing Warrant EuroSite Power Inc. and all rights evidenced thereby, irrevocably constitutes and does irrevocably constitute and appoint appoints ___________________________, attorney, to transfer that part of the said Warrant on the books of PERMAthe within-FIX ENVIRONMENTAL SERVICES, INCnamed Company. Dated:____________________ Signature_______________________ Address______________________________ Assignor Dated_________________________

Appears in 3 contracts

Samples: Subscription Agreement (Eurosite Power Inc), Eurosite Power Inc, Eurosite Power Inc

Subscription. The undersigned, _______________________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and the purchase ____________of ________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICESDYNAGEN, INC., . covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:____________________________ Signature:_________________________ Address:___________________________ ___________________________ ASSIGNMENT FOR VALUE RECEIVED, ______RECEIVED ___________________________ hereby sells, assigns and transfers unto _________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESDYNAGEN, INC. .. Dated:____________________________ Signature:_________________________ Address:___________________________ ___________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, ________RECEIVED _________________________ hereby sells, assigns and transfers unto _________________________________ the right to purchase _________ shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICESDYNAGEN, INC. by the foregoing Warrant, and a proportionate part of said Warrant and all the rights evidenced therebyhereby, and does irrevocably constitute and appoint ___________________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESDYNAGEN, INC. Dated:____________________ Signature_______________________ Address____________________________ Signature:_________________________ Address:___________________________ ___________________________ NET ISSUANCE ELECTION The undersigned, _______________________________, pursuant to the provisions of the foregoing Warrant, hereby tenders the right to purchase _____ shares of the Common Stock of DYNAGEN, INC., and a proportionate part of said Warrant and the rights evidenced thereby, in exchange for a number of shares of said Common Stock to be computed in accordance with the provisions of Section 1(b) of said Warrant. Dated:____________________________ Signature:_________________________ Address:___________________________ ___________________________

Appears in 2 contracts

Samples: Dynagen Inc, Dynagen Inc

Subscription. The undersigned, ________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and purchase ____________________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICESWorldwide Data, INC., Inc. covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:: ____________________ Signature_______________________ Address_________________________ ASSIGNMENT FOR VALUE RECEIVED, Signature: ________________________________ Name: _____________________________________ hereby sells, assigns and transfers unto Address: __________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address_________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, _________________________________ Tax I.D. No. _______________________________ -------------------------------------------------------------------------------- CASHLESS EXERCISE SUBSCRIPTION The undersigned ________________________ pursuant to the provisions of the foregoing Warrant, hereby sellsagrees to subscribe to that number of shares of stock of Worldwide Data, assigns Inc. as are issuable in accordance with the formula set forth in paragraph 1(b) of the Warrant, and transfers unto makes payment therefore in full by cancellation of _________________ Warrants. (If this is a partial exercise of the Warrant a new Warrant for the remaining number of unexercised Warrants shall be issued by the Company.) Dated: __________________________ Signature: ________________________________ Name: _____________________________________ the right to purchase _________ shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICES, INC. by the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint Address: _________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address__________________________________ Tax I.D. No. _______________________________

Appears in 2 contracts

Samples: Worldwide Data Inc, Worldwide Data Inc

Subscription. To: Date: --------------------------------- -------------------------------- The undersigned, undersigned hereby subscribes for ___________ shares of Preferred Stock covered by this Warrant. The certificate(s) for such shares shall be issued in the name of the undersigned or as otherwise indicated below: ------------------------------------------- Signature ------------------------------------------- Name for Registration ------------------------------------------- Mailing Address NET ISSUE ELECTION NOTICE To: Date: --------------------------------- -------------------------------- The undersigned hereby elects under SECTION 4 to surrender the right to purchase ______ shares of Preferred Stock pursuant to this Warrant. The certificate(s) for such shares issuable upon such net issue election shall be issued in the name of the undersigned or as otherwise indicated below: ------------------------------------------- Signature ------------------------------------------- Name for Registration ------------------------------------------- Mailing Address ASSIGNMENT For value received ________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and purchase ____________________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICES, INC., covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:____________________ Signature_______________________ Address_________________________ ASSIGNMENT FOR VALUE RECEIVED, _________________________________ hereby sells, assigns and transfers unto _____________________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address_________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, _________________________________ hereby sells, assigns [Please print or typewrite name and transfers unto address of Assignee] _______________________________________________________________________________ the right to purchase _________ shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICES, INC. by the foregoing Warrant and all rights evidenced therebywithin Warrant, and does hereby irrevocably constitute and appoint _________________________, attorney, _ its attorney to transfer that part of said the within Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INCthe within named Company with full power of substitution on the premises. Dated:____________________ Signature_______________________ Address_________________________: -------------------- ----------------------------------------- In the Presence of: ---------------------- EXHIBIT A AMENDED AND RESTATED CERTIFICATE OF INCORPORATION SEE ATTACHED PAGES. EXHIBIT B CAPITALIZATION TABLE

Appears in 2 contracts

Samples: Rigel Pharmaceuticals Inc, Rigel Pharmaceuticals Inc

Subscription. The undersigned, _______________________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and the purchase ____________of ________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICESDYNAGEN, INC., . covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:_____________________________ Signature:__________________________ Address:___________________________ ___________________________________ ___________________________________ ASSIGNMENT FOR VALUE RECEIVED, ______RECEIVED ___________________________ hereby sells, assigns and transfers unto _________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESDYNAGEN, INC. .. Dated:____________________________ Signature:____________________________ Address:___________________________ ___________________________________ ___________________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, ________RECEIVED _________________________ hereby sells, assigns and transfers unto _________________________________ the right to purchase _________ shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICESDYNAGEN, INC. by the foregoing Warrant, and a proportionate part of said Warrant and all the rights evidenced therebyhereby, and does irrevocably constitute and appoint ___________________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESDYNAGEN, INC. Dated:____________________ Signature_______________________ Address____________________________ Signature:____________________________

Appears in 1 contract

Samples: Dynagen Inc

Subscription. The undersigned, __________________________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and the purchase ____________________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICES, INC., covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:____________________ Signature_______________________ Address_________________________ shares of the Class A Common Stock of eSPEED, INC. covered by said Xxxxxxx, and makes payment therefor in full at the price per share provided by said Xxxxxxx. Dated Signature --------------- ------------------------------- Address -------------------------- -------------------------- ASSIGNMENT FOR VALUE RECEIVED, ________RECEIVED _________________________ hereby sells, assigns and transfers unto _________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESeSPEED, INC. Dated:____________________ Signature_______________________ Address_________________________ Dated Signature --------------- ------------------------------- Address -------------------------- -------------------------- PARTIAL ASSIGNMENT FOR VALUE RECEIVED, ________RECEIVED _________________________ hereby sells, assigns and transfers unto _________________________________ the right to purchase _________________________ shares of the Class A Common Stock of PERMA- FIX ENVIRONMENTAL SERVICESeSPEED, INC. by the foregoing Warrant, and a proportionate part of said Warrant and all the rights evidenced therebyhereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESeSPEED, INC. Dated:____________________ Signature_______________________ Address_________________________Dated Signature --------------- ------------------------------- Address -------------------------- --------------------------

