Number of Shares Subscribed for. Amount of Subscription: $__________________ ___________________________________________ ___________________________________________ Name of Individual Social Security No. ___________________________________________ ___________________________________________ Street Address Date of Birth ___________________________________________ __________________ _______________________ City State Zip Code Home Phone Business Phone Manner in which Shares are to be held (check one): / / Individual Ownership / / Community Property / / Tenants-in-Common / / Separate Property / / Joint Tenant with Right of Survivorship / / Other (please specify) ________________________________ Signature Accepted this ___ day of __________, 200_. ISECURETRAC CORP. By: ____________________________ THE ENTITY SIGNATURE PAGE FOR ISECURETRAC CORP. SUBSCRIPTION AGREEMENT Date:_________________, 200_____________
Number of Shares Subscribed for. Amount of Subscription: $___________________ __________________________________________ ____________________________________________ Name of Corporation or Entity Federal Tax Identification No. __________________________________________ ____________________________________________ Address State of Incorporation or Formation __________________________________________ ___________________ _______________________ City State Zip Code Phone Fax Manner in which Shares are to be held (check one): / / Partnership / / Limited Liability Company / / Corporation / / Limited Liability Partnership / / Trust / / Other (please specify)_____________ _________________________________ Signature _________________________________ Title Accepted this ___ day of __________, 200_. ISECURETRAC CORP. By: ____________________________
Number of Shares Subscribed for. Total Purchase Price: $___________________ A check in the full amount of the purchase price, payable to "Molecular Diagnostics and Therapeutics, Inc. Escrow Account" accompanies this executed Subscription Agreement. Form of Ownership: __Individual __Partnership __Joint Tenants With Rights of __Trust survivorship (both sign) __Limited Liability Company, LLC __Tenants in Common (all sign) __Corporation INDIVIDUALS _________________________ _____________________________ ___________ Signature of Subscriber Print Name Date ______________________________________________________________________________ Mailing Address _________________________________ _______________________________________ Telephone Number Social Security Number _________________________ _____________________________ ___________ Signature of Subscriber Print Name Date ______________________________________________________________________________ Mailing Address _________________________________ _______________________________________ Telephone Number Social Security Number CORPORATIONS, TRUSTS, PARTNERSHIP, LLCs ______________________________________________________________________________ Name of Corporation, Trust, Partnership or LLC By: ________________________________________ _____________________________ Signature of Authorized Representative Print Name ________________________________________ _____________________________ Capacity of Authorized Representative Date ______________________________________________________________________________ Mailing Address ********************** Accepted as to Shares on . ------------ ------------------------ Molecular Diagnostics and Therapeutics, Inc. By:_________________________________________ Its:__________________________________ Please make your check payable to: Molecular Diagnostics and Therapeutics, Inc. Escrow Account.
Examples of Number of Shares Subscribed for in a sentence
Number of Shares Subscribed for NAME OF PURCHASER at $0.12 per share.
Each Seller hereby appoints Xxxxx Xxxxxx as the agent, proxy and attorney-in-fact for such Seller for all purposes under this Agreement (including full power and authority to act on such Seller’s behalf).
NYISO publishes hourly load- weighted average LMPs for both real-time and day-ahead markets.
The Chief Accounting Officer is responsible for the maintenance, preparation and fair presentation of the Appropriation Account and Reconciliation Statements in accordance with the provisions in Article 148, 149, 150 and 152 of the Constitution of the Democratic Socialist Republic of Sri Lanka, other statutory provisions and the Public Finance and Administrative Regulations.
Number of Shares Subscribed for NAME OF PURCHASER at $ per share $ Total Purchase Price Signature Title of Authorized Signatory if Purchaser Is a corporation, partnership or other entity Signature of Spouse or Co-owner THE SECURITIES HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”) AND MAY NOT BE OFFERED, SOLD OR OTHERWISE TRANSFERRED UNLESS THE SECURITIES ARE REGISTERED UNDER THE ACT OR AN EXEMPTION THEREFROM IS AVAILABLE.
