Common use of Address Information Clause in Contracts

Address Information. For individual subscribers this address should be the Subscriber’s primary legal residence. For entities other than individual subscribers, please provide address information for the entities primary place of business. Information regarding a joint subscriber should be included in the column at right. Legal Address Legal Address City, State, and Zip Code City, State, and Zip Code AGREED AND SUBSCRIBED ACCEPTED This ___ day of _________, 2018 This ___ day of _______, 2018 By: By: Name: Name: Xxxxxx Xxxxxxx Title (if any): Title: Chief Executive Officer CERTIFICATE OF SIGNATORY (To be completed if the Securities are being subscribed for by an entity) I______________________ am the ___________________________ of ___________________________ (the “Entity”). I certify that I am empowered and duly authorized by the Entity to execute and carry out the terms of the Securities Purchase Agreement and to purchase and hold the Notes and Warrants, and certify further that the Securities Purchase Agreement has been duly and validly executed on behalf of the Entity and constitutes a legal and binding obligation of the Entity.

Address Information. For individual subscribers this address should be the SubscriberPurchaser’s primary legal residence. For entities other than an individual subscribersPurchaser, please provide address information for the entities primary place of business. Information regarding a joint subscriber should be included in the column at right. Legal Address Legal Address City, State, and Zip Code City, State, and Zip Code AGREED AND SUBSCRIBED ACCEPTED AGREED AND ACCEPTED This ___ day of _________, 2018 2021 This ___ day of _______, 2018 2021 By: By: Name: Name: Xxxxxx Xxxxxxx Title (if any): Title: Chief Executive Officer CERTIFICATE OF SIGNATORY (To be completed if the Securities are being subscribed for by an entity) I______________________ am the ___________________________ of ___________________________ (the “Entity”). I certify that I am empowered and duly authorized by the Entity to execute and carry out the terms of the Securities Purchase Agreement and to purchase and hold the Notes and Warrants, and certify further that the Securities Purchase Agreement has been duly and validly executed on behalf of the Entity and constitutes a legal and binding obligation of the Entity.

Address Information. For individual subscribers this address should be the Subscriber’s primary legal residence. For entities other than individual subscribers, please provide address information for the entities primary place of business. Information regarding a joint subscriber should be included in the column at right. 170 Xxxxxxxxx Xxxxxx Xxxxx Legal Address Legal Address Lexxx Xxxxxxx Xxxxxxxx, Xxxxxxx, X0X 0X0Xxxxxx City, State, and Zip Code City, State, and Zip Code AGREED AND SUBSCRIBED ACCEPTED This ___ day of _________, 2018 This ___ day of _______, 2018 By: By: Name: Iax Xxxxxxxx Name: Xxxxxx Xxxxxxx Paxxxxx Xxxxxxxx Title (if any): Title: Chief Executive Officer CERTIFICATE OF SIGNATORY (To be completed if the Securities are being subscribed for by an entity) I, ______________________ , am the ___________________________ of ___________________________ (the “Entity”). I certify that I am empowered and duly authorized by the Entity to execute and carry out the terms of the Securities Purchase Agreement and to purchase and hold the Notes Note and Warrants, and certify further that the Securities Purchase Agreement has been duly and validly executed on behalf of the Entity and constitutes a legal and binding obligation of the Entity.

Address Information. For individual subscribers this address should be the Subscriber’s primary legal residence. For entities other than individual subscribers, please provide address information for the entities primary place of business. Information regarding a joint subscriber should be included in the column at right. 650 Xxxxxxxxxxx Xx. Legal Address Legal Address Daxxxx, XX 00000 City, State, and Zip Code City, State, and Zip Code AGREED AND SUBSCRIBED ACCEPTED This ___ day of _________, 2018 This ___ day of _______, 2018 By: By: Name: Tixxxxx X’Xxxxxxxx Name: Xxxxxx Xxxxxxx Paxxxxx Xxxxxxxx Title (if any): Managing Member Title: Chief Executive Officer CERTIFICATE OF SIGNATORY (To be completed if the Securities are being subscribed for by an entity) I______________________ , Tixxxxx X’Xxxxxxxx, am the ___________________________ Managing Member of ___________________________ IC, LLC (the “Entity”). I certify that I am empowered and duly authorized by the Entity to execute and carry out the terms of the Securities Purchase Agreement and to purchase and hold the Notes Note and Warrants, and certify further that the Securities Purchase Agreement has been duly and validly executed on behalf of the Entity and constitutes a legal and binding obligation of the Entity.

Address Information. For individual subscribers this address should be the SubscriberPurchaser’s primary legal residence. For entities other than individual subscribers, please provide address information for the entities primary place of business. Information regarding a joint subscriber should be included in the column at right. Legal Address Legal Address City, State, and Zip Code City, State, and Zip Code AGREED AND SUBSCRIBED ACCEPTED This ___ day of _________, 2018 This ___ day of _______, 2018 By: By: Name: Name: Xxxxxx Xxxxxxx Title (if any): Title: Chief Executive Officer CERTIFICATE OF SIGNATORY (To be completed if the Securities are being subscribed for by an entity) I______________________ am the ___________________________ of ___________________________ (the “Entity”). I certify that I am empowered and duly authorized by the Entity to execute and carry out the terms of the Securities Purchase Subscription Agreement and to purchase and hold the Notes and WarrantsShares, and certify further that the Securities Purchase Subscription Agreement has been duly and validly executed on behalf of the Entity and constitutes a legal and binding obligation of the Entity.