Appears in 1 contract

Samples: Espeed Inc

Subscription. The undersigned, undersigned ___________________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and purchase ____________________ shares of the Common Stock of PERMAMid-FIX ENVIRONMENTAL SERVICESState Raceway, INC.Inc., covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:_________________________ Signature_____________________ Address_______________________ ASSIGNMENT FOR VALUE RECEIVED, ____________________________ hereby sells, assigns and transfers unto _______________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint ________________________ attorney, to transfer said Warrant on the books of Mid-State Raceway, Inc. Dated:________________________ Signature ________________________ Address___________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, _______________________ hereby assigns and transfers unto __________________________ the right to purchase ____________ shares of the Common Stock of Mid-State Raceway, Inc. by the foregoing Warrant, and a proportionate part of said Warrant and the rights evidenced hereby, and does irrevocably constitute and appoint ______________________, attorney, to transfer that part of said Warrant on the books of Mid-State Raceway, Inc. Dated: _______________________ Signature_______________________ Address_________________________ ASSIGNMENT FOR VALUE RECEIVED, _________________________________ hereby sells, assigns and transfers unto _________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMAEXHIBIT "A" TO WARRANT BETWEEN MID-FIX ENVIRONMENTAL SERVICESSTATE RACEWAY, INC. Dated:____________________ Signature_______________________ Address_________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVEDAND MID-STATE DEVELOPMENT, _________________________________ hereby sellsCORP. AND ALL CAPITAL, assigns and transfers unto _________________________________ the right to purchase _________ shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICES, INC. by the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address_________________________LLC

Appears in 1 contract

Samples: Mid State Raceway Inc

Subscription. The undersigned, ________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and purchase ____________________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICES, INC., covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:______________________ Signature____:___________________ Address____:_____________________ ASSIGNMENT FOR VALUE RECEIVED, ______RECEIVED ___________________________ hereby sells, assigns and transfers unto _________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. e Dated: Signature:____________________ Signature_______________________ Address____:_____________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVEDRECEIVED _______ hereby assigns and transfers unto ________ the right to purchase _______ shares of the Common Stock of ________ by the foregoing Warrant, and a proportionate part of said Warrant and the rights evidenced hereby, and does irrevocably constitute and appoint ____________ attorney, to transfer that part of said Warrant on the books of _________________. Dated: Signature:___________________ Address:_____________________ The undersigned ____________ pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe to that number of shares of stock ________ _______________ as are issuable in accordance with the formula set forth in paragraph 1(b) the of the Warrant, and makes payment therefore in full by surrender and delivery of this Warrant. Dated: Signature:___________________ Address:_________________________________ hereby sells, assigns and transfers unto _________________________________ the right to purchase _________ shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICES, INC. by the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address_________________________

Appears in 1 contract

Samples: Consulting Agreement (Internet Commerce Corp)

Subscription. The undersigned, ________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and purchase ____________________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICES, INC., covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:____________________ Signature_______________________ Address_________________________ ASSIGNMENT FOR VALUE RECEIVED, _________________________________ hereby sells, assigns and transfers unto _________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address_________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, _________________________________ hereby sells, assigns and transfers unto _________________________________ the right to purchase _________ shares of the Common Stock of PERMA- PERMA-FIX ENVIRONMENTAL SERVICES, INC. by the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address_________________________

Appears in 1 contract

Samples: Perma Fix Environmental Services Inc

Subscription. The undersigned, ____________________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and purchase ____________________ shares of the Common Stock of PERMAPerma-FIX ENVIRONMENTAL SERVICESFix Environmental Services, INC., Inc. covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:_____: _______________ SignatureSignature __________________________ AddressAddress ____________________________ ASSIGNMENT FOR VALUE RECEIVED, _______________RECEIVED __________________ hereby sells, assigns and transfers unto _________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMAPerma-FIX ENVIRONMENTAL SERVICESFix Environmental Services, INC. Inc. Dated:_____: _______________ SignatureSignature _________________________ AddressAddress ____________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, ______________RECEIVED ___________________ hereby sells, assigns and transfers unto _________________________________ the right to purchase ___________ shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICESPerma-Fix Environmental Services, INC. Inc. by the foregoing Warrant, and a proportionate part of said Warrant and all the rights evidenced therebyhereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer that part of said Warrant on the books of PERMAPerma-FIX ENVIRONMENTAL SERVICESFix Environmental Services, INC. Inc. Dated:_____: _______________ Signature_______________________ AddressSignature __________________________ Address ____________________________

Appears in 1 contract

Samples: Perma Fix Environmental Services Inc

Subscription. The undersigned, _______________________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and the purchase ____________of ________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICESDYNAGEN, INC., . covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:____________________________ Signature:____________________________ Address:___________________________ ASSIGNMENT FOR VALUE RECEIVED, ______RECEIVED ___________________________ hereby sells, assigns and transfers unto _________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESDYNAGEN, INC. .. Dated:____________________________ Signature:____________________________ Address:___________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, ________RECEIVED _________________________ hereby sells, assigns and transfers unto _________________________________ the right to purchase _________ shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICESDYNAGEN, INC. by the foregoing Warrant, and a proportionate part of said Warrant and all the rights evidenced therebyhereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESDYNAGEN, INC. Dated:____________________ Signature_______________________ Address____________________________ Signature:____________________________ Address:__________________________ __________________________________ NET ISSUANCE ELECTION The undersigned, _______________________________, pursuant to the provisions of the foregoing Warrant, hereby tenders the right to purchase _____ shares of the Common Stock of DYNAGEN, INC., and a proportionate part of said Warrant and the rights evidenced thereby, in exchange for a number of shares of said Common Stock to be computed in accordance with the provisions of Section 1(b) of said Warrant. Dated:____________________________ Signature:____________________________ Address:__________________________ __________________________________ __________________________________

Appears in 1 contract

Samples: Dynagen Inc

Subscription. Helix BioMedix, Inc. 00000 00xx Xxxxxx XX, Xxxxx 000 Xxxxxxx, XX 00000 Ladies and Gentlemen: The undersigned, ________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and purchase ____________________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICES, INC., covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:____________________ Signature_______________________ Address_________________________ ASSIGNMENT FOR VALUE RECEIVED, ___________________________________________, hereby elects to purchase, pursuant to the provisions of the Warrant dated June 27, 2008, held by the undersigned, _____________ shares of Common Stock of Helix BioMedix, Inc., a Delaware corporation, and tenders herewith payment of the purchase price of such shares in full. The undersigned hereby sellsconfirms and acknowledges the investment representations and warranties made in Section 6 of the Warrant and accepts such shares subject to the restrictions of the Warrant, copies of which are available from the Secretary of the Company. Date: Print Name(s): Signature: Title if applicable: Signature: Title if applicable: Address: Warrant Subscription FORM OF ASSIGNMENT The undersigned hereby assigns and transfers unto this Warrant to _______________________________________________________________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address_________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, ______________________________________ hereby sells, assigns and transfers unto _______________________________________________________________________________________ the right to purchase (Print or type name, address and zip code of assignee) Please insert Social Security or other identifying number of assignee: _______________________ shares and irrevocably appoints ___________________ as agent to transfer this Warrant on the books of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICES, INCCompany. by the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint The agent may substitute another to act for him or it. Date: _________________ Signed: _________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address______________________________________________________________ (All owners must sign exactly as name(s) appear(s) on the front of this Warrant) The undersigned assignee hereby confirms and acknowledges the investment representations and warranties made in Section 6 of the Warrant and agrees to be bound by the obligations set forth in the Warrant, copies of which are available from the Secretary of the Company. Date: By: Name: Title:

Appears in 1 contract

Samples: Note and Warrant Purchase Agreement (Helix Biomedix Inc)

Subscription. The undersigned, __________________________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and the purchase of _________________________ shares of the Class A Common Stock of PERMA-FIX ENVIRONMENTAL SERVICESeSPEED, INC., . covered by said WarrantXxxxxxx, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said WarrantXxxxxxx. Dated:__Dated __________________ Signature__________________________ Address____________________________ ASSIGNMENT FOR VALUE RECEIVED, ____________________________ ASSIGNMENT FOR VALUE RECEIVED _________________________ hereby sells, assigns and transfers unto _________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESeSPEED, INC. Dated:__Dated __________________ Signature_______________________ Address_________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, _________________________________ hereby sells, assigns and transfers unto _________________________________ the right to purchase _________ shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICES, INC. by the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address____________________________ ____________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED _________________________ hereby assigns and transfers unto _________________________ the right to purchase _________________________ shares of the Class A Common Stock of eSPEED, INC. by the foregoing Warrant, and a proportionate part of said Warrant and the rights evidenced hereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer that part of said Warrant on the books of eSPEED, INC. Dated __________________ Signature__________________________ Address____________________________

Appears in 1 contract

Samples: Espeed Inc

Subscription. The undersigned, ________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and purchase ____________________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICESNanoPierce Technologies, INC.Inc., covered by said Warrant, and makes payment therefor in full at the price per share Per Share Warrant provided by said Warrant pursuant to the terms of said Warrant. Dated:____________________ : Signature_______________________ : Address_________________________ : ASSIGNMENT ---------- FOR VALUE RECEIVED, _________________________________ hereby sells, assigns and transfers unto _________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Dated: Signature: Address: PARTIAL ASSIGNMENT ------------------ FOR VALUE RECEIVED _______________________ Address_________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, _________________________________ hereby sells, assigns and transfers unto _________________________________ the right to purchase ______________ shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICES, INC. ________________ by the foregoing Warrant, and a proportionate part of said Warrant and all the rights evidenced therebyhereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESNanoPierce Technologies, INC. Inc.. Dated:____________________ : Signature: Address: CASHLESS EXERCISE SUBSCRIPTION ------------------------------ The undersigned _______________________ pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe to that number of shares of stock of NanoPierce Technologies, Inc. as are issuable in accordance with the formula set forth in Section l(b) of the Warrant, and makes payment therefore in full by surrender and delivery of this Warrant. Dated: Signature: Address_________________________:

Appears in 1 contract

Samples: Nanopierce Technologies Inc

Subscription. The undersigned, _______________________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and the purchase ____________of ________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICESDYNAGEN, INC., . covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:____________________________ Signature:_____________________________ Address:___________________________ ___________________________________ ___________________________________ ASSIGNMENT FOR VALUE RECEIVED, ______RECEIVED ___________________________ hereby sells, assigns and transfers unto _________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESDYNAGEN, INC. .. Dated:____________________________ Signature:_____________________________ Address:___________________________ ___________________________________ ___________________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, ________RECEIVED _________________________ hereby sells, assigns and transfers unto _________________________________ the right to purchase _________ shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICESDYNAGEN, INC. by the foregoing Warrant, and a proportionate part of said Warrant and all the rights evidenced therebyhereby, and does irrevocably constitute and appoint ___________________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESDYNAGEN, INC. Dated:____________________ Signature_______________________ Address____________________________ Signature:____________________________

Appears in 1 contract

Samples: Dynagen Inc

Subscription. The undersigned, _______________________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and the purchase ____________of ________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICESDYNAGEN, INC., . covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:____________________________ Signature:_________________________________ Address:__________________________ __________________________ __________________________ ASSIGNMENT FOR VALUE RECEIVED, ______RECEIVED ___________________________ hereby sells, assigns and transfers unto _________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESDYNAGEN, INC. .. Dated:____________________________ Signature:_________________________________ Address:___________________________ ___________________________________ ___________________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, ________RECEIVED _________________________ hereby sells, assigns and transfers unto _________________________________ the right to purchase _________ shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICESDYNAGEN, INC. by the foregoing Warrant, and a proportionate part of said Warrant and all the rights evidenced therebyhereby, and does irrevocably constitute and appoint ___________________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESDYNAGEN, INC. Dated:____________________ Signature_______________________ Address____________________________ Signature:_________________________________

Appears in 1 contract

Samples: Dynagen Inc

Subscription. The undersigned, ________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and purchase ____________________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICES, INC., covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. DatedTo:____________________ Signature_______________________ Address_________________________ ASSIGNMENT FOR VALUE RECEIVED, Date:_______________________________ The undersigned hereby subscribes for _____________ shares of Preferred Stock covered by this Warrant. The certificate(s) for such shares shall be issued in the name of the undersigned or as otherwise indicated below: ___________________________________ Signature ___________________________________ Name for Registration ___________________________________ Mailing Address NET ISSUE ELECTION NOTICE To:______________________________ Date:_______________________________ The undersigned hereby elects under Section 4 to surrender the right to purchase _______________ shares of Preferred Stock pursuant to this Warrant. The certificate(s) for such shares issuable upon such net issue election shall be issued in the name of the undersigned or as otherwise indicated below: ___________________________________ Signature ___________________________________ Name for Registration ___________________________________ Mailing Address ASSIGNMENT For value received _____________________ hereby sells, assigns and transfers unto ______________________________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address_________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, _________________________________ hereby sells, assigns [Please print or typewrite name and transfers unto address of Assignee] _________________________________________________________________________ the right to purchase within Warrant, and does hereby irrevocably constitute and appoint ___________________ shares its attorney to transfer the within Warrant on the books of the Common Stock within named Company with full power of PERMA- FIX ENVIRONMENTAL SERVICES, INCsubstitution on the premises. by the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint DATED:_________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address_______________________________ IN THE PRESENCE OF: __________________________________

