Common use of FORM OF ELECTION TO PURCHASE Clause in Contracts

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To Owens Corning: The undersigned herexx xxrevocably elects to exer cise _______________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number __________________________________________________________ (Please print name and address) __________________________________________________________ If such number of Rights shall not be all the Rights evi denced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number __________________________________________________________ (Please print name and address) __________________________________________________________ Dated:__________________, ____ [Form of Election to Purchase -- continued] __________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)

Appears in 2 contracts

Samples: Rights Agreement (Owens Corning), Rights Agreement (Owens Corning)

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FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: XXXXXX GREETINGS, INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise _____________________________ Rights represented by this Right Cer tificate Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares be issued in the name ofof and delivered to: Xxease Please insert social security or other identifying number ________________________________________________________________ (Please print name and address) ________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number _________________________________________________________________ (Please print name and address) Dated:___________________, _____ ___________________________________ Dated:__________________, ____ [Form of Election to Purchase -- continued] _______________Signature Signature Guaranteed: Certificate ___________ Signature (Signature must conform in all respects to name of holder as specified on The undersigned hereby certifies by checking the face of this Right Certificate.)appropriate boxes that:

Appears in 2 contracts

Samples: Rights Agreement (Gibson Greetings Inc), Rights Agreement (Gibson Greetings Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Certificate.) To Owens CorningTo: OMEGA WORLDWIDE, INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise ________ Rights represented by this Right Certificate to purchase the Preferred Shares issuable upon the exercise of the Rights (or such other securities of the Corporation or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying number:____________________________________________________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number ________________________________________________________________________________ (Please print name and address) ______If such number of Rights shall not be all the Rights represented by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number:____________________________________________________ If such number of Rights shall not be all the Rights evi denced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ________________________________________________________________________________ (Please print name and address) Date:______________ , 19________________ ______________________________ DatedSignature Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:__________________, ____ [Form of Election to Purchase -- continued] __________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)

Appears in 2 contracts

Samples: Rights Agreement (Omega Worldwide Inc), Omega Worldwide Inc

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: INTERNET CAPITAL GROUP, INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise _____exercise __________ Rights represented by this Right Cer tificate Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares be issued in the name ofof and delivered to: Xxease insert social security or other identifying number __________________________________________________________ (Please print name and address) __________________________________________________________ (Please print social security or other identifying number) If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number __________________________________________________________ (Please print name and address) __________________________________________________________ (Please print social security or other identifying number) Dated:__________________, _____ [Form of Election to Purchase -- continued] ______________________________ Signature (Signature must conform in all respects to name of holder as specified on Guaranteed:__________________________ The undersigned hereby certifies by checking the face of this Right Certificate.)appropriate boxes that:

Appears in 2 contracts

Samples: Rights Agreement (Internet Capital Group Inc), Rights Agreement (Internet Capital Group Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: INSTINET GROUP INCORPORATED The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise __________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of and delivered to: Please insert social security or other identifying number _______________________________________________________________________________ (Please print name and address) If such number of Rights represented shall not be all the Rights evidenced by this Right Cer tificate to purchase Rights Certificate, a new Rights Certificate for the shares of Preferred Stock issuable upon the exercise balance of such Rights and requests that certifi cates for such shares shall be issued registered in the name ofof and delivered to: Xxease Please insert social security or other identifying number _______________________________________________________________________________ (Please print name and address) __________________________________________________________ If such number of Rights shall not be all the Rights evi denced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number __________________________________________________________ (Please print name and address) _______________________________________________________________________________ Dated:___: _______________, _____ [Form of Election to Purchase -- continued] ______________________________ Signature (Signature must conform in all respects to name of holder as specified on Guaranteed: Certificate The undersigned hereby certifies by checking the face of this Right Certificate.)appropriate boxes that:

Appears in 2 contracts

Samples: Rights Agreement (Instinet Group Inc), Rights Agreement (Instinet Group LLC)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right CertificateTO BE EXECUTED IF HOLDER DESIRES TO EXERCISE THE RIGHT CERTIFICATE.) To Owens CorningFAIRMARKET, INC.: The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise _______ Rights represented by this Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying taxpayer number: ____________ ________________________________________________________________________________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number ________________________________________________________________________________ (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Certificate or if the Rights are being exercised pursuant to Section 11(a)(ii) of the Rights Agreement, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying taxpayer number: ____________ ________________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ________________________________________________________________________________ (Please print name and address) Dated: _________, ________________ __________________________________ Dated:__________________, ____ [Form of Election to Purchase -- continued] __________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed: ______________________________

Appears in 2 contracts

Samples: Shareholder Rights Agreement (Fairmarket Inc), Shareholder Rights Agreement (Fairmarket Inc)

FORM OF ELECTION TO PURCHASE. (To be executed by the registered holder if such holder desires to exercise the Right Rights evidenced by this Rights Certificate.) To Owens CorningTo: MIM CORPORATION The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise ________________ Rights represented evidenced by this Right Cer tificate Rights Certificate to purchase the shares of Preferred Stock Units issuable upon the exercise of the Rights (or such Rights other securities, cash or property of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares Units (or such other securities which may be issuable upon the exercise of the Rights) be issued in the name ofof and delivered to: Xxease Please insert social security or other identifying number number: ________________________________ __________________________________________________ (Please print name and addressname) __________________________________________________________ If such number of Rights shall not be all the Rights evi denced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number __________________________________________________________ (Please print address) If such number of Rights shall not be all of the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and addressdelivered to: Please insert social security or other identifying number: ________________________________ __________________________________________________ (Please print name) __________________________________________________________ Dated:__________________, ____ [Form of Election to Purchase -- continued] _____________________________ Signature (Signature must conform in all respects to Please print address) Dated: ______________________________________, Signature: _______________________________________ (Sign exactly as your name of holder as specified appears on the face other side of this Right Rights Certificate.)) Signature Guarantee: _____________________________

Appears in 2 contracts

Samples: Rights Agreement (Mim Corp), Rights Agreement (Mim Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights evidenced by the Right Rights Certificate.) To Owens CorningTo: BURLINGTON INDUSTRIES, INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise _______exercise ________ Rights represented evidenced by this Right Cer tificate Rights Certificate to purchase the shares Units of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person or other property that may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares Units be issued in the name ofof and delivered to: Xxease insert social security or other identifying number ____________________________________________________________ (Please print name and address) ____________________________________________________________ Please insert social security or other identifying number: ______________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ____________________________________________________________ (Please print name and address) ____________________________________________________________ Dated:Please insert social security or other identifying number: __________________, ____ [Form of Election to Purchase -- continued] __________________________ Dated: , 199 /200 ---------------------- Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed:

Appears in 2 contracts

Samples: Rights Agreement (Burlington Industries Inc /De/), Rights Agreement (Burlington Industries Inc /De/)

FORM OF ELECTION TO PURCHASE. (To be executed by the registered holder if such holder desires to exercise the Right Rights evidenced by this Rights Certificate.) To Owens CorningTo: THE BISYS GROUP, INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise ________________ Rights represented evidenced by this Right Cer tificate Rights Certificate to purchase the shares of Preferred Company Common Stock issuable upon the exercise of the Rights (or such Rights other securities, cash or property of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares Company Common Stock (or such other securities which may be issuable upon the exercise of the Rights) be issued in the name ofof and delivered to: Xxease Please insert social security or other identifying number number: ____________________________ _______________________________________________________________________________ (Please print name and addressname) _______________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number _______________________________________________________________________________ (Please print address) If such number of Rights shall not be all of the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and addressdelivered to: Please insert social security or other identifying number: __________________________ _______________________________________________________________________________ (Please print name) __________________________________________________________ Dated:__________________, ____ [Form of Election to Purchase -- continued] _______________________________________________________________________________ Signature (Signature must conform in all respects to Please print address) Dated: ___________________, _______ Signature: ____________________________ (Sign exactly as your name of holder as specified appears on the face other side of this Right Rights Certificate.)) Signature Guarantee: ___________________

Appears in 2 contracts

Samples: Rights Agreement (Bisys Group Inc), Rights Agreement (Bisys Group Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Certificate.) To Owens CorningTo: Adobe Systems Incorporated The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise ________________ Rights represented by this Right Cer tificate Certificate to purchase the shares Units of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person or other property which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares Units be issued in the name ofof and delivered to: Xxease insert social security or other identifying number __________________________________________________________ (Please print name and address) ______________________________________________ Please insert social security or other identifying number: _____________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number __________________________________________________________ (Please print name and address) ______________________________________________ Please insert social security or other identifying number: _____________ Dated:: _________________ ____, _______ [Form of Election to Purchase -- continued] __________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed:

Appears in 2 contracts

Samples: Rights Agreement (Adobe Systems Inc), Rights Agreement (Adobe Systems Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: WINSTAR COMMUNICATIONS, INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise ________exercise _______ Rights represented by this Right Cer tificate Rights Certificate to purchase the shares Units of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person or other property which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares Units be issued in the name ofof and delivered to: Xxease insert social security or other identifying number __________________________________________________________ (Please print name and address) _____________________________________________ Please insert social security or other identifying number: ________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number __________________________________________________________ (Please print name and address) _____________________________________________ Please insert social security or other identifying number: ________________ Dated:: _________________ __, ____ [Form of Election to Purchase -- continued] ______________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed:

Appears in 2 contracts

Samples: Rights Agreement (Winstar Communications Inc), Rights Agreement (Winstar Communications Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Certificate.) To Owens CorningTo: Masco Corporation The undersigned herexx xxrevocably hereby irrevocably elects to exer cise ___exercise ____________ Rights represented by this Right Cer tificate Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares securities be issued in the name of: Xxease insert social security or other identifying number __________________________________________________________ (Please print name and address) __________________________________________________________ If such number of Rights shall not be all the Rights evi denced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number __________________________________________________________ (Please print name and address) ___________________________________________________________ Dated:If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number __________________, _________________________________________ [Form of Election to Purchase -- continued] (Please print name and address) ___________________________________________________________ Dated: ________________, 19__ ___________________________ Signature (Signature must conform in all respects to name of holder as specified on Guaranteed: Certificate The undersigned hereby certifies by checking the face of this Right Certificate.)appropriate boxes that:

Appears in 2 contracts

Samples: Rights Agreement (Masco Corp /De/), Rights Agreement (Masco Corp /De/)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTO: ONEIDA LTD. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise _________ Rights represented by this Rights Certificate to purchase the Units of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other Person or other property which may be issuable upon the exercise of the Rights) and requests that certificates for such Units be issued in the name of and delivered to: _______________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number _________________________________________________________________ (Please print name and address) _______________________________________________________________________________ Please insert social security or other identifying number: If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number _______________________________________________________________________________ (Please print name and address) __________________________________________________________ Dated:__________________, ____ [Form of Election to Purchase -- continued] __________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Please insert social security or other identifying number:

Appears in 2 contracts

Samples: Rights Agreement (Oneida LTD), Rights Agreement (Oneida LTD)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: -------------------------------------------------- The undersigned herexx xxrevocably hereby irrevocably elects to exer cise _______________ exercise ------------ Rights represented by this Right Cer tificate Rights Certificate to purchase the shares of Preferred Common Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares be issued in the name ofof and delivered to: Xxease insert social security or other identifying number __________________________________________________________ ---------------------------------------------------------------- (Please print name and address) __________________________________________________________ ---------------------------------------------------------------- Please insert social security or other identifying number: ----------------------------------- If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: ---------------------------------------------------------------- (Please print name and address) ---------------------------------------------------------------- Please insert social security or other identifying number __________________________________________________________ (Please print name and address) __________________________________________________________ number: ----------------------------------- ---------------------------------------------------------------- Dated: , 19 ---------------- -- ------------------------------ Signature Signature Guaranteed: Certificate ----------- The undersigned hereby certifies by checking the appropriate boxes that:__________________, ____ [Form of Election to Purchase -- continued] __________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)

Appears in 2 contracts

Samples: Rights Agreement (Cordis Corp), Rights Agreement (Cordis Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: INTEGRATED DEFENSE TECHNOLOGIES, INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise _____exercise __________ Rights represented by this Right Cer tificate Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares be issued in the name ofof and delivered to: Xxease insert social security or other identifying number __________________________________________________________ ------------------------------------------------- ------------------------------------------------- ------------------------------------------------- (Please print name and address) __________________________________________________________ ------------------------------------------------- (Please insert social security or other identifying number) If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: ------------------------------------------------- ------------------------------------------------- ------------------------------------------------- (Please print name and address) ------------------------------------------------- (Please insert social security or other identifying number __________________________________________________________ (Please print name and addressnumber) __________________________________________________________ Dated:: __________________, ____ [Form of Election to Purchase -- continued] __________________________ ------------------------------ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed:

Appears in 2 contracts

Samples: Rights Agreement (Integrated Defense Technologies Inc), Rights Agreement (Integrated Defense Technologies Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Certificate.) To Owens CorningTo: Xxxx-Xxxxx Company: The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise ______________________ Rights represented by this Right Cer tificate Certificate to purchase the shares of Preferred Common Stock issuable upon the exercise of such Rights (or such other securities of the Company or of any other Person which may be issuable upon the exercise of the Rights), and requests that certifi cates certificates for such shares (or other securities) be issued in the name of: Xxease insert social security or other identifying number _____________________________________________________________________________ (Please print name and address) ___________Please insert social security or other identifying number: _______________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number _____________________________________________________________________________ (Please print name and address) __________Please insert social security or other identifying number: ________________________________________________ DatedThe undersigned hereby certifies, by marking the appropriate boxes, that:__________________, ____ [Form of Election to Purchase -- continued] __________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)

Appears in 2 contracts

Samples: Stockholder Rights Agreement (Nash Finch Co), Stockholder Rights Agreement (Nash Finch Co)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: NEOSE TECHNOLOGIES, INC.: The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise ________ Rights represented by this Rights Certificate to purchase the Preferred Shares issuable upon the exercise of the Rights (or Common Shares or such other securities of the Company or of any other person that may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of and delivered to: Please insert social security or other identifying number _______________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number _________________________________________________________________ (Please print name and address) _______________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number _______________________________________________________________________________ (Please print name and address) __________________________________________________________ Dated:__________________, ____ [Form of Election to Purchase -- continued] _______________________________________________________________________________ Dated: , 19 -------------- --- -------------------------- Signature (Signature must conform in all respects to name of holder as specified on Guaranteed: Certificate The undersigned hereby certifies by checking the face of this Right Certificate.)appropriate boxes that

Appears in 2 contracts

Samples: Rights Agreement (Neose Technologies Inc), Rights Agreement (Neose Technologies Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningCBL & Associates Properties, Inc.: The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of and delivered to: _______________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number __________________________________________________________________ (Please print name and address) address ________________________________________________________________________________ Please insert social security or other identifying number: __________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ________________________________________________________________________________ (Please print name and address) address ________________________________________________________________________________ Please insert social security or other identifying number: Dated:_________: _________, ____ [Form of Election to Purchase -- continued] ______________________________ [Signature] Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed:

Appears in 2 contracts

Samples: Rights Agreement (CBL & Associates Properties Inc), Rights Agreement (CBL & Associates Properties Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: SCIENTIFIC-ATLANTA, INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise _______________ exercise Rights represented by this Right Cer tificate Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares be issued in the name ofof and delivered to: Xxease insert social security or other identifying number __________________________________________________________ ------------------------------------------------------------ (Please print name and address) __________________________________________________________ ------------------------------------------------------------ Please insert social security or other identifying number: ------------------------------- If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: ------------------------------------------------------------ (Please print name and address) ----------------------------------------------------------- Please insert social security or other identifying number __________________________________________________________ (Please print name and address) __________________________________________________________ number:-------------------------------- ------------------------------------------------------------ Dated: ------------------, 19-- ---------------------------------- Signature Signature Guaranteed:-------------------------- Certificate The undersigned hereby certifies by checking the appropriate boxes that:__________________, ____ [Form of Election to Purchase -- continued] __________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)

Appears in 2 contracts

Samples: Rights Agreement (Scientific Atlanta Inc), Rights Agreement (Scientific Atlanta Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise the Right Certificate.) To Owens Corning: The undersigned herexx xxrevocably elects to exer cise _______________ Rights represented by this Right Cer tificate the Rights Certificate) To: AMSURG CORP. The undersigned hereby irrevocably elects to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number __________________________________________________________ Rights represented by this Rights Certificate to purchase the Units of Preferred Stock, issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such Units be issued in the name of and delivered to: -------------------------------------------------------------------------------- (Please print name and address) __________________________________________________________ -------------------------------------------------------------------------------- Please insert social security or other identifying number: ---------------------- If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: -------------------------------------------------------------------------------- (Please print name and address) -------------------------------------------------------------------------------- Please insert social security or other identifying number __________________________________________________________ (Please print name and address) __________________________________________________________ number: ---------------------- Dated: -------------------------- ------------------------------------------- Signature Signature Guaranteed:__________________, ____ [Form of Election to Purchase -- continued] __________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)

Appears in 2 contracts

Samples: Rights Agreement (Amsurg Corp), Rights Agreement (Amsurg Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens Corning______________: The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of and delivered to: Please insert social security or other identifying number: ________________________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number __________________________________________________________________________ (Please print name and address) __________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number number: ________________________ __________________________________________________________________________ (Please print name and address) __________________________________________________________ Dated:_________________ Dated: _________, 20____ [Form of Election to Purchase -- continued] _____________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed:

Appears in 2 contracts

Samples: Rights Agreement (Forgent Networks Inc), Rights Agreement (Forgent Networks Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: BETZDEARBORN INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise _____exercise __________ Rights represented by this Right Cer tificate Rights Certificate to purchase the shares of Preferred Stock Common Shares issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person that may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares be issued in the name ofof and delivered to: Xxease Please insert social security or other identifying number __________________________________________________________ -------------------------------------------------------------------------------- (Please print name and address) __________________________________________________________ -------------------------------------------------------------------------------- If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number __________________________________________________________ -------------------------------------------------------------------------------- (Please print name and address) __________________________________________________________ -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- Dated: , ----------- ------ ------------------------------------ Signature Signature Guaranteed:__________________, ____ [Form of Election to Purchase -- continued] __________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)

Appears in 2 contracts

Samples: Rights Agreement (Betzdearborn Inc), Rights Agreement (Betzdearborn Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Certificate.) To Owens CorningTo: CD Radio Inc. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise _________ Rights represented by this Right Certificate to purchase the Series B Shares (or fractions thereof) issuable upon the exercise of such Rights (or such other securities of the Company or of any other entity that may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying number: ___________________________________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number number: _____________________________________ ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ Dated:__________________, ____ [Form of Election to Purchase -- continued] ______________________________________________ Dated: __________________, 19__ _________________________ Signature (Signature must conform in all respects to name of holder as specified on Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the face of this Right Certificate.)appropriate boxes that:

Appears in 2 contracts

Samples: Rights Agreement (Cd Radio Inc), Rights Agreement (Cd Radio Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To Owens CorningThe Sherxxx-Xxxxxxxx Xxxpany: The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise ________________ Rights represented by this Right Cer tificate Certificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares be issued in the name of: Xxease Please insert social security or other identifying number number: _____________________________________________ _______________________________________________________________________ (Please print name and address) _______________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number number: _____________________________________________ _______________________________________________________________________ (Please print name and address) _______________________________________________________________________ Dated:__________________, __19__ [Form of Election to Purchase -- continued] __________________________ ----------------------------------- Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed:

Appears in 2 contracts

Samples: Rights Agreement (Sherwin Williams Co), Rights Agreement (Sherwin Williams Co)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTO: VERADIGM INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise ______ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares (or other securities) be issued in the name of and delivered to: Please insert social security or other identifying number: ______________________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number ________________________________________________________________ (Please print name and address) ________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ____________________________________number: ______________________ (Please print name and address) __________________________________________________________ Dated:________ Dated: ______________, ____ [Form of Election to Purchase -- continued] __________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed:

Appears in 2 contracts

Samples: Rights Agreement (Veradigm Inc.), Rights Agreement (Veradigm Inc.)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: INTERPHASE CORPORATION The undersigned herexx xxrevocably hereby irrevocably elects to exer cise ___exercise ____________ Rights represented by this Right Cer tificate Rights Certificate to purchase the shares of Preferred Common Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares be issued in the name ofof and delivered to: Xxease Please insert social security or other identifying number __________________________________________________________ ---------------------------- -------------------------------------------------------------------------------- (Please print name and address) __________________________________________________________ -------------------------------------------------------------------------------- If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number __________________________________________________________ ---------------------------- -------------------------------------------------------------------------------- (Please print name and address) __________________________________________________________ -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- Dated: , --------------------- ----- ----------------------------------------- Signature Signature Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the appropriate boxes that:__________________, ____ [Form of Election to Purchase -- continued] __________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)

Appears in 2 contracts

Samples: Rights Agreement (Interphase Corp), Rights Agreement (Interphase Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: State Street Bank and Trust Company The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise ___________ Rights represented by this Rights Certificate to purchase the shares of Common Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of and delivered to: Please insert social security or other identifying number __________________________________________________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number ___________________________________________________________________________ (Please print name and address) ___________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number __________________________________________________ ___________________________________________________________________________ (Please print name and address) __________________________________________________________ Dated:__________________ Dated: _, _____________ [Form of Election to Purchase -- continued] _____________________________ Signature (Signature must conform in all respects to name Guaranteed: Reverse Side of holder as specified on Rights Certificate Certificate The undersigned hereby certifies by checking the face of this Right Certificate.)appropriate boxes that:

Appears in 2 contracts

Samples: Rights Agreement (Lifeline Systems Inc), Rights Agreement (Lifeline Systems Inc)

FORM OF ELECTION TO PURCHASE. ([To be executed by the registered holder if such holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens Corning] To: The Rights Agent The undersigned herexx xxrevocably hereby irrevocably elects to exer cise _exercise ______________ Rights represented by this Right Cer tificate Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other Person which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares be issued in the name ofof and delivered to: Xxease insert social security or other identifying number ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ Please insert social security or other identifying number: _______ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ________________________________________________________________________________ (Please print name and address) __________________________________________________________ Dated:__________________, _____ [Form of Election to Purchase -- continued] Please insert social security or other identifying number: ___________________ Dated: _________________ __________________________________________ Signature (Signature must conform in all respects to name of holder as specified on Guaranteed: Certificate The undersigned hereby certifies by checking the face of this Right Certificate.)appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Nexmed Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: WYNDHAM WORLDWIDE CORPORATION The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of and delivered to: Please insert social security or other identifying number _______________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number ________________________________________________________________________________________________ (Please print name and address) ______________________________________________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ______________________________________________________________________________________________________________ (Please print name and address) __________________________________________________________ Dated:__________________, ____ [Form of Election to Purchase -- continued] ________________________________ ______________________________________________________________________________________________________________ Dated: , Signature (Signature must conform in all respects to name of holder as specified on Guaranteed: Certificate The undersigned hereby certifies by checking the face of this Right Certificate.)appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Wyndham Worldwide Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: L. X. Xxxxxx Company: The undersigned herexx xxrevocably hereby irrevocably elects to exer cise ___exercise ____________ Rights represented by this Right Cer tificate Rights Certificate to purchase the shares of Preferred Common Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person that may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares be issued in the name ofof and delivered to: Xxease ______________________________ Please insert social security or other identifying number ______________________________ ______________________________ ______________________________ (Please print name and address) ____________________________If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: ______________________________ If such number of Rights shall not be all the Rights evi denced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ______________________________ ______________________________ ______________________________ (Please print name and address) Dated:_____________ ___, _________________ ______________________________ DatedSignature Signature Guaranteed:__________________, ____ [Form of Election to Purchase -- continued] __________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.):

Appears in 1 contract

Samples: Rights Agreement (Foster L B Co)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: Global TeleSystems Group, Inc. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise ___exercise ____________ Rights represented by this Right Cer tificate Rights Certificate to purchase the shares Units of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person or other property which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares Units be issued in the name ofof and delivered to: Xxease insert social security or other identifying number ____________________________________________________________ (Please print name and address) ____________________________________________________________ Please insert social security or other identifying number: ______________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ______________________________________________________________ (Please print name and address) __________________________________________________________ Dated:_____ Please insert social security or other identifying number: ______________, ____ [Form of Election to Purchase -- continued] __________________________ Dated: , [199__] [200__] ------- -- ------------------------------ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed: 54

Appears in 1 contract

Samples: Rights Agreement (Global Telesystems Group Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Rights Certificate.) To Owens CorningTO: HARVEST NATURAL RESOURCES, INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise _______________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number ______________________ _____________________________________ Rights represented by this Rights Certificate to purchase the Preferred Shares (or such other securities of the Company) issuable upon the exercise of such Rights and requests that certificate for such Preferred Shares (or other securities of the Company) be issued in the name of: -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- (Please print name and address) __________________________________________________________ -------------------------------------------------------------------------------- (Please insert social security or other identifying number) If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- (Please print name and address) -------------------------------------------------------------------------------- (Please insert social security or other identifying number __________________________________________________________ (Please print name and addressnumber) __________________________________________________________ Dated:__________________, ____ [Form of Election to Purchase -- continued] __________________________ : ---------------------------- ----------------------------------- ----------------------------------- Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Signature

Appears in 1 contract

Samples: Rights Agreement (Harvest Natural Resources Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Certificate.) To Owens CorningCHINDEX INTERNATIONAL, INC.: The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise _________ Rights represented by this Right Certificate to purchase the Preferred Shares issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying number _______________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number ______________________________________________________________________________________________________________________________ (Please print name and address) ____________________________________________________________________________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ____________________________________________________________________________________________________________________________________________ (Please print name and address) __________________________________________________________ Dated:___________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________ Dated as of _______________, ____ [Form of Election to Purchase -- continued] _______________________________________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed: BACK

Appears in 1 contract

Samples: Rights Agreement (Chindex International Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Certificate.) To Owens CorningTo: PACIFIC GATEWAY EXCHANGE, INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise ________ Rights represented by this Right Certificate to purchase the Preferred Shares issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying number: __________________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number _____________________________________________________________________________ (Please print name and address) __________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number number: __________________ _____________________________________________________________________________ (Please print name and address) Date: ________________ __, ________________ ____________________________ DatedSignature Signature Guaranteed: CERTIFICATE ----------- The undersigned hereby certifies by checking the appropriate boxes that:__________________, ____ [Form of Election to Purchase -- continued] __________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)

Appears in 1 contract

Samples: Rights Agreement (Pacific Gateway Exchange Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: RAWLINGS SPORTING GOODS COMPANY, INC.: The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise _______ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other Person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of and delivered to: Please insert social security or taxpayer identification number_______________________________________________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number taxpayer identification number_______________________________________________ ________________________________________________________________________________ (Please print name and address) __________________________________________________________ Dated:_______________________ Dated: ______________, ____ [Form of Election to Purchase -- continued] ___________________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed:

Appears in 1 contract

Samples: Rights Agreement (Rawlings Sporting Goods Co Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: _____________CORPORATION: The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise __________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of and delivered to: Please insert social security or other identifying number _______________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number __________________________________________________________________ (Please print name and address) ________________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ________________________________________________________________________________ (Please print name and address) __________________________________________________________ Dated:_______________________ Dated: _______________, _____ [Form of Election to Purchase -- continued] __________________________________ Signature (Signature must conform in all respects to name of holder as specified on Guaranteed: Certificate ----------- The undersigned hereby certifies by checking the face of this Right Certificate.)appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (HSB Group Inc)

FORM OF ELECTION TO PURCHASE. (To be executed by the registered holder if such holder desires to exercise the Right Rights evidenced by this Rights Certificate.) To Owens CorningTo: DUKE REALTY INVESTMENTS, INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise ________________ Rights represented evidenced by this Right Cer tificate Rights Certificate to purchase the shares of Preferred Stock Units issuable upon the exercise of the Rights (or such Rights other securities, cash or property of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares Units (or such other securities which may be issuable upon the exercise of the Rights) be issued in the name ofof and delivered to: Xxease Please insert social security or other identifying number number:____________________ ___________________________________________________________________________ (Please print name and addressname) ___________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ___________________________________________________________________________ (Please print address) If such number of Rights shall not be all of the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and addressdelivered to: Please insert social security or other identifying number:____________________ ___________________________________________________________________________ (Please print name) ___________________________________________________________________________ Dated:__________________, ____ [Form of Election to Purchase -- continued] ______________________________________________________ Signature (Signature must conform in all respects to Please print address) Dated: ____________, ____ Signature:_____________________________________________ (Sign exactly as your name of holder as specified appears on the face other side of this Right Rights Certificate.)) Signature Guarantee:____________________ CERTIFICATE ----------- The undersigned hereby certifies by checking the appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Duke Realty Investments Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: MARITRANS INC.: The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise ________ Rights represented by this Rights Certificate to purchase the Preferred Shares issuable upon the exercise of the Rights (or Common Shares or such other securities of the Company or of any other person that may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of and delivered to: Please insert social security or other identifying number _______________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number __________________________________________________________________ (Please print name and address) ________________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ________________________________________________________________________________ (Please print name and address) __________________________________________________________ Dated:__________________, _____ [Form of Election to Purchase -- continued] ________________________________________________________________________________ Dated: _____________, 20__ _____________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed:

Appears in 1 contract

Samples: Rights Agreement (Maritrans Inc /De/)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: Optical Sensors Incorporated The undersigned herexx xxrevocably irrevocably hereby elects to exer cise ____exercise ___________ Rights represented by this Right Cer tificate Rights Certificate to purchase the shares of Preferred Stock Shares issuable upon the exercise of the Rights (or Common Shares or such Rights other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares be issued in the name ofof and delivered to: Xxease Please insert social security or other identifying number __________________________________________________________ -------------------------------------------------- ------------------------------------------------------------------------------- (Please print name and address) __________________________________________________________ ------------------------------------------------------------------------------- If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number __________________________________________________________ -------------------------------------------------- ------------------------------------------------------------------------------- (Please print name and address) __________________________________________________________ ------------------------------------------------------------------------------- Dated: ----------------------------------------- ----------------------- Signature Signature Guaranteed:__________________, ____ [Form of Election to Purchase -- continued] __________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)

Appears in 1 contract

Samples: Rights Agreement (Optical Sensors Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: R&B FALCON CORPORATION: The undersigned herexx xxrevocably hereby irrevocably elects to exer cise _____exercise __________ Rights represented by this Right Cer tificate Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares be issued in the name ofof and delivered to: Xxease Please insert social security or other identifying number ____________________________________________________________ (Please print name and address) ____________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ____________________________________________________________ (Please print name and address) ____________________________________________________________ Dated:____________________________________________________________ Dated: _______________, ____ [Form of Election to Purchase -- continued] ___________________________ Signature (Signature must conform in all respects to name of holder as specified on Guaranteed: Certificate The undersigned hereby certifies by checking the face of this Right Certificate.)appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (R&b Falcon Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To Owens CorningXxxxxx International Industries, Incorporated: The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise __________ Rights represented by this Right Certificate to purchase the one one-hundredths of a Preferred Share or other securities issuable upon the exercise of such Rights and requests that certificates for such securities be issued in the name of and delivered to: Please insert social security or other identifying number: ____________________________________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number _________________________________________________________________ (Please print name and addressaddress of transferee) _________________________________________________________________ If such number of Rights shall is not be all the Rights evi denced evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall will be registered in the name of and delivered to: Please insert social security or other identifying number number: _______________________________________________________________ _______________________________________________________________ (Please print name and addressaddress of transferee) _______________________________________________________________ Dated:________: __________, ____ [Form of Election to Purchase -- continued] _____________________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed:

Appears in 1 contract

Samples: Rights Agreement (Harman International Industries Inc /De/)

FORM OF ELECTION TO PURCHASE. (To be executed if the register holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: FROZEN FOOD EXPRESS INDUSTRIES, INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise ________________ Rights represented by this Right Cer tificate Rights Certificate to purchase the shares of Preferred Common Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other Person which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares be issued in the name ofof and delivered to: Xxease insert social security or other identifying number _________________________________________________________________ (Please print name and address) _________________________________________________________________ Please insert social security or other identifying number: ____________________________________ If such number of Rights shall not be all the Rights evi denced rights evidence by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number _________________________________________________________________ (Please print name and address) _________________________________________________________________ DatedPlease insert social security or other identifying number:_____________________________________ Dated: ______________, _______ [Form of Election to Purchase -- continued] ____________________________________ Signature (Signature must conform in all respects to name of holder as specified on Guaranteed: ___________________________________________________________________ Certificate The undersigned hereby certifies by checking the face of this Right Certificate.)appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Frozen Food Express Industries Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To Owens CorningTo: UNI-MARTS INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise __________________________ Rights represented by this Right Cer tificate Certificate to purchase the shares of Preferred Stock Fractional Share issuable upon the exercise of such Rights (or such other securities of the Company or of any other Person which may be issuable upon the exercise of such Rights) and requests that certifi cates certificates for such the shares of Common Stock be issued in the name of: Xxease Please insert social security or other identifying number _______________________________________ ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number _______________________________________ ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ Dated:_: _________________, ____ [Form of Election to Purchase -- continued] ________________________________ Signature Signature Guaranteed: ____________________________ Signatures must be guaranteed by an eligible guarantor institution (Signature must conform a bank, stockbroker, savings and loan association or credit union with membership in all respects an approved signature guarantee medallion program) pursuant to name Rule 17Ad-15 of holder as specified on the face Securities Exchange Act of this Right Certificate1934.)

Appears in 1 contract

Samples: Rights Agreement (Uni Marts Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Certificate.) To Owens CorningTo: Eagle River Interactive, Inc. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise ____ Rights represented by this Right Certificate to purchase the Preferred Shares issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying number: ___________________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number __________________________________________________________ (Please print name and address) __________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number number: ___________________ ___________________________________________ (Please print name and address) ___________________________________________ ___________________________________________ Dated:__________________, __19__ [Form of Election to Purchase -- continued] __________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed:

Appears in 1 contract

Samples: Rights Agreement (Mastering Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: InterAmericas Communications Corporation The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise ________________ Rights represented by this Right Cer tificate Rights Certificate to purchase the shares of Preferred Common Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares be issued in the name ofof and delivered to: Xxease Please insert social security or other identifying number ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ ________________________________________________________________________________ Dated:__________________, ____, 19___ [Form of Election to Purchase -- continued] ___________________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed:

Appears in 1 contract

Samples: Rights Agreement (Interamericas Communications Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Certificate.) To Owens CorningTo: CPI CORP. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise ___exercise ____________ Rights represented by this Right Cer tificate Certificate to purchase the shares of Preferred Stock Series A Shares issuable upon the exercise of the Rights (or Common Shares or such Rights other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares be issued in the name of: Xxease Please insert social security or other identifying number number: ________________ ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ ________________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: ________________ Please insert social security or other identifying number number: ________________ ________________________________________________________________________________ (Please print name and address) __________________________________________________________ Dated:__________________, _____ [Form of Election to Purchase -- continued] ________________________________________________________________________________ Dated: _______________, 200_ ______________________________ Signature (Signature must conform in all respects to name of holder as specified on Guaranteed: Certificate The undersigned hereby certifies by checking the face of this Right Certificate.)appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Cpi Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: NTL EUROPE, INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise __________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of and delivered to: Please insert social security or other identifying number: _______________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number _________________________________________________________________ (Please print name and address) _______________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number number: _______________________________________________________________________________ (Please print name and address) __________________________________________________________ Dated:__________________, ____ [Form of Election to Purchase -- continued] _______________________________________________________________________________ Dated: _______________, ____ ________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed:

Appears in 1 contract

Samples: Rights Agreement (NTL Inc/De/)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: CHEMFIRST INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise __________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of and delivered to: Please insert social security or other identifying number: _______________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number _________________________________________________________________ (Please print name and address) _______________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number number: _______________________________________________________________________________ (Please print name and address) __________________________________________________________ Dated:____: ______________, _____ [Form of Election to Purchase -- continued] __________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed:

Appears in 1 contract

Samples: Rights Agreement (Chemfirst Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: OPTIKA INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise _______________ Rights represented by this Right Cer tificate Rights Certificate to purchase the shares Units of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person or other property which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares Units be issued in the name ofof and delivered to: Xxease __________________________________ ________________________________________________________________________ (Please print name and address) _______________________________ (Please insert social security or other identifying number). If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: __________________________________________________________ (Please print name and address) __________________________________________________________ If such number of Rights shall not be all the Rights evi denced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: (Please insert social security or other identifying number number). Dated __________________________ _________________________________ Signature Signature Guaranteed: Certificate ----------- The undersigned hereby certifies by checking the appropriate boxes in (Please print name 1) and address(2) __________________________________________________________ Datedthat:__________________, ____ [Form of Election to Purchase -- continued] __________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)

Appears in 1 contract

Samples: Rights Agreement (Optika Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: IMATION CORP. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise _____exercise __________ Rights represented by this Right Cer tificate Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares be issued in the name ofof and delivered to: Xxease Please insert social security or other identifying number _____________________________________________________ Please print name and address __________________________________________________________________________________________ (Please print name and address) __________________________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number _____________________________________________________ Please print name and address __________________________________________________________________________________________ (Please print name and address) __________________________________________________________________________________________ Dated:________: __________, ____ [Form of Election to Purchase -- continued] __________________________ Signature: Signature (Signature must conform in all respects to name of holder as specified on Medallion Guaranteed: CERTIFICATE The undersigned hereby certifies by checking the face of this Right Certificate.)appropriate boxes that:

Appears in 1 contract

Samples: 382 Rights Agreement (Imation Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To Owens CorningANDOVER BANCORP, INC.: The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise _______ Rights represented by this Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying taxpayer number: __________________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ ________________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right CertificateCertificate or if the Rights are being exercised pursuant to Section 11(a)(ii) of the Rights Agreement, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number taxpayer number: _____________________ ________________________________________________________________________________ (Please print name and address) __________________________________________________________ Dated:__________________, _____ [Form of Election to Purchase -- continued] ________________________________________________________________________________ Dated: _________, __ _________________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed: ____________________

Appears in 1 contract

Samples: Shareholder Rights Agreement (Andover Bancorp Inc)

FORM OF ELECTION TO PURCHASE. (To be executed by the registered holder if such holder desires to exercise any or all of the Rights represented by this Right Certificate.) To Owens CorningTo: The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise ____________________________ (__________) of the Rights represented by this Right Cer tificate Certificate to purchase the shares of Preferred the Common Stock of the Company, or other securities or property issuable upon the exercise of such said number of Rights and pursuant to the Rights Agreement. The undersigned hereby requests that certifi cates a certificate for any such shares securities and any such property be issued in the name ofof and delivered to: Xxease insert social security or other identifying number ________________________________________________________________________________ ________________________________________________________________________________ (Please print Name, address and social security or other identifying number of issuee) The undersigned hereby further requests that if said number of Rights shall not be all the Rights represented by this Right Certificate, a new Right Certificate for the remaining balance of such Rights be issued in the name of and address) delivered to: __________________________________________________________ If such number of Rights shall not be all the Rights evi denced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number __________________________________________________________ (Please print name Name, address and addresssocial security or other identifying number of issuee) Dated:______________________ ________________________________________ Dated(Signature) Signature Guaranteed:__________________, ____ [Form of Election to Purchase -- continued] __________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)

Appears in 1 contract

Samples: Rights Agreement (Vantive Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right CertificateRights Certificate other than pursuant to Section 11(a)(ii) of the Rights Agreement.) To Owens CorningTo: FIBERSTARS, INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise Rights represented by this Rights Certificate to purchase the one one-thousandths of a share of Preferred Stock (or such other securities of the Company or any other Person) issuable upon the exercise of the Rights and requests that certificates for such shares be issued in the name of: ___________________________________________________________________________________________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease (Please insert social security or other identifying number number) ___________________________________________________________________________________________ (Please print name and address) ___________________________________________________________________________________________ If such number of Rights shall not be all applicable, the Rights evi denced by this Right CertificateCertificate indicating the balance, a new Right Certificate for the balance remaining if any, of such Rights which may still be exercised pursuant to Section 11(a)(ii) of the Rights Agreement shall be returned to the undersigned unless such Person requests that the Rights Certificate be registered in the name of and delivered to: ___________________________________________________________________________________________ Please insert social security or other identifying number (complete only if Rights Certificate is to be registered in a name other than the undersigned) ___________________________________________________________________________________________ (Please print name and address) __________________________________________________________ Dated:__________________, ____ [Form of Election to Purchase -- continued] __________________________ Dated: ________________________, 20____. ________________________ Signature (Signature Guaranteed: Signatures must conform be guaranteed by an Eligible Guarantor Institution, as defined in all respects to name Rule 17Ad-15 under the Securities Exchange Act of holder as specified on the face of this Right Certificate1934.)

Appears in 1 contract

Samples: Rights Agreement (Fiberstars Inc /Ca/)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate) To: WEBMETHODS, INC.) To Owens Corning: The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise ____________________________Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of and delivered to: Please insert social security or other identifying number______________________________________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number __________________________________________________________ (Please print name and address) ____________________If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number______________________________________ If such number of Rights shall not be all the Rights evi denced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number __________________________________________________________ (Please print name and address) Dated:______________________ ______________________________________ Dated:__________________, ____ [Form of Election to Purchase -- continued] Signature Signature Guaranteed: __________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)_____

Appears in 1 contract

Samples: Rights Agreement (Webmethods Inc)

FORM OF ELECTION TO PURCHASE. (To be executed by the registered holder if such holder desires to exercise any or all of the Rights represented by this Right Certificate.) To Owens CorningNorthstar Neuroscience, Inc.: The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise ( ) of the Rights represented by this Right Certificate to purchase the shares of the Common Stock of the Company, or other securities or property issuable upon the exercise of said number of Rights pursuant to the Rights Agreement. The undersigned hereby requests that a certificate for any such securities and any such property be issued in the name of and delivered to: ____________________________________________________________________________________________________________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number ____________________________________________________________________________________________________________ (Please print Name, address and social security or other identifying number of issuee) The undersigned hereby further requests that if said number of Rights shall not be all the Rights represented by this Right Certificate, a new Right Certificate for the remaining balance of such Rights be issued in the name of and address) delivered to: ____________________________________________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ____________________________________________________________________________________________________________ (Please print name Name, address and addresssocial security or other identifying number of issuee) Dated: ___________________________________________________, _______ Dated:__________________, ____ [(Signature) Signature Guaranteed: Form of Election to Purchase -- Reverse Side of Right Certificate (continued] __________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)

Appears in 1 contract

Samples: Rights Agreement (Northstar Neuroscience, Inc.)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise the Right Rights represented by this Rights Certificate.) To Owens CorningTo: BE AEROSPACE, INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise ________ Rights represented by this Rights Certificate to purchase the Units of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such Units be issued in the name of and delivered to: _______________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number __________________________________________________________________ (Please print name and address) ________________________________________________________________________________ Please insert social security or other identifying number: ________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ________________________________________________________________________________ (Please print name and address) __________________________________________________________ Dated:__________________, ____ [Form of Election to Purchase -- continued] __________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Please insert social security or other identifying number: Dated: ___________ __, ____

Appears in 1 contract

Samples: Rights Agreement (Be Aerospace Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: CENDANT CORPORATION The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of and delivered to: Please insert social security or other identifying number _______________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number ______________________________________________________________________________________________ (Please print name and address) ____________________________________________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ____________________________________________________________________________________________________________ (Please print name and address) __________________________________________________________ Dated:__________________, ____ [Form of Election to Purchase -- continued] ______________________________ ____________________________________________________________________________________________________________ Dated: , Signature (Signature must conform in all respects to name of holder as specified on Guaranteed: Certificate The undersigned hereby certifies by checking the face of this Right Certificate.)appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Cendant Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To Owens CorningTo: NATCO GROUP INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise ___exercise ____________ Rights represented by this Right Cer tificate Certificate to purchase the shares of Preferred Stock Shares (or other securities) issuable upon the exercise of such Rights and requests that certifi cates certificates for such shares Preferred Shares (or for such other securities) be issued in the name of: Xxease Please insert social security or other identifying number __________________________________________________________ number: ----------------------------------------------- ---------------------------------------------------------------------------- (Please print name and address) __________________________________________________________ ---------------------------------------------------------------------------- If such number of Rights shall not be all the Rights evi denced evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number __________________________________________________________ number: ----------------------------------------------- ---------------------------------------------------------------------------- (Please print name and address) __________________________________________________________ ---------------------------------------------------------------------------- Dated:_____: _____________, _19___ [--------------------------- Signature (Form of Election to Purchase Reverse Side of Right Certificate -- continued] __________________________ ) Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed:

Appears in 1 contract

Samples: Rights Agreement (Natco Group Inc)

FORM OF ELECTION TO PURCHASE. (To be executed by the registered holder if such holder desires to exercise the Right Rights evidenced by this Rights Certificate.) To Owens CorningTo: MIM CORPORATION The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise ________________ Rights represented evidenced by this Right Cer tificate Rights Certificate to purchase the shares of Preferred Stock Units issuable upon the exercise of the Rights (or such Rights other securities, cash or property of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares Units (or such other securities which may be issuable upon the exercise of the Rights) be issued in the name ofof and delivered to: Xxease Please insert social security or other identifying number:_________________________ ________________________________________ (Please print name) ________________________________________ ________________________________________ (Please print address) If such number of Rights shall not be all of the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: ________________________ ________________________________________ (Please print name) ________________________________________ ________________________________________ (Please print address) Dated: ______________________________________, Signature: _____________________________________________________________________ (Please print Sign exactly as your name and address) __________________________________________________________ If such number of Rights shall not be all the Rights evi denced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number __________________________________________________________ (Please print name and address) __________________________________________________________ Dated:__________________, ____ [Form of Election to Purchase -- continued] __________________________ Signature (Signature must conform in all respects to name of holder as specified appears on the face other side of this Right Rights Certificate.)

Appears in 1 contract

Samples: Rights Agreement (Mim Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTO: ONEIDA LTD. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise _________ Rights represented by this Rights Certificate to purchase the Units of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other Person or other property which may be issuable upon the exercise of the Rights) and requests that certificates for such Units be issued in the name of and delivered to: _______________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number __________________________________________________________________ (Please print name and address) ________________________________________________________________________________ Please insert social security or other identifying number: ________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ________________________________________________________________________________ (Please print name and address) __________________________________________________________ Dated:__________________, _____ [Form of Election to Purchase -- continued] Please insert social security or other identifying number: ______________________________ Dated: _________________, __ ---------------------------------------- Signature (Signature must conform in all respects to name of holder as specified on Certificate The undersigned hereby certifies by checking the face of this Right Certificate.)appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Oneida LTD)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: INPUT/OUTPUT, INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise _______________ Rights represented by this Right Cer tificate Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Corporation or of any other person which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares be issued in the name ofof and delivered to: Xxease Please insert social security or other identifying number __________________________________________________________ ------------------------------------------------------------------------------- (Please print name and addressPLEASE PRINT NAME AND ADDRESS) __________________________________________________________ ------------------------------------------------------------------------------- If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number __________________________________________________________ ------------------------------------------------------------------------------- (Please print name and addressPLEASE PRINT NAME AND ADDRESS) __________________________________________________________ ------------------------------------------------------------------------------- Dated: ---------------------------- ------------------------------------- Signature Signature Guaranteed:__________________, ____ [Form of Election to Purchase -- continued] __________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)

Appears in 1 contract

Samples: Rights Agreement (Input Output Inc)

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FORM OF ELECTION TO PURCHASE. (a) (To be executed if holder desires desire to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: ICU MEDICAL, INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise __________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of and delivered to: Please insert social security or other identifying number:______________________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number number:______________________ ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ ________________________________________________________________________________ Dated:: ___________________, ____ [Form of Election to Purchase -- continued] __. _________________________________________ Signature (Signature Guaranteed: Signatures must conform be guaranteed by a bank, broker, dealer, credit union or savings association or other entity that is a member in all respects to name good standing of holder as specified on a signature guarantee medallion program approved by the face of this Right Certificate.)Securities Transfer Association, Inc.

Appears in 1 contract

Samples: Rights Agreement (Icu Medical Inc/De)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: XXXXXX FINANCIAL CORPORATION: The undersigned herexx xxrevocably hereby irrevocably elects to exer cise _exercise ______________ Rights represented by this Right Cer tificate Rights Certificate to purchase the shares of Preferred Common Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares be issued in the name ofof and delivered to: Xxease Please insert social security or other identifying number __________________________________________________________ (Please print name and address) __________________________________________________________ If such number of Rights shall not be all the Rights evi denced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number __________________________________________________________ If such number Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number (Please print name and address) ________________________________________________________________________________ ________________________________________________________________________________ Dated:: ________________________, 19 __. ____ [Form of Election to Purchase -- continued] _______________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed: 6

Appears in 1 contract

Samples: Rights Agreement (Fulton Financial Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: BALLY ENTERTAINMENT CORPORATION The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise _______ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Corporation or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of and delivered to: _______________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number _________________________________________________________________ (Please print name and address) _______________________________________________________________________________ Please insert social security or other identifying number:______________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number _______________________________________________________________________________ (Please print name and address) _______________________________________________________________________________ DatedPlease insert social security or other identifying number:__________________, ____ [Form of Election to Purchase -- continued] _________________________________ Dated:_______________, 19__ ________________________ Signature (Signature must conform in all respects to name of holder as specified on Guaranteed. Certificate ___________ The undersigned hereby certifies by checking the face of this Right Certificate.)appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Bally Entertainment Corp)

FORM OF ELECTION TO PURCHASE. (To be executed by the registered holder if such holder desires to exercise the Right Rights represented by this Rights Certificate.) To Owens CorningTO: ST. FRANXXX XXXITAL CORPORATION The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise __________ Rights represented by this Rights Certificate to purchase the Preferred Shares (or other securities, cash or property) issuable upon the exercise of such Rights and requests that certificates for such Preferred Shares be issued in the name of: Please print name and address: ______________________________________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number ______________________________________ ______________________________________________________________________________ (Please print name and address) ______________________________________________________________________________ Please insert social security, taxpayer identification or other identifying number: ______________________________________ If such number of Rights shall not be all the Rights evi denced represented by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such unexercised Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number print name and address: ______________________________________ ______________________________________ ______________________________________________________________________________ (Please print name and address) ______________________________________________________________________________ Dated:Please insert social security, taxpayer identification or other identifying number: ______________________________________ Dated: __________________ , ____ [Form of Election to Purchase -- continued] ______________________________________ Signature (Signatures must be guaranteed by an Eligible Guarantor Institution, as defined in Rule 17Ad-15 promulgated under the Securities Exchange Act of 1934, as amended. Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed:___________________________________________________________

Appears in 1 contract

Samples: Shareholder Rights Agreement (St Francis Capital Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: ALLTRISTA CORPORATION The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise __________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of and delivered to: Please insert social security or other identifying number:___________________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number _____________________________________________________________________________ (Please print name and address) _____________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number number: ___________________ ______________________________________________________________________________ (Please print name and address) __________________________________________________________ Dated:__________________, ___ Dated: ____________, 19__ [Form of Election to Purchase -- continued] __________________________________________ Signature (Signature must conform in all respects to name of holder as specified on Guaranteed: Certificate The undersigned hereby certifies by checking the face of this Right Certificate.)appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Alltrista Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To Owens CorningCORE, INC.: The undersigned herexx xxrevocably hereby irrevocably elects to exer cise ________exercise _______ Rights represented by this Right Cer tificate Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares be issued in the name of: Xxease Please insert social security or other identifying number __________________________________________________________ taxpayer number: ---------------------------- ------------------------------------------------------------------------------- (Please print name Print Name and addressAddress) __________________________________________________________ ------------------------------------------------------------------------------- ------------------------------------------------------------------------------- If such number of Rights shall not be all the Rights evi denced evidenced by this Right CertificateCertificate or if the Rights are being exercised pursuant to Section 11(a)(ii) of the Rights Agreement, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number __________________________________________________________ taxpayer number: ---------------------------- ------------------------------------------------------------------------------- (Please print name Print Name and addressAddress) __________________________________________________________ ------------------------------------------------------------------------------- ------------------------------------------------------------------------------- Dated:__________________, ____ [Form of Election to Purchase -- continued] __________________________ : Signature: ------------------------- --------------------------- Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed: ----------------------------------

Appears in 1 contract

Samples: Shareholder Rights Agreement (Core Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires TO BE EXECUTED IF HOLDER DESIRES TO EXERCISE RIGHTS REPRESENTED BY THE RIGHTS CERTIFICATE.) To: Mellon Investor Services LLC The undersigned hereby irrevocably elects to exercise __________ Rights represented by this Rights Certificate to purchase the Right Certificate.shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person that may be issuable upon the exercise of the Rights) To Owens Corningand requests that certificates for such shares be issued in the name of and delivered to: The undersigned herexx xxrevocably elects to exer cise Please insert social security or other identifying number ______________________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number ________________________________________________________________________________ ________________________________________________________________________________ (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ______________________ ________________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ________________________________________________________________________________ (Please print name and address) Dated: __________________________ _________________________________ Dated:__________________, ____ [Form of Election to Purchase -- continued] __________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Guaranteed: Certificate.)

Appears in 1 contract

Samples: Rights Agreement (Centene Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: ELECTROGLAS, INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise ____________________ Rights represented by this Right Cer tificate Rights Certificate to purchase the shares Units of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person or other property which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares Units be issued in the name ofof and delivered to: Xxease __________________________________ ________________________________________________________________________ (Please print name and address) _______________________________ (Please insert social security or other identifying number). If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: __________________________________________________________ (Please print name and address) __________________________________________________________ If such number of Rights shall not be all the Rights evi denced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: (Please insert social security or other identifying number number). Dated ___________________________ ________________________________ Signature Signature Guaranteed: Certificate ----------- The undersigned hereby certifies by checking the appropriate boxes in (Please print name 1) and address(2) __________________________________________________________ Datedthat:__________________, ____ [Form of Election to Purchase -- continued] __________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)

Appears in 1 contract

Samples: Rights Agreement (Electroglas Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise the Right Rights represented by this Rights Certificate.) To Owens CorningTo: BE AEROSPACE, INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise ________ Rights represented by this Rights Certificate to purchase the Units of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such Units be issued in the name of and delivered to: _______________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number __________________________________________________________________ (Please print name and address) ________________________________________________________________________________ Please insert social security or other identifying number: ________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ________________________________________________________________________________ (Please print name and address) Please insert social security or other identifying number: ________________________________________________________________________ Dated:__________________, ____ [Form of Election to Purchase -- continued] _______________: ___________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)__, ____

Appears in 1 contract

Samples: Rights Agreement (Be Aerospace Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Right Certificate.) To Owens CorningTO _____________________: The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise _________________ Rights represented by this Right Cer tificate Certificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates certificates for such shares share(s) be issued in the name offollowing name: Xxease Please insert social security or other identifying number number:_________________________________________________________________________ ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number number:_________________________________________________________________________ ________________________________________________________________________________ (Please print name and address) __________________________________________________________ Dated:__________________, _____ [Form of Election to Purchase -- continued] Dated: _____________, 20___ ____________________________________ Signature (Signature must conform in all respects to name of holder as specified on the face fact of this Right Certificate.)

Appears in 1 contract

Samples: Rights Agreement (Six Flags, Inc.)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights Represented by the Right Second Rights Certificate.) To Owens CorningTo: WGNB CORP. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise _____ Rights represented by this Rights Certificate to purchase the shares of Common Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other Person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of and delivered to (please type or print): Social Security or other identifying number: [ _________________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights ] Name and requests that certifi cates for such shares be issued in the name ofAddress: Xxease insert social security or other identifying number ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ ___________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number Name and Address: ___________________________________________________________________ (Please print name and address) ___________________________________________________________________ Dated:__________________, ____ [Form of Election to Purchase -- continued] ______________________________________________ Signature (Signature must conform in all respects to name of holder as specified on Social Security or other identifying number: ______________________ Dated: ____________________ Certificate The undersigned hereby certifies by checking the face of this Right Certificate.)appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (WGNB Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: ORGANIC, INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise ____________________ Rights represented by this Right Cer tificate Rights Certificate to purchase the shares Units of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person or other property which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares Units be issued in the name ofof and delivered to: Xxease _____________________ ________________________________________________________________________ (Please print name and address) _______________________________ (Please insert social security or other identifying number). If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: __________________________________________________________ (Please print name and address) __________________________________________________________ If such number of Rights shall not be all the Rights evi denced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: (Please insert social security or other identifying number __________________________________________________________ (Please print name and address) __________________________________________________________ Datednumber). Dated ------------------------------- ------------------------------------ Signature Signature Guaranteed:__________________, ____ [Form of Election to Purchase -- continued] __________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)

Appears in 1 contract

Samples: Rights Agreement (Organic Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Rights Certificate.) To Owens CorningTO: HARVEST NATURAL RESOURCES, INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise ____________________ Rights represented by this Right Cer tificate Rights Certificate to purchase the shares Preferred Shares (or such other securities of Preferred Stock the Company) issuable upon the exercise of such Rights and requests that certifi cates certificate for such shares Preferred Shares (or other securities of the Company) be issued in the name of: Xxease insert social security or other identifying number ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ (Please insert social security or other identifying number) If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ (Please print name and address) __________________________________________________________ Dated:__________________, _____ [Form of Election to Purchase -- continued] (Please insert social security or other identifying number) Dated: ____________________________ ___________________________________ _________________________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Signature(s) Guaranteed: ___________________________________ 39

Appears in 1 contract

Samples: Rights Agreement (Harvest Natural Resources Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Certificate.) To Owens CorningXXXXXXX & XXXXX, INC.: The undersigned herexx xxrevocably hereby irrevocably elects to exer cise _____exercise __________ Rights represented by this Right Cer tificate Certificate to purchase the shares of Preferred Stock Shares issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares be issued in the name of: Xxease Please insert social security or other identifying number ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ________________________________________________________________________________ Please insert social security or other identifying number (Please print name and address) __________________________________________________________ Dated:__________________, _____ [Form of Election to Purchase -- continued] ________________________________________________________________________________ Dated as of ____________, ____ ----------------------------------- Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed:

Appears in 1 contract

Samples: Rights Agreement (Willcox & Gibbs Inc /De)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: UNIROYAL TECHNOLOGY CORPORATION The undersigned herexx xxrevocably hereby irrevocably elects to exer cise ________exercise _______ Rights represented by this Right Cer tificate Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares be issued in the name ofof and delivered to: Xxease insert social security or other identifying number __________________________________________________________ (Please print name and address) __________________________________________________________ Please insert social security or other identifying number:______________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number __________________________________________________________ (Please print name and address) __________________________________________________________ DatedPlease insert social security or other identifying number:__________________, ____ [Form of Election to Purchase -- continued] __________________________ Dated: _________________ Signature (Signature must conform in all respects to name of holder as specified on Guaranteed:______________________ Certificate The undersigned hereby certifies by checking the face of this Right Certificate.)appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Uniroyal Technology Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: XXXX XX INDUSTRIES, INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise __________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of and delivered to: Please insert social security or other identifying number _______________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number ____________________________________________________________ (Please print name and address) __________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number __________________________________________________________________________ (Please print name and address) __________________________________________________________________________ Dated:__________________, ____ [Form of Election to Purchase -- continued] _____________________________________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Dated: _______________, 19__ ______________________________ Signature

Appears in 1 contract

Samples: Rights Agreement (Mark Iv Industries Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Certificate.) To Owens CorningTo: Horizon Offshore, Inc. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise ___exercise ____________ Rights represented by this Right Cer tificate Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares securities be issued in the name ofof and delivered to: Xxease Please insert social security or other identifying number __________________________________________________________________________________________ (Please print name and address) __________________________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number __________________________________________________________________________________________ (Please print name and address) __________________________________________________________________________________________ Dated:: _____________________, 20___ ____ [Form of Election to Purchase -- continued] _____________________________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed:

Appears in 1 contract

Samples: Rights Agreement (Horizon Offshore Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: REALOGY CORPORATION The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of and delivered to: Please insert social security or other identifying number _______________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number ________________________________________________________________________________________________________________________________ (Please print name and address) ______________________________________________________________________________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ______________________________________________________________________________________________________________________________________________ (Please print name and address) __________________________________________________________ Dated:__________________, ____ [Form of Election to Purchase -- continued] ________________________________________________________________ ______________________________________________________________________________________________________________________________________________ Dated: , Signature (Signature must conform in all respects to name of holder as specified on Guaranteed: Certificate The undersigned hereby certifies by checking the face of this Right Certificate.)appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Realogy Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To Owens CorningT CELL SCIENCES, INC.: The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise ______ Rights represented by this Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying taxpayer number: ____________ _______________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number __________________________________________________________________ (Please print name and address) ________________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right CertificateCertificate or if the Rights are being exercised pursuant to Section 11(a)(ii) of the Rights Agreement, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number taxpayer number: ____________ ________________________________________________________________________________ (Please print name and address) __________________________________________________________ Dated:__________________, _____ [Form of Election to Purchase -- continued] ________________________________________________________________________________ Dated: ___________ ____________________________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed: ____________

Appears in 1 contract

Samples: Shareholder Rights Agreement (Avant Immunotherapeutics Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Rights Certificate.) To Owens CorningTO: BENTON OIL AND GAS COMPANY The undersigned herexx xxrevocably hereby ixxxxxxably elects to exer cise _______________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number __________________________________________________________ Rights represented by this Rights Certificate to purchase the Preferred Shares (or such other securities of the Company) issuable upon the exercise of such Rights and requests that certificate for such Preferred Shares (or other securities of the Company) be issued in the name of: -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- (Please print name and address) __________________________________________________________ -------------------------------------------------------------------------------- (Please insert social security or other identifying number) If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- (Please print name and address) -------------------------------------------------------------------------------- (Please insert social security or other identifying number __________________________________________________________ (Please print name and addressnumber) __________________________________________________________ Dated:__________________, ____ [Form of Election to Purchase -- continued] __________________________ : --------------------------- --------------------------------- --------------------------------- Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Signature

Appears in 1 contract

Samples: Rights Agreement (Harvest Natural Resources Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: THE CHEFS’ WAREHOUSE, INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise _________exercise ______ Rights represented by this Right Cer tificate Rights Certificate to purchase the shares Units of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person or other property that may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares Units be issued in the name ofof and delivered to: Xxease insert social security or other identifying number __________________________________________________________ (Please print name and address) ____________________________________________________ ____________________________________________________ Please insert social security or other identifying number: _____________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number __________________________________________________________ (Please print name and address) __________________________________________________________ Dated:__________________, ____ [Form of Election to Purchase -- continued] _______________________________ Please insert social security or other identifying number: _____________________________ Dated: _____ __, 202_ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed:

Appears in 1 contract

Samples: Rights Agreement (Chefs' Warehouse, Inc.)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Certificate.) To Owens CorningTo: INDEPENDENT BANK CORP. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise _____exercise __________ Rights represented by this Right Cer tificate Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares be issued in the name ofof and delivered to: Xxease Please insert social security number or other identifying number ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Such Rights shall be registered in the name of and delivered to: Please insert social security number or other identifying number ________________________________________________________________________________ (Please print name and address) __________________________________________________________ Dated:__________________, _____ [Form of Election to Purchase -- continued] ________________________________________________________________________________ Dated: _________________ _____________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed: ___________________________ 7B

Appears in 1 contract

Samples: Renewal Rights Agreement (Independent Bank Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To Owens CorningMEDFORD BANCORP, INC.: The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise _________ Rights represented by this Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying taxpayer number: ____________________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number _____________________________________________________________ (Please print name and address) _____________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right CertificateCertificate or if the Rights are being exercised pursuant to Section 11(a)(ii) of the Rights Agreement, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number taxpayer number: ____________________ _____________________________________________________________ (Please print name and address) _____________________________________________________________ Dated:_____________________________________________________________ Dated: _____________, _____ [Form of Election to Purchase -- continued] _______________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed: ____________________

Appears in 1 contract

Samples: Shareholder Rights Agreement (Medford Bancorp Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Certificate.) To Owens CorningTo: THE XXXXXXXX AND XXXXXXXX COMPANY The undersigned herexx xxrevocably hereby irrevocably elects to exer cise _exercise ______________ Rights represented by this Right Cer tificate Certificate to purchase the shares of Preferred Stock Units issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person or other property which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares Units be issued in the name ofof and delivered to: Xxease insert social security or other identifying number __________________________________________________________ ----------------------------------- (Please print name and address) __________________________________________________________ ----------------------------------- Please insert social security or other identifying number: --------------- If such number of Rights shall not be all the Rights evi denced evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: ----------------------------------- (Please print name and address) ----------------------------------- Please insert social security or other identifying number _________________________________________________number: --------------- Dated: _________ (Please print name and address) __________________________________________________________ Dated:__________________, __200__ [Form of Election to Purchase -- continued] __________________________ ---------------------------- Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Medallion Guaranteed:

Appears in 1 contract

Samples: Rights Agreement (Reynolds & Reynolds Co)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: WOLVERINE WORLD WIDE, INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise _________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of and delivered to: Please insert social security or other identifying number: ______________________________________________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number ___________________________________________________________________________ (Please print name and address) ___________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number number: ______________________________________________ ___________________________________________________________________________ (Please print name and address) __________________________________________________________ Dated:__________________, _ Dated: ______________, 19__ [Form of Election to Purchase -- continued] ___________________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed:

Appears in 1 contract

Samples: Rights Agreement (Wolverine World Wide Inc /De/)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: AMERICAN RETIREMENT CORPORATION The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise ________________ Rights represented by this Right Cer tificate Rights Certificate to purchase the shares Units of Preferred Stock Stock, issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares Units be issued in the name ofof and delivered to: Xxease insert social security or other identifying number __________________________________________________________ ------------------------------------------------------------------------------- (Please print name and address) ______________________________________-------------------------------------------------------------------------------- Please insert social security or other identifying number: ____________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: ------------------------------------------------------------------------------- (Please print name and address) ------------------------------------------------------------------------------- Please insert social security or other identifying number __________________________________________________________ (Please print name and address) ______________________________________number: ____________________ Dated:__________________, ____ [Form of Election to Purchase -- continued] __________________________ : --------------------------- ------------------------------------------- Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed: -------------------------------------------------------------------------------

Appears in 1 contract

Samples: Rights Agreement (American Retirement Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: ------------------------------ The undersigned herexx xxrevocably hereby irrevocably elects to exer cise ___exercise ____________ Rights represented by this Right Cer tificate Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares be issued in the name ofof and delivered to: Xxease insert social security or other identifying number __________________________________________________________ ------------------------------------------------------------------------------- (Please print name and address) __________________________________________________________ ------------------------------------------------------------------------------- Please insert social security or other identifying number: --------------------------------------- If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: -------------------------------------------------------------------------------- (Please print name and address) -------------------------------------------------------------------------------- Please insert social security or other identifying number __________________________________________________________ (Please print name and address) __________________________________________________________ number: --------------------------------------- -------------------------------------------------------------------- Dated: , -------------------- ---- --------------------------------- Signature Signature Guaranteed: The undersigned hereby certifies by checking the appropriate boxes that:__________________, ____ [Form of Election to Purchase -- continued] __________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)

Appears in 1 contract

Samples: Rights Agreement (Sunrise Assisted Living Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: GUIDANT CORPORATION: The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise __________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of and delivered to: Please insert social security or other identifying number _______________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number _________________________________________________________________ (Please print name and address) _______________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number _______________________________________________________________________________ (Please print name and address) __________________________________________________________ Dated:__________________, ____ [Form of Election to Purchase -- continued] _______________________________________________________________________________ Dated: __________________,__ _______________________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed:

Appears in 1 contract

Samples: Rights Agreement (Guidant Corp)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: AMERICAN BANKERS INSURANCE GROUP, INC.: The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise ________________ __________________________ Rights represented by this Right Cer tificate Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities, cash or other assets of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares (or such cash or other assets) be issued in the name ofof and delivered to: Xxease Please insert social security or other identifying number______________________ _______________________________________________________________________________ (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number______________________ _______________________________________________________________________________ (Please print name and address) __________________________________________________________ If such number of Rights shall not be all the Rights evi denced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number __________________________________________________________ (Please print name and address) __________________________________________________________ Dated:__________________, _19___ [Form of Election to Purchase -- continued] __________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)______________

Appears in 1 contract

Samples: Rights Agreement (American Bankers Insurance Group Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: AngioDynamics, Inc.: The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise __________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of and delivered to: Please insert social security or other identifying number _______________________________________________________________________________ (Please print name and address) If such number of Rights represented shall not be all the Rights evidenced by this Right Cer tificate to purchase Rights Certificate, a new Rights Certificate for the shares of Preferred Stock issuable upon the exercise balance of such Rights and requests that certifi cates for such shares shall be issued registered in the name ofof and delivered to: Xxease Please insert social security or other identifying number _______________________________________________________________________________ (Please print name and address) __________________________________________________________ If such number of Rights shall not be all the Rights evi denced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number __________________________________________________________ (Please print name and address) _______________________________________________________________________________ Dated:: __________________, __,__ [Form of Election to Purchase -- continued] __________________________ -------------------------- Signature (Signature must conform in all respects to name of holder as specified on Guaranteed: Certificate The undersigned hereby certifies by checking the face of this Right Certificate.)appropriate boxes that:

Appears in 1 contract

Samples: Rights Agreement (Angiodynamics Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTo: CODORUS VALLEY BANCORP, INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise ____________________ Rights represented by this Right Cer tificate Rights Certificate to purchase the shares of Preferred Common Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares be issued in the name ofof and delivered to: Xxease Please insert social security or other identifying number __________________________________________________________ (Please print name Print Name and addressAddress) __________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ________________________________________________________ (Please Print Name and Address) ________________________________________________________ (Please print name and address) __________________________________________________________ Dated: ------------------------------ ---------------------------------------- Signature Signature Medallion Guaranteed:__________________, ____ [Form of Election to Purchase -- continued] __________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)

Appears in 1 contract

Samples: Rights Agreement (Codorus Valley Bancorp Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights repre- sented by the Right Rights Certificate.) To Owens CorningTo: LENDINGTREE INC.: The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise __________ Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of and delivered to: Please insert social security or other identifying number _______________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number ________________________________________________________________ (Please print name and address) ______________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ______________________________________________________________________________ (Please print name and address) __________________________________________________________ Dated:_____________________ ______________________________________________________________________________ Dated: _______________, _____ [Form of Election to Purchase -- continued] __________________________________ Signature (Signature must conform in all respects to name of holder as specified on Guaranteed: Certificate The undersigned hereby certifies by checking the face of this Right Certificate.)appropriate boxes that:

Appears in 1 contract

Samples: Lendingtree Inc

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Certificate.) To Owens CorningTo: CHECKPOINT SYSTEMS, INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise_____ Rights represented by this Right Certificate to purchase the Common Shares issuable upon the exercise of the Rights (or such other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of: Please insert social security or other identifying number ______________________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ______________________ ________________________________________________________________________________ (Please print name and address) __________________________________________________________ Dated:__________________, _____ [Form of Election to Purchase -- continued] Dated: ___________ ___, ___ _____________________________________________ Signature (Signature Guaranteed: Signatures must conform be guaranteed by an eligible financial institution or broker who is a member participant in all respects to name of holder as specified on a Medallion Program approved by the face of this Right Certificate.)Securities Transfer Association, Inc.

Appears in 1 contract

Samples: Rights Agreement (Checkpoint Systems Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if the register holder desires to exercise the Right Certificate.) To Owens Corning: The undersigned herexx xxrevocably elects to exer cise _______________ Rights represented by this Right Cer tificate the Rights Certificate) To: HORIZON MENTAL HEALTH MANAGEMENT, INC. The undersigned hereby irrevocably elects to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number __________________________________________________________ Rights represented by this Rights Certificate to purchase the shares of Common Stock issuable upon the exercise of the Rights (or such other securities of the Company or of any other Person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of and delivered to: -------------------------------------------------------------------------------- (Please print name and address) __________________________________________________________ -------------------------------------------------------------------------------- Please insert social security or other identifying number: ---------------------------------------------------- If such number of Rights shall not be all the Rights evi denced rights evidence by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: -------------------------------------------------------------------------------- (Please print name and address) -------------------------------------------------------------------------------- Please insert social security or other identifying number __________________________________________________________ (Please print name and address) __________________________________________________________ number: ---------------------------------------------------- Dated:__________________: , ____ [Form of Election to Purchase -- continued] __________________________ ------------------------------------ -------- ---------------------------------------- Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed: --------------------------------------------------------------------------------

Appears in 1 contract

Samples: Rights Agreement (Horizon Mental Health Management Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTO: GALERA THERAPEUTICS, INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise _________exercise ______ Rights represented by this Right Cer tificate Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares (or other securities) be issued in the name ofof and delivered to: Xxease Please insert social security or other identifying number number: _____________________________________ (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number: ______________________ (Please print name and address) __________________________________________________________ If such number of Rights shall not be all the Rights evi denced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number __________________________________________________________ (Please print name and address) __________________________________________________________ Dated:____: ______________, ____ [Form of Election to Purchase -- continued] __________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed:

Appears in 1 contract

Samples: Stockholder Rights Agreement (Galera Therapeutics, Inc.)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To Owens CorningChrysler Corporation: The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise _______________ Rights represented by this Right Cer tificate Certificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights (or such other securities of the Company or of any other Person which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares be issued in the name of: Xxease Please insert social security or other identifying number ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ Dated:__________________, ____ [Form of Election to Purchase -- continued] __________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)

Appears in 1 contract

Samples: Rights Agreement (Chrysler Corp /De)

FORM OF ELECTION TO PURCHASE. (To be executed if the registered holder desires to exercise the Right Certificate.) To Owens Corning: The undersigned herexx xxrevocably elects to exer cise _______________ Rights represented by this Right Cer tificate the Rights Certificate) To: O'CHARLEY'S INC. The undersigned hereby irrevocably elects to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number __________________________________________________________ Rights represented by this Rights Certificate to purchase the Units of Preferred Stock, issuable upon the exercise of the Rights (or such other securities of the Company or of any other person that may be issuable upon the exercise of the Rights) and requests that certificates for such Units be issued in the name of and delivered to: -------------------------------------------------------------------------------- (Please print name and address) _____________________________________-------------------------------------------------------------------------------- Please insert social security or other identifying number: _____________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: -------------------------------------------------------------------------------- (Please print name and address) -------------------------------------------------------------------------------- Please insert social security or other identifying number __________________________________________________________ (Please print name and address) _____________________________________number: _____________________ Dated: ------------------------- -------------------------------------------- Signature Signature Guaranteed:__________________, ____ [Form of Election to Purchase -- continued] __________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)

Appears in 1 contract

Samples: Rights Agreement (O Charleys Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Rights Certificate.) To Owens CorningTO: WHG RESORTS & CASINOS INC. The undersigned herexx xxrevocably hereby irrevocably elects to exer cise exercise Rights represented by this Rights Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such other securities of WHG Resorts & Casinos Inc. or of any other person which may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name of and delivered to: Please insert social security or other identifying number _______________ Rights represented by this Right Cer tificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certifi cates for such shares be issued in the name of: Xxease insert social security or other identifying number __________________________________________________________________ (Please print name and address) ________________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ Dated:_______________________, ____ [Form of Election to Purchase -- continued] _____________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate.)Guaranteed:

Appears in 1 contract

Samples: Rights Agreement (WHG Resorts & Casinos Inc)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise Rights represented by the Right Certificate.) To Owens CorningSynagro Technologies, Inc.: The undersigned herexx xxrevocably hereby irrevocably elects to exer cise ___exercise ____________ Rights represented by this Right Cer tificate Certificate to purchase the shares of Preferred Stock issuable upon the exercise of the Rights (or such Rights other securities or property of the Company or of any other person which may be issuable upon the exercise of the Rights) and requests that certifi cates certificates for such shares be issued in the name ofof and delivered to: Xxease Please insert social security or other identifying number number:____________________ ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ If such number of Rights shall not be all the Rights evi denced evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ Please insert social security or other identifying number:_____________________ ________________________________________________________________________________ (Please print name and address) ________________________________________________________________________________ Dated:__________________, __ ____ [Form of Election to Purchase -- continued] _____________________________________ Signature (Signature Guaranteed: NOTICE The signatures to the foregoing Form of Election To Purchase must conform in all respects correspond to the name of holder as specified on written upon the face of this Right CertificateCertificate in every particular, without alteration or enlargement or any change whatsoever.)

Appears in 1 contract

Samples: Rights Agreement (Synagro Technologies Inc)

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