Common use of TO BE EXECUTED IF WARRANT HOLDER DESIRES Clause in Contracts

TO BE EXECUTED IF WARRANT HOLDER DESIRES. TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on __________, ____ (the “Exercise Date”), _____________ Warrants, evidenced by this Warrant Certificate, to purchase, _________________ shares (the “Warrant Shares”) of Common Stock, par value of $0.0001 per share (the “Common Stock”) of Medovex Corp., a Nevada corporation (the “Company”), and represents that on or before the Exercise Date [ ] such holder has tendered payment for such Warrant Shares by certified or official bank check or bank wire transfer in immediately available funds to the order of the Company c/o InterWest Transfer Company, Inc., 0000 Xxxxxx Xxxxxxxx Road, Suite 100, Salt Lake City, UT 84117, in the amount of $_____________ in accordance with the terms hereof, or [ ] [if permitted] the cancellation of such number of Warrant Shares as is necessary, in accordance with the formula set forth in subsection 3.3.7 of the Warrant Agreement, to exercise this Warrant with respect to the maximum number of Warrant Shares purchasable pursuant to the cashless exercise procedure set forth in subsection 3.3.7. The undersigned requests that said number of Warrant Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Warrant Shares is less than all of the Warrant Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: ______________ __, ____ Name __________________________ (Please Print) / / / / - / / /- / / / / / (Insert Social Security or Other Identifying Number of Holder) Address ________________________ ________________________ Signature _______________________ This Warrant may only be exercised by presentation to the Warrant Agent at one of the following locations: By hand at: By mail at: The method of delivery of this Warrant Certificate is at the option and risk of the exercising holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to assure timely delivery. (Instructions as to form and delivery of Warrant Shares and/or Warrant Certificates) Name in which Warrant Shares are to be registered if other than in the name of the registered holder of this Warrant Certificate: ______________________________ Address to which Warrant Shares are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: ______________________________ (Street Address) ______________________________ (City and State) (Zip Code) Name in which Warrant Certificate evidencing unexercised Warrants, if any, are to be registered if other than in the name of the registered holder of this Warrant Certificate: _____________________________ Address to which certificate representing unexercised Warrants, if any, are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: ______________________________ (Street Address) ______________________________ (City and State) (Zip Code) Dated: ______________________________ Signature Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate. If Warrant Shares, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the registered holder hereof or are to be delivered to an address other than the address of such holder as shown on the books of the Warrant Agent, the above signature must be guaranteed by a an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Name Title Dated: __________________________, 200___ ASSIGNMENT (FORM OF ASSIGNMENT TO BE EXECUTED IF WARRANT HOLDER DESIRES TO TRANSFER WARRANTS EVIDENCED HEREBY) FOR VALUE RECEIVED, _________________ HEREBY SELL(S), ASSIGN(S) AND TRANSFER(S) UNTO ________________________________________________________ __________________________________ _______________________________________ (Please print name and address (Please insert social security or including zip code of assignee) other identifying number of assignee) the rights represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint ____________ Attorney to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. Dated: _____________________________________________ Signature (Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Name Title

Appears in 2 contracts

Samples: Warrant Agency Agreement (Medovex Corp.), Warrant Agency Agreement (Medovex Corp.)