Appears in 1 contract

Samples: Rigel Pharmaceuticals Inc

Subscription. The undersigned, _______________________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and the purchase ____________of ________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICESDYNAGEN, INC., . covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:____________________________ Signature:_________________________ Address:___________________________ ___________________________ ___________________________ ASSIGNMENT FOR VALUE RECEIVED, ______RECEIVED ___________________________ hereby sells, assigns and transfers unto _________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESDYNAGEN, INC. .. Dated:____________________________ Signature:_________________________ Address:___________________________ ___________________________ ___________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, ________RECEIVED _________________________ hereby sells, assigns and transfers unto _________________________________ the right to purchase _________ shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICESDYNAGEN, INC. by the foregoing Warrant, and a proportionate part of said Warrant and all the rights evidenced therebyhereby, and does irrevocably constitute and appoint ___________________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESDYNAGEN, INC. Dated:____________________ Signature_______________________ Address____________________________ Signature:_________________________ Address:___________________________ ___________________________ ___________________________ NET ISSUANCE ELECTION The undersigned, _______________________________, pursuant to the provisions of the foregoing Warrant, hereby tenders the right to purchase _____ shares of the Common Stock of DYNAGEN, INC., and a proportionate part of said Warrant and the rights evidenced thereby, in exchange for a number of shares of said Common Stock to be computed in accordance with the provisions of Section 1 (b) of said Warrant. Dated:____________________________ Signature:_________________________ Address:___________________________ ___________________________ ___________________________

Appears in 1 contract

Samples: Dynagen Inc

Subscription. The undersigned, ________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and purchase ____________________ shares of the Common Stock Stock, par value $.01 per share, of PERMA-FIX ENVIRONMENTAL SERVICESPalatin Technologies, INC., Inc. covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:_______________ Signature:____________________ Signature_Address:______________________ AddressThe undersigned ___________________, pursuant to the provisions of the foregoing Warrant, hereby elects to exchange its Warrant for ___________________ shares of Common Stock, par value $.01 per share, of Palatin Technologies, Inc. pursuant to the Cashless Exercise provisions of the Warrant. Dated:_______________ Signature:____________________ Address:______________________ ASSIGNMENT FOR VALUE RECEIVED, __________________RECEIVED _______________ hereby sells, assigns and transfers unto _________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESPalatin Technologies, INC. Inc. Dated:_______________ Signature:____________________ Signature_______________________ Address___:______________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, __________________RECEIVED _______________ hereby sells, assigns and transfers unto _________________________________ the right to purchase _________ shares of the Common Stock Stock, par value $.01 per share, of PERMA- FIX ENVIRONMENTAL SERVICESPalatin Technologies, INC. Inc. covered by the foregoing Warrant, and a proportionate part of said Warrant and all the rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESPalatin Technologies, INC. Inc. Dated:_______________ Signature:____________________ SignatureAddress:_______________________ Address_________________________

Appears in 1 contract

Samples: Palatin Technologies Inc

Subscription. The undersigned, __________________________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and the purchase ____________________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICES, INC., covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:____________________ Signature_______________________ Address_________________________ shares of the Class A Common Stock of eSPEED, INC. covered by said Xxxxxxx, and makes payment therefor in full at the price per share provided by said Xxxxxxx. Dated ------------------------------------------- Signature --------------------------------------- Address ----------------------------------------- ----------------------------------------- ASSIGNMENT FOR VALUE RECEIVED, ________RECEIVED _________________________ hereby sells, assigns and transfers unto _________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESeSPEED, INC. Dated:____________________ Signature_______________________ Address_________________________ Dated ------------------------------------------- Signature --------------------------------------- Address ----------------------------------------- ----------------------------------------- PARTIAL ASSIGNMENT FOR VALUE RECEIVED, ________RECEIVED _________________________ hereby sells, assigns and transfers unto _________________________________ the right to purchase _________________________ shares of the Class A Common Stock of PERMA- FIX ENVIRONMENTAL SERVICESeSPEED, INC. by the foregoing Warrant, and a proportionate part of said Warrant and all the rights evidenced therebyhereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESeSPEED, INC. Dated:____________________ Signature_______________________ Address_________________________Dated ------------------------------------------- Signature --------------------------------------- Address -----------------------------------------

Appears in 1 contract

Samples: Espeed Inc

Subscription. The undersigned, ________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and purchase ____________________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICESIterated Systems, INC.Inc., covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:: ____________________ Signature_______________________ Address_________________________ ASSIGNMENT FOR VALUE RECEIVED, (Signature) ___________________________ (Address) ASSIGNMENT FOR VALUE RECEIVED, ____________________ hereby sells, assigns and transfers unto _________________________________ the foregoing Warrant and all rights evidenced thereby, thereby and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESIterated Systems, INC. Inc. Dated:: ____________________ Signature_______________________ Address_________________________ (Signature) ___________________________ (Address) PARTIAL ASSIGNMENT FOR VALUE RECEIVED, _________________________________ hereby sells, assigns and transfers unto _________________________________ the right to purchase _________ [ ] shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICESIterated Systems, INC. Inc. by the foregoing Warrant and all the rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESIterated Systems, INC. Inc. Dated:: _______________, _____ Signature_______________________ Address___________________________ (Signature) ___________________________ (Address)

Appears in 1 contract

Samples: Iterated Systems Inc

Subscription. The undersigned, _______________________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and the purchase ____________of ________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICESDYNAGEN, INC., . covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:____________________________ Signature:_________________________________ Address:___________________________ ___________________________ ___________________________ ASSIGNMENT FOR VALUE RECEIVED, ______RECEIVED ___________________________ hereby sells, assigns and transfers unto _________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESDYNAGEN, INC. .. Dated:____________________________ Signature:_________________________________ Address:___________________________ ___________________________ ___________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, ________RECEIVED _________________________ hereby sells, assigns and transfers unto _________________________________ the right to purchase _________ shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICESDYNAGEN, INC. by the foregoing Warrant, and a proportionate part of said Warrant and all the rights evidenced therebyhereby, and does irrevocably constitute and appoint ___________________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESDYNAGEN, INC. Dated:____________________ Signature_______________________ Address____________________________ Signature:_________________________________ Address:___________________________ ___________________________ ___________________________ NET ISSUANCE ELECTION The undersigned, _______________________________, pursuant to the provisions of the foregoing Warrant, hereby tenders the right to purchase _____ shares of the Common Stock of DYNAGEN, INC., and a proportionate part of said Warrant and the rights evidenced thereby, in exchange for a number of shares of said Common Stock to be computed in accordance with the provisions of Section 1 (b) of said Warrant. Dated:____________________________ Signature:_________________________________ Address:___________________________ ___________________________ ___________________________

Appears in 1 contract

Samples: Dynagen Inc

Subscription. The undersigned, ________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and the purchase ______of ______________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICESGoHealth.MD, INC., Inc. covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. DatedDated:_____________Signature:____________________ Signature_______________________ Address:__________________________ ___________________________ ASSIGNMENT FOR VALUE RECEIVED, ___________________RECEIVED ______________ hereby sells, assigns and transfers unto ______________________ ____________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint __________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESGoHealth.MD, INC. DatedInc. Dated:______________Signature:____________________ Signature_______________________ Address:_________________________ __________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, ____________RECEIVED _____________________ hereby sells, assigns and transfers unto _________________________________ the right to purchase _________ _shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICESNugget Exploration, INC. Inc. by the foregoing Warrant, and a proportionate Part of said Warrant and all the rights evidenced therebyhereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESGoHealth.MD, INC. DatedInc. Dated:______________Signature:____________________ Signature_______________________ Address:_________________________ __________________________

