Name of Holder. Signature: ________________________ Address: ________________________ ________________________ ________________________ NOTICE OF CONVERSION The undersigned hereby irrevocably elects to convert, pursuant to Section 7 of the Warrant Certificate accompanying this Notice of Conversion, __________ Warrants of the total number of Warrants owned by the undersigned pursuant to the accompanying Warrant Certificate into shares of the Common Stock of the Company (the "Shares"). The number of Shares to be received by the undersigned shall be calculated in accordance with the provisions of Section 7.1 of the accompanying Warrant Certificate.
Name of Holder. Signature: ________________________ Address: ________________________ ________________________ ________________________ Section 3 Representations and Warranties of the Company. Schedule of Exceptions.
Name of Holder. Xxxxx Xxxxxxx Address: ____________________________ NOTICE OF EXERCISE To: Universal Automotive Industries, Inc.
Examples of Name of Holder in a sentence
Name of Holder: ......................................................................
Date: (Legal Name of Holder) By: Name: Title: Signature Guaranteed: Participant in a Recognized Signature Guarantee Medallion Program By: Authorized Signatory * Must be an Authorized Denomination.
Date: (Legal Name of Holder) By: Name: Title: Signature Guaranteed: Participant in a Recognized Signature By: Authorized Signatory * Must be an Authorized Denomination.
HOLDER: __________________________________________ (Signature of Holder) __________________________________________ (Print Name of Holder) __________________________________________ Number of Shares of Common Stock Beneficially Owned Represented by ______________ shares of Common Stock and options, warrants and rights to acquire ______________ additional shares of Common Stock COMPANY: ATTITUDE DRINKS, INC.
Date: Full Name of Holder*: Signature of Holder or Authorized Representative: Name and Title of Authorized Representative†: Additional Signature of Holder (if jointly held): Address of Holder: Full Name of Transferee: Address of Transferee: In the presence of: * Must conform in all respects to name of holder as specified on the face of the Warrant.
More Definitions of Name of Holder
Name of Holder. Jxxxxxxxx High Yield Trading, LLC Address: The Metro Center Oxx Xxxxxxx Xxxxx, Xxxxx Xxxxx Xxxxxxxx, XX 00000 Amount of 12% Senior Subordinated Notes due August 1, 2009 Beneficially Owned: $12,690,000 JXXXXXXXX HIGH YIELD TRADING, LLC By: /s/ Rxxxxx X. Xxxxx Name: Rxxxxx X. Xxxxx Title: Chief Financial Officer 6. Name of Holder: Wxxxxxx Xxxxxx Growth Fund, L.P. Address: 100 Xxxxxxx Xxxxxx, Suite 1850 New York, NY 10038 Amount of 12% Senior Subordinated Notes due August 1, 2009 Beneficially Owned: $1,621,000 WXXXXXX XXXXXX GROWTH FUND, L.P. By: WXXXXXX XXXXXX ASSOCIATES LLC, a Delaware limited liability company, its General Partner By: /s/ Nxxxxxxx X. Xxxxx CFA Name: Nxxxxxxx X. Xxxxx CFA Title: Principal Name of Holder: Wxxxxxx Xxxxxx International Limited Address: 100 Xxxxxxx Xxxxxx, Suite 1850 New York, NY 10038 Amount of 12% Senior Subordinated Notes due August 1, 2009 Beneficially Owned: $2,856,000 WXXXXXX XXXXXX INTERNATIONAL LIMITED By: WXXXXXX XXXXXX LLC, a Delaware limited liability company, its Investment Manager By: /s/ Nxxxxxxx X. Xxxxx CFA Name: Nxxxxxxx X. Xxxxx CFA Title: Principal
Name of Holder. (Please type or print) Signature of Holder: _________________________________________ Address of Holder: _________________________________________ _________________________________________
Name of Holder. By: WSV Management, L.L.C., General Parnter Signature of Authorized Signatory of Holder: /s/ Patrick Walker ------------------- Name of Authorized Signatory: Patrick Walker, Member ________________________ Title of Authorized Signatory: _______________________ [SIGNATURE PAGES CONTINUE] [SIGNATURE PAGE OF HOLDERS TO CEIW RRA] WS Opportunity Fund (QP), L.P. By: WS Ventures Management, L.P., General Partner
Name of Holder. Sabby Volatility Warrant Master Fund, Ltd. Signature of Authorized Signatory of Holder: __________________________ Name of Authorized Signatory: _________________________ Title of Authorized Signatory: __________________________ Date: ___________________, 2013 Series A Warrants Exercised: ___________________________ Series C Warrants Exercised: __________________________ Name of Holder: Sabby Healthcare Volatility Master Fund, Ltd. Signature of Authorized Signatory of Holder: __________________________ Name of Authorized Signatory: _________________________ Title of Authorized Signatory: __________________________ Date: ___________________, 2013 Series A Warrants Exercised: ____________________________ Series C Warrants Exercised: ___________________________
Name of Holder. Jona, Inc. (the "Holder")
Name of Holder. RG Education Investment Limited By: /s/ Xxxxxx Xxx Name: Xxxxxx Xxx Title: Director
Name of Holder. Mailing Address: City: State: Zip: Holder FEIN: State of Inc.: Date of Inc.: Contact Name: Title: Telephone: Email: If utilizing a 3rd party holder representative, please indicate name and contact information: Name of Firm: Name of Contact: Telephone: Email: Company Affiliate Information: List any affiliates or subsidiaries along with the parent company including their FEIN: Xxxx xxxxxx file a consolidated unclaimed property report or will each entity report separately? 000 XXXXX XXXXXXXXX XXXXXX, XXXXXXX, XXXXX XXXXXXXX 00000-0000 Telephone (000) 000-0000 Fax (000)000-0000 xxx.XXXxxx.xxx NC Department of State Treasurer Unclaimed Property Program Voluntary Disclosure Agreement We agree subject to the following conditions: ❖ The Holder has not been contacted by the State or State’s audit representative for the purposes of performing an examination. ❖ The Holder agrees to file all types of property from reporting year 1998 forward, if required by statute. Such property would include both general xxxxxx and securities. Holder shall provide names and addresses, when available. ❖ Holder submits separate report and remittance for each year that property is being reported. No property will be accepted on behalf of another state. ❖ The State shall accept any amounts remitted under the agreement as have been timely filed and paid and shall not assess any penalties or interest. ❖ The Holder agrees that when names and addresses are available but the records are too voluminous or not practical to review, an allocation based upon statistical sampling will be used. Holder will provide a written explanation of the techniques and principles used. ❖ The State reserves the right to approve/review sampling and estimation methodology used by the Holder and its representative. ❖ The Holder will perform due diligence mailings according to the statute. ❖ The State reserves the right to examine the books and records of the Holder for the reporting period one year after receipt of the report. ❖ The State shall maintain the complete confidentiality of this agreement and shall not disclose any of the provisions set forth herein. ❖ The State will take no criminal action against Xxxxxx and its directors or officers for failure to report or remit unclaimed property during said period. ❖ The State agrees to reimburse Holder for any amount subsequently paid to a lawful owner in an amount equal to that paid by the Holder to the State. ❖ The terms of the agreement are based on the facts p...