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TO BE EXECUTED IF WARRANT HOLDER DESIRES. TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on __________, ____ (the “Exercise Date”), _____________ Warrants, evidenced by this Warrant Certificate, to purchase, _________________ shares (the “Warrant Shares”) of Common Stock, par value of $0.0001 0.00001 per share (the “Common Stock”) of Medovex Corp.Red Mountain Resources, Inc., a Nevada Florida corporation (the “Company”), and represents that on or before the Exercise Date [ ] ¨ such holder has tendered payment for such Warrant Shares by certified or official bank check or bank wire transfer in immediately available funds to the order of the Company c/o InterWest Transfer CompanyBroadridge Corporate Issuer Solutions, Inc., 0000 Xxxxxx Xxxxxxxx RoadXxxx Xx., Suite 100Xxxxx 0000, Salt Lake CityXxxxxxxxxxxx, UT 84117XX 00000, in the amount of $_____________ $ in accordance with the terms hereof, or [ ] ¨ [if permitted] the cancellation of such number of Warrant Shares as is necessary, in accordance with the formula set forth in subsection 3.3.7 3.3.3 of the Warrant Agreement, to exercise this Warrant with respect to the maximum number of whole Warrant Shares purchasable pursuant to the cashless exercise procedure set forth in subsection 3.3.73.3.3. The undersigned requests that said number of Warrant Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Warrant Shares is less than all of the Warrant Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: ______________ __, ____ Name __________________________ (Please Print) / / / / - / / /- / / / / / (Insert Social Security or Other Identifying Number of Holder) Address ________________________ ________________________ Signature _______________________ This Warrant may only be exercised by presentation to the Warrant Agent at one of the following locations: By hand or overnight courier at: Broadridge, Attn: Reorganization Dept., 0000 Xxxxxx Xxx., Xxxxx 000, Xxxx Xxxxxxx, XX 00000 By mail at: Broadridge, Attn: Reorganization Dept., X.X. Xxx 0000, Xxxxxxxxx, XX 00000 The method of delivery of this Warrant Certificate is at the option and risk of the exercising holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to assure timely delivery. (Instructions as to form and delivery of Warrant Shares and/or Warrant Certificates) Name in which Warrant Shares are to be registered if other than in the name of the registered holder of this Warrant Certificate: ______________________________ Address to which Warrant Shares are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: ______________________________ (Street Address) ______________________________ (City and State) (Zip Code) Name in which Warrant Certificate evidencing unexercised Warrants, if any, are to be registered if other than in the name of the registered holder of this Warrant Certificate: _____________________________ Address to which certificate representing unexercised Warrants, if any, are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: ______________________________ (Street Address) ______________________________ (City and State) (Zip Code) Dated: ______________________________ Signature Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate. If Warrant Shares, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the registered holder hereof or are to be delivered to an address other than the address of such holder as shown on the books of the Warrant Agent, the above signature must be guaranteed by a an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Name Title Dated: __________________________, 200___ ASSIGNMENT (FORM OF ASSIGNMENT TO BE EXECUTED IF WARRANT HOLDER DESIRES TO TRANSFER WARRANTS EVIDENCED HEREBY) FOR VALUE RECEIVED, _________________ HEREBY SELL(S), ASSIGN(S) AND TRANSFER(S) UNTO ________________________________________________________ __________________________________ _______________________________________ (Please print name and address (Please insert social security or including zip code of assignee) other identifying number of assignee) the rights represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint ____________ Attorney to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. Dated: _____________________________________________ Signature (Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Name Title

Appears in 1 contract

Samples: Warrant Agreement (Red Mountain Resources, Inc.)