Appears in 1 contract

Samples: Gohealth Md Inc

Subscription. The undersigned, ________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and purchase To: ____________________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICES, INC., covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:_Date: ___________________ Signature________________The undersigned hereby subscribes for _______ Address_shares of Common Stock covered by this Warrant. The certificate(s) for such shares shall be issued in the name of the undersigned or as otherwise indicated below: ________________________ ASSIGNMENT FOR VALUE RECEIVED, _________Signature ________________________ hereby sells, assigns and transfers unto _________Name for Registration ________________________ the foregoing Warrant and all rights evidenced therebyMailing Address EXHIBIT B ADDITIONAL RETAINED WARRANT CERTIFICATE THESE SECURITIES HAVE NOT BEEN REGISTERED WITH THE UNITED STATES SECURITIES AND EXCHANGE COMMISSION OR THE SECURITIES COMMISSION OF ANY STATE PURSUANT TO AN EXEMPTION FROM REGISTRATION UNDER REGULATION D PROMULGATED UNDER THE SECURITIES ACT OF 1933, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books AS AMENDED (THE "ACT") OR OTHERWISE. THIS WARRANT SHALL NOT CONSTITUTE AN OFFER TO SELL NOR A SOLICITATION OF AN OFFER TO BUY THE SECURITIES IN ANY JURISDICTION IN WHICH SUCH OFFER OR SOLICITATION WOULD BE UNLAWFUL. THE SECURITIES ARE "RESTRICTED" AND MAY NOT BE RESOLD OR TRANSFERRED EXCEPT AS PERMITTED UNDER THE ACT PURSUANT TO REGISTRATION OR EXEMPTION THEREFROM. COMMON STOCK PURCHASE WARRANT Number of PERMA-FIX ENVIRONMENTAL SERVICESShares: 100,000 CONSTELLATION 3D, INC. Dated:____________________ Signature_______________________ Address_________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED---------------------- Void after December 1, _________________________________ hereby sells, assigns and transfers unto _________________________________ the right to purchase _________ shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICES, INC. by the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address_________________________2004

Appears in 1 contract

Samples: Settlement and Release Agreement (Constellation 3d Inc)

Subscription. The undersigned, ____________________________ , pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and the purchase ___________of _________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICESXXXXXXX XXXXX, INC., . covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:________Dated ____________ Signature_______________________ AddressAddress __________________ __________________ ASSIGNMENT FOR VALUE RECEIVED, ________RECEIVED _________________________ hereby sells, assigns and transfers unto _______________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESXXXXXXX XXXXX, INC. Dated:Dated ______________________ Signature__________________________ Address____________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, ____________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED __________________________ hereby sells, assigns and transfers unto _______________________ the right to purchase ___________ the right to purchase ___________ shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICESXXXXXXX XXXXX, INC. by the foregoing Warrant, and a proportionate part of said Warrant and all the rights evidenced therebyhereby, and does irrevocably constitute and appoint __________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESXXXXXXX XXXXX, INC. Dated:____________________ Signature_________________________ Address___________________________

Appears in 1 contract

Samples: Chaus Bernard Inc

Subscription. The undersigned, ________________________, pursuant to the provisions of the foregoing attached Warrant, hereby agrees irrevocably elects to subscribe for and purchase ____________________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICES, INC., covered by said Warrant, and makes hereby tenders payment therefor by delivery of $________________in full at cash or by certified or official bank check for the exercise price per share provided by said required under the Warrant pursuant to the terms of said Warrantwhich accompanies this notice. Dated:______________________________________ Signature:___________________________________ Address:____________________________________ Tax Identification or Social Security Number________________________ ASSIGNMENT FOR VALUE RECEIVED, _________________________________ hereby sells, assigns and transfers unto _________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:______________________________________ Signature:___________________________________ Address:____________________________________ Tax Identification or Social Security Number________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, _________________________________ hereby sells, assigns and transfers unto _________________________________ the right to purchase _________ shares of the Common Stock of PERMA- PERMA-FIX ENVIRONMENTAL SERVICES, INC. by the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address_________________________.

Appears in 1 contract

Samples: Perma Fix Environmental Services Inc

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Subscription. The undersigned, ________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and purchase ____________________ shares of the Class B Common Stock of PERMA-FIX ENVIRONMENTAL SERVICESof, TELEWAY, INC., covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrantwarrant. Dated:: ___________________, 199_ Signature_______________________ Address_________________________ ASSIGNMENT FOR VALUE RECEIVED, _________________________________ hereby sells, assigns and transfers unto (Signature) ________________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint (Address) _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address_________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, _________________________________ ASSIGNMENT FOR VALUE RECEIVED, hereby sells, assigns and transfers unto the foregoing Warrant and all rights evidenced thereby and does irrevocably constitute and appoint , attorney, to transfer said Warrant of the books of TELEWAY, INC. Dated: _________________, 199_ ________________________________________ the right to purchase _________ shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICES, INC. by the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint (Signature) _________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ (Address) ________________________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, hereby assigns and transfers unto the right to purchase shares of the Class B Common Stock of TELEWAY, INC. by the foregoing Warrant and the rights evidenced thereby, and does irrevocably constitute and appoint , attorney, to transfer said warrant on the books of TELEWAY, INC. Dated: _________________, 199_ ________________________________________ (Signature) ________________________________________ (Address)

Appears in 1 contract

Samples: 1 800 Flowers Com Inc

Subscription. The undersigned, ________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and the purchase ______of ______________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICESNugget Exploration, INC., Inc. covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:____________________ Signature_______________________ Address:_________________________ ASSIGNMENT FOR VALUE RECEIVED, Address:____________________ ----------------- ASSIGNMENT FOR VALUE RECEIVED ______________ hereby sells, assigns and transfers unto ______________________ ____________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint __________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESNugget Exploration, INC. Inc. Dated:____________________ Signature:________________________ Address________:_________________ ----------------- PARTIAL ASSIGNMENT FOR VALUE RECEIVED, _______________RECEIVED __________________ hereby sells, assigns and transfers unto _________________________________ the right to purchase _________ _shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICESNugget Exploration, INC. Inc. by the foregoing Warrant, and a proportionate Part of said Warrant and all the rights evidenced therebyhereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESNugget Exploration, INC. Inc. Dated:____________________ Signature:________________________ Address:__________________________ ----------------

Appears in 1 contract

Samples: Nugget Exploration Inc

Subscription. The undersigned, ________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and purchase ____________________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICES, INC., covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:____________________ Signature_______________________ Address_________________________ ASSIGNMENT FOR VALUE RECEIVED, _________________________________ hereby sells, assigns and transfers unto _________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address_________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, _________________________________ hereby sells, assigns and transfers unto _________________________________ the right to purchase _________ shares of the Common Stock of PERMA- PERMA-FIX ENVIRONMENTAL SERVICES, INC. by the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address_________________________

Appears in 1 contract

Samples: Perma Fix Environmental Services Inc

Subscription. The undersigned, __________________________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and the purchase of _________________________ shares of the Class A Common Stock of PERMA-FIX ENVIRONMENTAL SERVICESeSpeed, INC., Inc. covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:__Dated __________________ Signature__________________________ Address__________________________ ASSIGNMENT FOR VALUE RECEIVED, __________________________ ASSIGNMENT FOR VALUE RECEIVED _________________________ hereby sells, assigns and transfers unto _________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESeSpeed, INC. Dated:__Inc. Dated __________________ Signature_______________________ Address_________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, _________________________________ hereby sells, assigns and transfers unto _________________________________ the right to purchase _________ shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICES, INC. by the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address__________________________ __________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED _________________________ hereby assigns and transfers unto _________________________ the right to purchase _________________________ shares of the Class A Common Stock of eSpeed, Inc. by the foregoing Warrant, and a proportionate part of said Warrant and the rights evidenced hereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer that part of said Warrant on the books of eSpeed, Inc. Dated __________________ Signature__________________________ Address__________________________ __________________________

Appears in 1 contract

Samples: Espeed Inc

Subscription. The undersigned, ________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and purchase ____________________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICES, INC., covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. DatedTo:____________________ Signature_______________________ Address_________________________ ASSIGNMENT FOR VALUE RECEIVED, Date:_______________________________ The undersigned hereby subscribes for _____________ shares of Preferred Stock covered by this Warrant. The certificate(s) for such shares shall be issued in the name of the undersigned or as otherwise indicated below: ___________________________________ Signature ___________________________________ Name for Registration ___________________________________ Mailing Address NET ISSUE ELECTION NOTICE To:______________________________ Date:_______________________________ The undersigned hereby elects under Section 4 to surrender the right to purchase _______________ shares of Preferred Stock pursuant to this Warrant. The certificate(s) for such shares issuable upon such net issue election shall be issued in the name of the undersigned or as otherwise indicated below: ___________________________________ Signature ___________________________________ Name for Registration ___________________________________ Mailing Address ASSIGNMENT For value received _____________________ hereby sells, assigns and transfers unto ______________________________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address_________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, _________________________________ hereby sells, assigns [Please print or typewrite name and transfers unto address of Assignee] _________________________________________________________________________ the right to purchase within Warrant, and does hereby irrevocably constitute and appoint ___________________ shares its attorney to transfer the within Warrant on the books of the Common Stock within named Company with full power of PERMA- FIX ENVIRONMENTAL SERVICES, INCsubstitution on the premises. by the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint DATED:_________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address_______________________________ IN THE PRESENCE OF:

Appears in 1 contract

Samples: Rigel Pharmaceuticals Inc

Subscription. The undersigned, ________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and purchase ____________________ shares of the Common Stock Stock, par value $.001 per share, of PERMA-FIX ENVIRONMENTAL SERVICESXenometrix, INC., Inc. covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:: Signature: ---------------- ---------------------------- Address: ---------------------------- CASHLESS EXERCISE The undersigned ____________________ Signature____, pursuant to the provisions of the foregoing Warrant, hereby elects to exchange its Warrant for ___________________ shares of Common Stock, par value $.001 per share, of Xenometrix, Inc. pursuant to the Cashless Exercise provisions of the Warrant. Dated: Signature: ---------------- ---------------------------- Address_________________________ : ---------------------------- ASSIGNMENT FOR VALUE RECEIVED, __________________RECEIVED _______________ hereby sells, assigns and transfers unto _________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESXenometrix, INC. Inc. Dated:____________________ : Signature_______________________ : ---------------- ---------------------------- Address_________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, _________________________________ hereby sells, assigns and transfers unto _________________________________ the right to purchase _________ shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICES, INC. by the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address_________________________: ----------------------------

Appears in 1 contract

Samples: Xenometrix Inc \De\

Subscription. The undersigned, ________________________, pursuant to the provisions of the foregoing WarrantOption, hereby agrees elects to subscribe for and purchase exercise the foregoing Option to the extent of purchasing ____________________ shares of the Common Stock under such Option and hereby makes payment of PERMA-FIX ENVIRONMENTAL SERVICES$___________ by certified or official bank check in payment of the exercise price for such Option . The undersigned hereby represents and warrants to the Company that the undersigned is acquiring the shares of the Company's Common Stock pursuant to exercise of the foregoing Option for investment purposes only. The undersigned hereby further acknowledges that the undersigned understands that such shares (a) have not been registered under the Securities Act of 1933, INC., covered by said Warrantas amended (the “Act”), and makes payment therefor in full at the price per share provided by said Warrant pursuant are being issued to the terms undersigned by the Company in reliance upon the foregoing representation and warranty and (b) may not be resold except in accordance with the requirements of said Warrantthe Act, including Rule 144 under the Act, if applicable. Dated:The undersigned further consents to the placing of a legend on the certificates for the shares being purchased to the foregoing effect. Date: ___________________________ Signature: ________________________________________________ Address: ________________________________________________ ASSIGNMENT FOR VALUE RECEIVED, _______________ hereby sells, assigns and transfers unto ____________________ hereby sellsthe foregoing Option and all rights evidenced by such Option, assigns and transfers unto does irrevocably constitute and appoint _____________________, attorney, to transfer such Option on the books of ZIOPHARM, Inc. Date: ___________________________ Signature: ________________________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint Address: _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address_________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, _______________ hereby assigns and transfers unto ____________________ hereby sellsthe right to purchase _______ shares of the Common Stock of ZIOPHARM, assigns Inc. covered by the foregoing Option, and transfers unto a proportionate part of such Option and the rights evidenced by such Option, and does irrevocably constitute and appoint ____________________, attorney, to transfer that part of such Option on the books of ZIOPHARM, Inc. Date: ___________________________ Signature: ________________________________________________ the right to purchase _________ shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICES, INC. by the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint Address: _________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address_________________________ZIOPHARM Oncology, Inc. Addendum Dated September 14, 2005 to Option for the Purchase of Shares of Common Stock dated October 15, 2004 Pursuant to an Agreement and Plan of Merger dated August 3, 2005, on September 13, 2005, a wholly-owned subsidiary of EasyWeb, Inc. merged with and into ZIOPHARM, Inc. (“ZIOPHARM”) with XXXXXXXX remaining as the surviving corporation and a wholly-owned subsidiary of EasyWeb, Inc. (the “Merger”). On September 14, 2005, XXXXXXXX was merged with and into EasyWeb, Inc. and the combined corporation changed its name to ZIOPHARM Oncology, Inc. (“ZIOPHARM Oncology”). In accordance with the terms of the Merger, each outstanding option, warrant or other right to purchase capital stock of ZIOPHARM was automatically converted into an option, warrant or other right to purchase approximately 0.500974 shares of common stock of ZIOPHARM Oncology, $.001 par value per share (“ZIOPHARM Oncology Common Stock”), rounded down to the nearest whole share, for each share of ZIOPHARM capital stock subject to such option, warrant or other right immediately prior to the Merger. As a result, this option, warrant or other right was adjusted such that the holder is entitled to purchase shares of ZIOPHARM Oncology Common Stock in the amounts, and at the per share exercise price, set forth below: Number of Shares: 27,616 Exercise Price: $0.02/share Vesting Schedule: No. of Shares Vesting Date 6,904 October 15, 2004 6,904 Upon the dosing of the first patient in the first Phase III clinical trial of Licensed Product in the United States under a Company or Company sublicense sponsored IND