More Definitions of Number of Shares Subscribed for
Number of Shares Subscribed for. A number equal to (A) the product of (i) 120% and (ii) the sum of Investor ARYA Shares and the Top Up Shares (as defined below), plus (B) the difference of Sponsor Promote Allocation Shares (as defined below) minus Investor ARYA Shares. The “Top Up Shares” shall mean a number of Shares equal to (A) the product of (i) the Investor ARYA Shares and (ii) the quotient of the redemption value per Investor ARYA Share on the Closing Date divided by $10.00, minus (B) the Investor AXXX Xxxxxx.
Number of Shares Subscribed for. Total Payment enclosed: $___________ USD (PLEASE MAKE CHECK PAYABLE TO PORTALTOCHINA.COM, INC.)
Number of Shares Subscribed for. Total Payment enclosed: $___________ USD (PLEASE MAKE CHECK PAYABLE TO AMP PRODUCTIONS, LTD.)
Number of Shares Subscribed for. Total Purchase Price: $_________________________ A check in the full amount of the purchase price, payable to "Power Save International, Inc. Escrow Account" accompanies this executed Subscription Agreement. Form of Ownership: __ Individual __ Partnership __ Joint Tenants With Rights of __ Trust survivorship (both sign) __ Limited Liability Company, LLC __Tenants in Common (all sign) __ Corporation INDIVIDUALS ----------------------------- ------------------------------ ---------- Signature of Subscriber Print Name Date Mailing Address ----------------------------- ------------------------------ Telephone Number Social Security Number ----------------------------- ------------------------------ ----------- Signature of Subscriber Print Name Date Mailing Address ----------------------------- ------------------------------ Telephone Number Social Security Number CORPORATIONS, TRUSTS, PARTNERSHIPS, LLCs Name of Corporation, Trust, Partnership or LLC By: _________________________________ __________________________________ Signature of Authorized Representative Print Name --------------------------------- ---------------------------------- Capacity of Authorized Representative Date Mailing Address ************************* Accepted as to ______________ Shares on ________________ , 199 _. Power Save International, Inc. By: _________________________________ Its: ______________________________ Please make your check payable to: Power Save International, Inc. Escrow Account.
Number of Shares Subscribed for. Name: Subscription Paid: $_______ Title: Stock Certificate to be made out as follows: (Print name and address) (Print social security number of Employer Id No.)
Number of Shares Subscribed for. Shares INDIVIDUAL SUBSCRIBER: ENTITY SUBSCRIBER: ------------------------------------ ------------------------------------ (Signature of Subscriber) (Print Name of Subscriber) By: ------------------------------------ -------------------------------- (Typed or Printed Name) Name: ------------------------------ Title: ----------------------------- ------------------------------------ ------------------------------------ (Residence Address) (Address) ------------------------------------ ------------------------------------ (City, State and Zip Code) (City, State and Zip Code) ------------------------------------ ------------------------------------ (Telephone Number) (Telephone Number) ------------------------------------ ------------------------------------ (Telecopier Number) (Telecopier Number) ------------------------------------ ------------------------------------ (Tax I.D. or Social Security Number) (Tax I.D. or Social Security Number) ACCEPTED: NEUROBIOLOGICAL TECHNOLOGIES, INC. By: ________________________________________ Name: Xxxx X. Xxxxxxx Title: President and Chief Executive Officer Date: _________, 2000 SCHEDULE A NTI Shares Reserved as of March 16, 2000 25,000,000 Authorized (13,846,881) Common stock issues (1,900,771) Options issued (91,108) Reserved for options (65,266) Reserved for ESPP (4,777,676) Warrants issued (2,332,000) Preferred ----------- 1,986,298 Remaining
Number of Shares Subscribed for. Shares against payment in cash in the amount of $____________, representing $1.00 per Share.