TO BE EXECUTED IF WARRANT HOLDER DESIRES. TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on __________, ____ (the “Exercise Date”), _____________ Warrants, evidenced by this Warrant Certificate, to purchase, _________________ shares (the “Warrant Shares”) of Common Stock, par value of $0.0001 0.001 per share (the “Common Stock”) of Medovex Corp.Vuzix Corporation, a Nevada Delaware corporation (the “Company”), and represents that on or before the Exercise Date [ ] such holder has tendered payment for such Warrant Shares Shares, and all applicable taxes and charges due in connection therewith, by certified or official bank check or bank wire transfer in immediately available funds to the order of the Company c/o InterWest Transfer Computershare Trust Company, Inc., 0000 Xxxxxx Xxxxxxxx Road, Suite 100, Salt Lake City, UT 84117N.A.________________, in the amount of $_____________ in accordance with the terms hereof, or [ ] [if permitted] , the cancellation of such number of Warrant Shares as is necessary, in accordance with the formula set forth in subsection 3.3.7 of the Warrant Agreement, to exercise this Warrant with respect to the maximum number of Warrant Shares purchasable pursuant to the cashless exercise procedure set forth in subsection 3.3.7. The undersigned requests that said number of Warrant Shares be in fully registered form, registered in such names and delivered, all as specified in accordance with the instructions set forth below. If said number of Warrant Shares is less than all of the Warrant Shares purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. Dated: ______________ __, ____ Name __________________________ (Please Print) / / / / - / / /- / / / / / (Insert Social Security or Other Identifying Number of Holder) Address ________________________ ________________________ Signature _______________________ This Warrant may only be exercised by presentation to the Warrant Agent at one of the following locations: By hand at: By mail at: The method of delivery of this Warrant Certificate is at the option and risk of the exercising holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to assure timely delivery. (Instructions as to form and delivery of Warrant Shares and/or Warrant Certificates) Name in which Warrant Shares are to be registered if other than in the name of the registered holder of this Warrant Certificate: ______________________________ Address to which Warrant Shares are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: ______________________________ (Street Address) ______________________________ (City and State) (Zip Code) Name in which Warrant Certificate evidencing unexercised Warrants, if any, are to be registered if other than in the name of the registered holder of this Warrant Certificate: _____________________________ Address to which certificate representing unexercised Warrants, if any, are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: ______________________________ (Street Address) ______________________________ (City and State) (Zip Code) Dated: ______________________________ Signature Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate. If Warrant Shares, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the registered holder hereof or are to be delivered to an address other than the address of such holder as shown on the books of the Warrant Agent, the above signature must be guaranteed by a an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Name Title Dated: __________________________, 200___ ASSIGNMENT (FORM OF ASSIGNMENT TO BE EXECUTED IF WARRANT HOLDER DESIRES TO TRANSFER WARRANTS EVIDENCED HEREBY) FOR VALUE RECEIVED, _________________ HEREBY SELL(S), ASSIGN(S) AND TRANSFER(S) UNTO ________________________________________________________ __________________________________ _______________________________________ (Please print name and address (Please insert social security or including zip code of assignee) other identifying number of assignee) the rights represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint ____________ Attorney to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. Dated: _____________________________________________ Signature (Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Name Title

Appears in 1 contract

Samples: Vuzix Corporation Warrant Agency Agreement (Vuzix Corp)

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TO BE EXECUTED IF WARRANT HOLDER DESIRES. TO EXERCISE THE WARRANTS EVIDENCED HEREBY The undersigned hereby irrevocably elects to exercise, on __________, ____ (the “Exercise Date), _____________ Warrants, evidenced by this Warrant Certificate, to purchase, ____[$_____________ shares principal amount] [ ] of the [title of Securities purchasable upon exercise of Warrants] [If Warrants for Depositary Shares are to be offered: , each representing a 1/___th interest in a share of [title of securities represented by the Depositary Shares]] (the “Warrant SharesSecurities”) of Common StockS&T BANCORP, par value of $0.0001 per share (the “Common Stock”) of Medovex Corp.INC., a Nevada Pennsylvania corporation (the “Company”), and represents that on or before the Exercise Date [ ] such holder has tendered payment for such Warrant Shares Securities by certified or official bank check or bank wire transfer in immediately available funds to the order of the Company c/o InterWest Transfer Company, Inc., 0000 Xxxxxx Xxxxxxxx Road, Suite 100, Salt Lake City, UT 84117[Name and address of Warrant Agent], in the amount of $_____________ in accordance with the terms hereof, or [ ] [if permitted] the cancellation of such number of Warrant Shares as is necessary, in accordance with the formula set forth in subsection 3.3.7 of the Warrant Agreement, to exercise this Warrant with respect to the maximum number of Warrant Shares purchasable pursuant to the cashless exercise procedure set forth in subsection 3.3.7. The undersigned requests that said [principal amount of] [number of of] Warrant Shares Securities be in fully registered form, in the authorized denominations, registered in such names and delivered, all as specified in accordance with the instructions set forth below. [Unless Warrants may be exercised on only one date: If said number [principal amount] [number] of Warrant Shares Securities is less than all of the Warrant Shares Securities purchasable hereunder, the undersigned requests that a new Warrant Certificate evidencing the remaining balance of the Warrants evidenced hereby be issued and delivered to the holder of the Warrant Certificate unless otherwise specified in the instructions below. .] Dated: ______________ __, ____ Name __________________________ (Please Print) / / / / - /- / / /- / / / / / (Insert Social Security or Other Identifying Number of Holder) Address ________________________ _Address_______________________ Signature ________________________ This Warrant may only be exercised by presentation to the Warrant Agent at one of the following locations: By hand at: at By mail at: at The method of delivery of this Warrant Certificate is at the option and risk of the exercising holder and the delivery of this Warrant Certificate will be deemed to be made only when actually received by the Warrant Agent. If delivery is by mail, registered mail with return receipt requested, properly insured, is recommended. In all cases, sufficient time should be allowed to assure timely delivery. (Instructions as to form and delivery of Warrant Shares Securities and/or Warrant Certificates) Name in which Warrant Shares Securities are to be registered if other than in the name of the registered holder of this Warrant Certificate: Address to which Warrant Securities are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: ______________________________ Address to which Warrant Shares are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: __________________________________ (Street Address) _______________________________________________________________ (City and State) (Zip Code) [Except for Global Warrant Certificate:] Name in which Warrant Certificate evidencing unexercised Warrants, if any, are to be registered if other than in the name of the registered holder of this Warrant Certificate: _____________________________ Address to which certificate representing unexercised Warrants, if any, are to be mailed if other than to the address of the registered holder of this Warrant Certificate as shown on the books of the Warrant Agent: _______________________________________________________________ (Street Address) _______________________________________________________________ (City and State) (Zip Code) DatedDate: ______Signature ________________________ Signature ([Except for Global Warrant Certificate: Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate. .] If Warrant SharesSecurities, or a Warrant Certificate evidencing unexercised Warrants, are to be issued in a name other than that of the registered holder hereof or are to be delivered to an address other than the address of such holder as shown on the books of the Warrant Agent, the above signature must be guaranteed by a an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 member firm of a registered national stock exchange, a member of the National Association of Securities Dealers, Inc., a participant in the Security Transfer Agents Medallion Program or the Stock Exchange Act of 1934Medallion Program, as amended). or by a commercial bank or trust company having an office or correspondent in the United States.) SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Name Title Dated: __________________________, 200___ ASSIGNMENT (FORM OF ASSIGNMENT TO BE EXECUTED IF WARRANT HOLDER DESIRES TO TRANSFER WARRANTS EVIDENCED HEREBY) FOR VALUE RECEIVED, RECEIVED _________________ HEREBY SELL(S)hereby sells, ASSIGN(S) AND TRANSFER(S) UNTO assigns and transfers unto ________________________________________________________ __________________________________ _______________________________________ . (Please print name and address including zip code) (Please insert social security or including zip code of assignee) other identifying number of assigneenumber) the rights represented by the within Warrant Certificate and does hereby irrevocably constitute and appoint _____________ Attorney Attorney, to transfer said Warrant Certificate on the books of the Warrant Agent with full power of substitution in the premises. Dated: _____________________________________________ Signature (Signature must conform in all respects to the name of the holder as specified on the face of this Warrant Certificate and must bear a signature guarantee by an Eligible Guarantor Institution (as that term is defined in Rule 17Ad-15 of the Securities Exchange Act of 1934, as amended). SIGNATURE GUARANTEE Name of Firm Address Area Code and Number Authorized Signature Name Title:

Appears in 1 contract

Samples: Warrant Agreement (S&t Bancorp Inc)

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