Number of Shares Subscribed. For: _________________________________ ______________________ (Signature) _________________________________ (Signature) ASSIGNMENT (To Be Executed By the Registered Holder to Effect a Transfer of the Within Warrant) FOR VALUE RECEIVED, the undersigned Warrant Holder(s) do(es) hereby sell, assign and transfer unto _____________________________________________ the right to purchase common stock evidenced by this Warrant, and does hereby irrevocably constitute and appoint _________________________________________ to transfer the said right on the books of the Company, with full power of substitution. Dated: _________________________ _________________________________ (Signature) _________________________________ (Signature)
Number of Shares Subscribed. Aggregate Purchase Price: Executed at ____________________________ this ____ day of ________________, 2004 Agreed to and Accepted on this _____ day of ________, 2004 Number of Shares Accepted_________ IMMTECH INTERNATIONAL, INC. By:____________________________________ Name: T. Stephen Thompson Title: President and Chief Executive Oxxxxxx XXXX NAME AND ADDRESS OF SUBSCRIBER FOR REGISTRATION PURPOSES: NAME: _____________________________________________________________ ADDRESS: _____________________________________________________________ TEL NO: _____________________________________________________________ FAX NO: _____________________________________________________________ CONTACT _____________________________________________________________ NAME: _____________________________________________________________ DELIVERY INSTRUCTIONS (IF DIFFERENT FROM REGISTRATION NAME): NAME: _____________________________________________________________ ADDRESS: _____________________________________________________________ TEL NO: _____________________________________________________________ FAX NO: _____________________________________________________________ CONTACT NAME: _____________________________________________________________ SPECIAL INSTRUCTIONS: _____________________________________________________________ Exhibit C IMMTECH INTERNATIONAL, INC. ACCREDITED INVESTOR QUESTIONNAIRE Note: Individuals must complete SECTION I and Corporations, Partnerships, Trusts and other Entities must complete SECTION II ALL QUESTIONS IN THE APPROPRIATE SECTION MUST BE ANSWERED
Number of Shares Subscribed. 363,636 Shares of Class A Common Stock Total Subscription Amount: $1,000,000 MEDTRONIC ASSET MANAGEMENT, INC. By: ------------------------------- Name: Title: Taxpayer Identification Number ---------------------------------- ---------------------------------- Address ACCEPTED AND AGREED ECHOCATH, INC. By: ------------------------------- Name: Title: Date: October 29, 1997 EchoCath, Inc. Warrants & Options as of October 28, 1997 Warrants Issued In connection with the Company's initial public offering, the Company issued one Class A warrant and one Class B warrant. Each Class A warrant entitles the holder to purchase, at an exercise price of $7.00 (subject to adjustment) one share of Class A common stock and one Class B warrant. Each Class B warrant entitles the holder to purchase, at an exercise price of $9.15 (subject to adjustment) one share of Class A common stock. The Class A warrants and Class B warrants are exercisable through January 2001. 1,610,000 Class A warrants and 1,610,000 Class B warrants were issued in connection with the public offering. In connection with the Company's initial public offering, the Company sold to the Underwriter and its designees a unit purchase option to purchase up to 140,000 units. The securities underlying the unit purchase option are substantially identical in all respects to the units (One share of Class A common stock, one Class A warrant and one Class B warrant) sold in the Company's initial public offering. Warrants issued as a result of the September 1995 Bridge Financing total 500,000 warrants that are identical to the Class A and Class B warrants issued in the initial public offering. Warrants for 50,000 shares will be issued resulting form the release of the $750,000 contingent liability. Additionally, 50,000 shares of Class A common stock will be issued. Options Granted Under the terms of the 1995 Stock Option Plan, 150,000 share options have been granted at an exercise price of $5.00 and 592,500 share options have been granted at an exercise price of 3 1/8. Under the terms of the employee investment plan, 552 share options are currently reserved.
Examples of Number of Shares Subscribed in a sentence
Number of Shares Subscribed For: Total Purchase Price: $ Signature of Investor: Name of Investor: Address of Investor: Electronic Mail Address: Investor’s SS# or Tax ID#: ACCEPTED BY: EHAVE, INC.
Number of Shares Subscribed For: Total Purchase Price: Signature of Subscriber: Name of Subscriber: Address of Subscriber: Subscriber’s SS# or tax ID#: ACCEPTED BY: STARFLEET INNOTECH INC.
Number of Shares Subscribed For: Total Purchase Price: $ Signature of Investor: Name of Investor: Address of Investor: Electronic Mail Address: Investor’s SS# or Tax ID#: ACCEPTED BY: AURI INCORPORATED Signature of Authorized Signatory: __________________________________ Name of Authorized Signatory: ___________________________, CEO Date of Acceptance: _________________, 2022.