Appears in 1 contract

Samples: Ziopharm Oncology Inc

Subscription. The undersigned, ,______________________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and the purchase ____________________ shares of_________________shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICESXXXXXXX XXXXX, INC., . covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:________Dated ____________ Signature__Signature _____________________ AddressAddress _____________________ _____________________ ASSIGNMENT FOR VALUE RECEIVED, ________RECEIVED _________________________ hereby sells, assigns and transfers unto _______________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESXXXXXXX XXXXX, INC. Dated:Dated ______________________ Signature_________________________ Address___________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, ___________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED __________________________ hereby sells, assigns and transfers unto _______________________ the right to purchase ___________ the right to purchase ___________ shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICESXXXXXXX XXXXX, INC. by the foregoing Warrant, and a proportionate part of said Warrant and all the rights evidenced therebyhereby, and does irrevocably constitute and appoint __________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESXXXXXXX XXXXX, INC. Dated:____________________ Signature_______________________ Address_________________________

Appears in 1 contract

Samples: Chaus Josephine

Subscription. The undersigned, ________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and purchase ____________________ shares of the Common Stock Stock, par value $0.001 per share, of PERMA-FIX ENVIRONMENTAL SERVICESPacific Beach Biosciences, INC., Inc. covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:____________________ Signature_______________________ AddressSignature:____________________________ ASSIGNMENT FOR VALUE RECEIVED, ____Address:_____________________________ ASSIGNMENT FOR VALUE RECEIVED _______________ (“Assignor”) hereby sells, assigns and transfers unto _________________________________ (“Transferee”) the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESPacific Beach Biosciences, INCInc. By acceptance of the foregoing Warrant, Transferee shall become a Holder under said Warrant and subject to the rights, obligations and representations of Holder set forth in said Warrant. ASSIGNOR: Dated:________________________ Signature:____________________________ Address:_____________________________ TRANSFEREE: Dated:________________________ Signature:____________________________ Address:_____________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, __________________RECEIVED _______________ (“Assignor”) hereby sells, assigns and transfers unto _________________________________ (“Transferee”) the right to purchase _________ shares of the Common Stock Stock, par value $0.001 per share, of PERMA- FIX ENVIRONMENTAL SERVICESPacific Beach Biosciences, INC. Inc. covered by the foregoing Warrant, and a proportionate part of said Warrant and all the rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer that such part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESPacific Beach Biosciences, INCInc. By acceptance of the proportionate part of foregoing Warrant, Transferee shall become a Holder under said proportionate part of said Warrant and subject to the rights, obligations and representations of Holder set forth in said Warrant. ASSIGNOR: Dated:____________________ Signature_______________________ AddressSignature:____________________________ Address:_____________________________ TRANSFEREE: Dated:________________________ Signature:____________________________ Address:_____________________________

Appears in 1 contract

Samples: Iaso Pharma Inc

Subscription. The undersigned, ________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and purchase ____________________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICES, INC., covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:____________________ Signature_______________________ Address_________________________ ASSIGNMENT FOR VALUE RECEIVED, _________________________________ hereby sells, assigns and transfers unto _________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address_________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, _________________________________ hereby sells, assigns and transfers unto _________________________________ the right to purchase _________ shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICES, INC. by the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address_________________________

Appears in 1 contract

Samples: Perma Fix Environmental Services Inc

Subscription. The undersigned, ________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and purchase ____________________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICESNanoPierce Technologies, INC.Inc., covered by said Warrant, and makes payment therefor in full at the price per share Per Share Warrant provided by said Warrant pursuant to the terms of said Warrant. Dated:____________________ : Signature_______________________ : Address_________________________ : ASSIGNMENT ---------- FOR VALUE RECEIVED, _________________________________ hereby sells, assigns and transfers unto _________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Dated: Signature: Address: PARTIAL ASSIGNMENT ------------------ FOR VALUE RECEIVED _______________________ Address_________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, _________________________________ hereby sells, assigns and transfers unto _________________________________ the right to purchase ______________ shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICES, INC. ________________ by the foregoing Warrant, and a proportionate part of said Warrant and all the rights evidenced therebyhereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESNanoPierce Technologies, INC. Inc. Dated:____________________ : Signature: Address: CASHLESS EXERCISE SUBSCRIPTION ------------------------------ The undersigned _______________________ pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe to that number of shares of stock of NanoPierce Technologies, Inc. as are issuable in accordance with the formula set forth in Section l(b) of the Warrant, and makes payment therefore in full by surrender and delivery of this Warrant. Dated: Signature: Address_________________________:

Appears in 1 contract

Samples: Nanopierce Technologies Inc

Subscription. The undersigned, ________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and the purchase ______of ______________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICESGoHealth. MD, INC., Inc. covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:_____________ Signature:_________________ Address:____________________ Signature_______________________ Address_________________________ ---------------- ASSIGNMENT FOR VALUE RECEIVED, ___________________RECEIVED ______________ hereby sells, assigns and transfers unto ______________________ ____________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint __________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESGoHealth.MD, INC. Inc. Dated:______________ Signature:_________________ Address:____________________ Signature_______________________ Address_________________________ ----------------- PARTIAL ASSIGNMENT FOR VALUE RECEIVED, ____________RECEIVED _____________________ hereby sells, assigns and transfers unto _________________________________ the right to purchase _________ _shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICESGoHealth.MD, INC. Inc. by the foregoing Warrant, and a proportionate Part of said Warrant and all the rights evidenced therebyhereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESGoHealth.MD, INC. Inc. Dated:______________ Signature:_________________ Address:____________________ Signature_______________________ Address_________________________-----------------

Appears in 1 contract

Samples: Nugget Exploration Inc

Subscription. The undersigned, ________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and purchase ____________________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICES, INC., covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. DatedTo:____________________ Signature_______________________ Address_________________________ ASSIGNMENT FOR VALUE RECEIVED, Date:____________________________ The undersigned hereby subscribes for _________________ shares of Common Stock covered by this Warrant. The certificate(s) for such shares shall be issued in the name of the undersigned or as otherwise indicated below: Signature __________________________________ hereby sells, assigns and transfers unto Name for Registration ______________________ Mailing Address ____________________________ ____________________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint NET ISSUE ELECTION NOTICE To:_________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address_Date:________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, The undersigned hereby elects under Section 4 to surrender the right to purchase ___________ shares of Common Stock Pursuant to this Warrant. The certificate(s) for the shares issuable upon such net issue election shall be issued in the name of the undersigned or as otherwise indicated below. Signature __________________________________ hereby sells, assigns and transfers unto Name for Registration ______________________ Mailing Address ____________________________ ____________________________________________ the right to purchase _________ shares of the Common Stock of PERMA- FIX COMMON STOCK WARRANT NO. W-12/30/96-S THIS WARRANT HAS NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE "ACT"), OR ANY APPLICABLE STATE SECURITIES LAWS, AND MAY NOT BE SOLD OR TRANSFERRED UNLESS SUCH SALE OR TRANSFER IS IN ACCORDANCE WITH THE REGISTRATION REQUIREMENTS OF SUCH ACT AND APPLICABLE LAWS OR SOME OTHER EXEMPTION FROM THE REGISTRATION REQUIREMENTS OF SUCH ACT AND APPLICABLE LAWS IS AVAILABLE WITH RESPECT THERETO. ENSYS ENVIRONMENTAL SERVICESPRODUCTS, INC. by the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address_________________________WARRANT TO PURCHASE COMMON STOCK

Appears in 1 contract

Samples: Edison Venture Fund Ii Lp

Subscription. The undersigned, _______________________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and the purchase ____________of ________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICESDYNAGEN, INC., . covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:____________________________ Signature:_________________________ Address:__________________________ __________________________ __________________________ ASSIGNMENT FOR VALUE RECEIVED, ______RECEIVED ___________________________ hereby sells, assigns and transfers unto _________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESDYNAGEN, INC. .. Dated:____________________________ Signature:_________________________ Address:__________________________ __________________________ __________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, ________RECEIVED _________________________ hereby sells, assigns and transfers unto _________________________________ the right to purchase _________ shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICESDYNAGEN, INC. by the foregoing Warrant, and a proportionate part of said Warrant and all the rights evidenced therebyhereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESDYNAGEN, INC. Dated:____________________ Signature_______________________ Address____________________________ Signature:_________________________ Address:__________________________ __________________________ __________________________ NET ISSUANCE ELECTION The undersigned, _______________________________, pursuant to the provisions of the foregoing Warrant, hereby tenders the right to purchase _____ shares of the Common Stock of DYNAGEN, INC., and a proportionate part of said Warrant and the rights evidenced thereby, in exchange for a number of shares of said Common Stock to be computed in accordance with the provisions of Section 1(b) of said Warrant. Dated:____________________________ Signature:_________________________ Address:__________________________ __________________________ __________________________

Appears in 1 contract

Samples: Dynagen Inc

Subscription. The undersigned, ________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and purchase ____________________ shares of the Common Stock Stock, par value $.001 per share, of PERMA-FIX ENVIRONMENTAL SERVICESXenometrix, INC., Inc. covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:_______________ Signature:____________________ Signature_Address:______________________ AddressThe undersigned ___________________, pursuant to the provisions of the foregoing Warrant, hereby elects to exchange its Warrant for ___________________ shares of Common Stock, par value $.001 per share, of Xenometrix, Inc. pursuant to the Cashless Exercise provisions of the Warrant. Dated:_______________ Signature:____________________ Address:______________________ ASSIGNMENT FOR VALUE RECEIVED, __________________RECEIVED _______________ hereby sells, assigns and transfers unto _________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESXenometrix, INC. Inc. Dated:_______________ Signature:____________________ SignatureAddress:_______________________ Address_________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, _________________________________ hereby sells, assigns and transfers unto _________________________________ the right to purchase _________ shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICES, INC. by the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address_________________________

Appears in 1 contract

Samples: Xenometrix Inc \De\

Subscription. The undersigned, ____________________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and purchase ____________________ shares of the Common Stock of PERMAPerma-FIX ENVIRONMENTAL SERVICESFix Environmental Services, INC., Inc. covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:_____: _______________ SignatureSignature _________________________ AddressAddress ___________________________ ASSIGNMENT FOR VALUE RECEIVED, _______________RECEIVED __________________ hereby sells, assigns and transfers unto _________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMAPerma-FIX ENVIRONMENTAL SERVICESFix Environmental Services, INC. Inc. Dated:_____: _______________ SignatureSignature _________________________ AddressAddress ____________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, ______________RECEIVED ___________________ hereby sells, assigns and transfers unto _________________________________ the right to purchase ___________ shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICESPerma-Fix Environmental Services, INC. Inc. by the foregoing Warrant, and a proportionate part of said Warrant and all the rights evidenced therebyhereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer that part of said Warrant on the books of PERMAPerma-FIX ENVIRONMENTAL SERVICESFix Environmental Services, INC. Inc. Dated:_____: _______________ Signature_______________________ AddressSignature __________________________ Address ____________________________

Appears in 1 contract

Samples: Perma Fix Environmental Services Inc

Subscription. The undersigned, ____________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees elects to subscribe for and purchase exercise the within Warrant to the extent of purchasing _____________________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICES, INC., covered by said Warrant, thereunder and hereby makes payment therefor of $_______________ by certified or official bank check in full at payment of the exercise price per share provided by said Warrant pursuant to the terms of said Warranttherefor. Dated:_______________ Signature:______ Signature________________________ Address:_______________________________ ASSIGNMENT FOR VALUE RECEIVED, RECEIVED _______________________________________ hereby sells, assigns and transfers unto _____________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _____________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESGenta, INC. Inc. Dated:_______________ Signature:______ Signature_______________________ Address_________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, ___Address:______________________________ hereby sells, assigns and transfers unto PARTIAL ASSIGNMENT FOR VALUE RECEIVED __________________________ hereby assigns and transfers unto _________________________ the right to purchase __________ shares of the Common Stock Stock, no par value per share, of PERMA- FIX ENVIRONMENTAL SERVICESGenta, INC. Inc. covered by the foregoing Warrant, and a proportionate part of said Warrant and all the rights evidenced thereby, and does irrevocably constitute and appoint __________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICESGenta, INC. Inc. Dated:____________________ Signature_______________________ Address:___________________________ Address:_____________________________

Appears in 1 contract

Samples: Genta Incorporated /De/

Subscription. The undersigned, ________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and purchase ____________________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICES, INC., covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:____________________ Signature_______________________ Address_________________________ ASSIGNMENT FOR VALUE RECEIVED, _________________________________ hereby sells, assigns and transfers unto _________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address_________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, _________________________________ hereby sells, assigns and transfers unto _________________________________ the right to purchase _________ shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICES, INC. by the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address_________________________

Appears in 1 contract

Samples: Perma Fix Environmental Services Inc

Subscription. The undersigned, ________________________, pursuant to the provisions of the foregoing Warrant, hereby agrees to subscribe for and purchase ____________________ shares of the Common Stock of PERMA-FIX ENVIRONMENTAL SERVICES, INC., covered by said Warrant, and makes payment therefor in full at the price per share provided by said Warrant pursuant to the terms of said Warrant. Dated:____________________ Signature_______________________ Address_________________________ ASSIGNMENT FOR VALUE RECEIVED, _________________________________ hereby sells, assigns and transfers unto _________________________________ the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address_________________________ PARTIAL ASSIGNMENT FOR VALUE RECEIVED, _________________________________ hereby sells, assigns and transfers unto _________________________________ the right to purchase _________ shares of the Common Stock of PERMA- FIX ENVIRONMENTAL SERVICES, INC. by the foregoing Warrant and all rights evidenced thereby, and does irrevocably constitute and appoint _________________________, attorney, to transfer that part of said Warrant on the books of PERMA-FIX ENVIRONMENTAL SERVICES, INC. Dated:____________________ Signature_______________________ Address_________________________

Appears in 1 contract

Samples: Perma Fix Environmental Services Inc

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