Number of Shares Subscribed For: common shares Signature of Subscriber: Name of Subscriber: Address of Subscriber: ACCEPTED BY: QUADRA VENTURES, INC.
Number of Shares Subscribed For: Total Purchase Price: $ Signature of Investor: Name of Investor: Address of Investor: Electronic Mail Address: Investor's SS# or Tax ID#: ACCEPTED BY: CR GLOBAL HOLDINGS, INC.
More Definitions of Number of Shares Subscribed
Number of Shares Subscribed. For: 50,000 (10,000 Share minimum) Aggregate Price (number of Shares purchased multiplied by $100.00) $5,000,000 ACCEPTED: FLORIDA BANKS, INC. By: /s/ T. Edwin Stinson, Jr. Dated: December 31, 2002 -------------------------------------- Name: T. Edwin Stinson, Jr. Title: Chief Financial Officer EXHIBIT A ARTICLES OF AMENDMENT TO THE SECOND AMENDED AND RESTATED ARTICLES OF INCORPORATION OF FLORIDA BANKS, INC. The name of the Corporation is FLORIDA BANKS, INC. The undersigned certifies, on behalf of the Corporation, that pursuant to the authority contained in its Second Amended and Restated Articles of Incorporation (the "Articles of Incorporation"), and in accordance with the provisions of Section 607.0602(4) of the Florida Business Corporation Act (the "Act"), the Board of Directors of the Corporation by unanimous written consent, dated December 9, 2002, pursuant to Section 607.0821 of the Act, duly approved and adopted the following resolution, which resolution is effective without approval of the Corporation's shareholders pursuant to Section 607.0602(4) of the Act and remains in full force and effect on the date hereof: RESOLVED, that pursuant to the authority vested in the Board of Directors of the Corporation in accordance with the provisions of the Articles of Incorporation and Section 607.0602 of the Act, a series of preferred stock of the Corporation be, and it hereby is, created, and the designation and amount thereof and the voting powers, preferences and relative, participating, optional and other special rights of the shares of such series, and the qualifications, limitations or restrictions thereof, are as follows:
Number of Shares Subscribed. For: Subscription Amount: $ You must pay the full Subscription Amount pursuant to the instructions provided by the Company. SCHEDULE A ELIGIBILITY REPRESENTATIONS OF THE INVESTOR A. ACCREDITED INVESTOR STATUS (PLEASE CHECK ALL THAT APPLY):
Number of Shares Subscribed. For: ________________________________________ Total Purchase Price: ________________________________________ Signature of Subscriber: ________________________________________ Name of Subscriber: ________________________________________ Address of Subscriber: ________________________________________ ACCEPTED BY: AMERICAS DIAMOND CORP. Signature of Authorized Signatory: ________________________________________ Name of Authorized Signatory: ________________________________________ Date of Acceptance: ________________________________________ APPENDIX "A" TERMS AND CONDITIONS dated ________ ___, 201_, attached to the Warrants issued by Americas Diamond Corp.
Number of Shares Subscribed. 280,000 Shares of Preferred Stock Total Subscription Amount: $1,400,000 EP MEDSYSTEMS, INC. By: ------------------------------ Name: Title: Taxpayer Identification Number ---------------------------------- ---------------------------------- Address ACCEPTED AND AGREED ECHOCATH, INC. By: ------------------------------ Name: Title: Date: February 27, 1997
Number of Shares Subscribed. 280,000 Shares of Preferred Stock Total Subscription Amount: $1,400,000 EP MEDSYSTEMS, INC. By: /s/ Xxxxx X. Xxxxxxx Name: Xxxxx X. Xxxxxxx Title: President Address: 00 Xxxxx 00 Xxxx Xxxx Xxxx, XX 00000 Taxpayer Identification Number: 22-3212190 ACCEPTED AND AGREED ECHOCATH, INC. By: /s/ Xxxxx XxXxxxxxxxx Name: Xxxxx XxXxxxxxxxx Title: President Date: February 27, 1997
Number of Shares Subscribed. For: ____________________________________ Price = $_____ (must be a whole number of shares) Aggregate Purchase Price (see Section 1.1):____________________________________ The Investor hereby provides the following additional information:
Number of Shares Subscribed. Name of Subscriber: (Minimum of 1000 Shares) Total Subscription Price: Please PRINT or Type exact name(s) in which undersigned (at $10.00 per share) desires shares to be registered $ Date: Signature* Area Code and Telephone Number Signature* Social Security or Federal Taxpayer Please indicate form of ownership the undersigned Identification Number desires for the shares (individual, joint tenants with right of survivorship, tenants in common, trust, corporation, partnership, custodian, etc.) The undersigned wishes to pay for the Stock as follows: