Common use of Telephone Number Clause in Contracts

Telephone Number. Address: ------------------------------- ------------------------------- ------------------------------- (MUST BE SIGNED BY REGISTERED HOLDER(S) EXACTLY AS NAME(S) APPEAR(S) ON STOCK CERTIFICATE(S) REPRESENTING THE ORIUS COMMON OR BY PERSON(S) AUTHORIZED TO BECOME REGISTERED HOLDER(S) BY CERTIFICATE(S) AND DOCUMENTS TRANSMITTED HEREWITH.) 124 SIGNATURE JOINDER TO REORGANIZATION AGREEMENT AND TRANSMITTAL OF ORIUS COMMON The undersigned agrees to be bound by the terms of the Reorganization Agreement and agrees to all of the provisions thereof, as well as the terms and agreements above, and makes the representations and warranties set forth above. SIGN HERE -------------------------------- IF THE UNDERSIGNED IS AN INDIVIDUAL: EXCEPTIONS SCHEDULE -------------------------------- DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Print Name -------------------------------- -------------------------------- // DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Signature -------------------------------- Address: 401 Xx Xxxxx Xx. ------------------------------ -------------------------------- Beavxx Xxx, XX 00000 ------------------------------ -------------------------------- ------------------------------ -------------------------------- If the Undersigned is a Corporation, Partnership or Trust: ---------------------------------------- Name of Entity ---------------------------------------- Signature Print Name: ----------------------------- Title: ----------------------------------

Appears in 1 contract

Samples: Agreement and Plan of Reorganization (Natg Holdings LLC)

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Telephone Number. AddressAccepted this ________ day of _______________________, _____________ KAT RACING BY: ------------------------------- ------------------------------- ------------------------------- _______________________________________ THE SHARES SUBSCRIBED FOR HEREBY HAVE NOT BEEN REGISTERED WITH THE SECURITIES AND EXCHANGE COMMISSION OR ANY STATE SECURITIES COMMISSION AND MAY NOT BE SOLD OR TRANSFERRED IN THE ABSENCE OF AN EFFECTIVE REGISTRATION STATEMENT UNDER THE SECURITIES ACT OF 1933 AND ANY APPLICABLE STATE SECURITIES LAWS OR AN OPINION OF COUNSEL ACCEPTABLE TO THE COMPANY THAT SUCH REGISTRATION IS NOT REQUIRED. SUITABILITY AND REPRESENTATION LETTER KAT RACING 6000 Xxxxxxxx Xxxxxxxxx, Xxxxx X000 Xxx Xxxxx, Xxxxxx 00000 Gentlemen: The undersigned is furnishing the following information to enable you to determine whether you may make offers and sales of shares in the Private Offering dated April 24, 2006 (MUST BE SIGNED BY REGISTERED HOLDER(Sthe "Offering”) EXACTLY AS NAME(S) APPEAR(S) ON STOCK CERTIFICATE(S) REPRESENTING THE ORIUS COMMON OR BY PERSON(S) AUTHORIZED TO BECOME REGISTERED HOLDER(S) BY CERTIFICATE(S) AND DOCUMENTS TRANSMITTED HEREWITH.) 124 SIGNATURE JOINDER TO REORGANIZATION AGREEMENT AND TRANSMITTAL OF ORIUS COMMON without registration of the shares under the Securities Act of 1933, as amended (the "Securities Act"). The undersigned understands that his/her questionnaire does not constitute an offer to sell or an offer to purchase the shares or any other securities. The undersigned agrees that, in the event he or she purchases any common stock offered hereby, KAT RACING may provide this Letter or any portions of it to be bound by persons the terms Company deems appropriate in order to assure that the offer and sale of common stock are in accordance with federal and state securities laws. The undersigned represents that the information set forth in this letter is complete and accurate and that the undersigned will notify you immediately of any change in any of the Reorganization Agreement and agrees information occurring prior to all the closing of the provisions thereof, sale of the shares. The undersigned specifically represents as well as the terms and agreements above, and makes the representations and warranties set forth above. SIGN HERE -------------------------------- IF THE UNDERSIGNED IS AN INDIVIDUALfollows: EXCEPTIONS SCHEDULE -------------------------------- DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Print Name -------------------------------- -------------------------------- // DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Signature -------------------------------- PERSONAL INFORMATION Name: ___________________________________________________________________________________ Residential Address: 401 Xx Xxxxx Xx. ------------------------------ -------------------------------- Beavxx Xxx, XX 00000 ------------------------------ -------------------------------- ------------------------------ -------------------------------- If the Undersigned is a Corporation, Partnership Business Address: __________________________________ _________________________________ __________________________________ _________________________________ __________________________________ _________________________________ Telephone: __________________________ Telephone: _________________________ Tax I.D. # or TrustSocial Security Number: ---------------------------------------- Name of Entity ---------------------------------------- Signature Print Name___________________ Age: ----------------------------- Title: ----------------------------------_____________________________ RESIDENCE

Appears in 1 contract

Samples: Subscription Agreement (KAT Racing, Inc.)

Telephone Number. Address: ------------------------------- ------------------------------- ------------------------------- Address: ------------------------------------ ------------------------------------ ------------------------------------ ------------------------------------ ------------------------------------ ------------------------------------ (MUST BE SIGNED BY REGISTERED HOLDER(S) EXACTLY AS NAME(S) APPEAR(S) ON STOCK CERTIFICATE(S) REPRESENTING THE ORIUS COMMON LISN SHARES AND LISN JUNIOR NOTES OR BY PERSON(S) AUTHORIZED TO BECOME REGISTERED HOLDER(S) BY CERTIFICATE(S) AND DOCUMENTS TRANSMITTED HEREWITH.) 124 195 SIGNATURE JOINDER TO REORGANIZATION AGREEMENT AND TRANSMITTAL OF ORIUS COMMON LISN SHARES SPECIFIC AGREEMENT TO EXCHANGE NOTES SIGN HERE SIGN HERE The undersigned agrees to be bound by the terms of the Reorganization Agreement and agrees to all of the provisions thereof, as well as the The undersigned hereby agrees to terms and agreements above, and makes other than those exchange the LISN Junior Notes (as exclusively relating to the LISN defined above) pursuant to the Note Junior Notes, including by making Exchange Agreement. the representations and warranties set forth above. SIGN HERE -------------------------------- IF THE UNDERSIGNED IS AN INDIVIDUAL: EXCEPTIONS SCHEDULE -------------------------------- DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- IF THE UNDERSIGNED IS AN INDIVIDUAL: ------------------------------------ ------------------------------------ Print Name -------------------------------- -------------------------------- // DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Print Name ------------------------------------ ------------------------------------ Signature -------------------------------- AddressSignature IF THE UNDERSIGNED IS A CORPORATION, IF THE UNDERSIGNED IS A CORPORATION, PARTNERSHIP OR TRUST: 401 Xx Xxxxx Xx. ------------------------------ -------------------------------- Beavxx Xxx, XX 00000 ------------------------------ -------------------------------- ------------------------------ -------------------------------- If the Undersigned is a Corporation, Partnership or TrustPARTNERSHIP OR TRUST: ---------------------------------------- Jamex X. Xxxxxx Xxxcting Small Business ------------------------------------ ------------------------------------ Name of Entity ---------------------------------------- Name of Entity /s/ J. S. Xxxxxx /s/ J. S. Xxxxxx ------------------------------------ ------------------------------------ Signature Signature Print Name: ----------------------------- JAMEX X. XXXXXX Print Name: JAMEX X. XXXXXX ------------------------- ------------------------- Title: ----------------------------------TRUSTEE Title: ------------------------------ ------------------------------ Taxpayer I.D. No.: Taxpayer I.D. No.: 34-7000000 ###-##-#### ------------------------------------ ------------------------------------ Telephone Number: Telephone Number: 419-000-0000 419-000-0000 ------------------------------------ ------------------------------------ Address: Address: 1919 Xxxxx Xxxxx Xx 1919 Xxxxx Xxxxx Xx ------------------------------------ ------------------------------------ Sandxxxx XX 00000 Sandxxxx XX 00000 ------------------------------------ ------------------------------------ ------------------------------------ ------------------------------------ (MUST BE SIGNED BY REGISTERED HOLDER(S) EXACTLY AS NAME(S) APPEAR(S) ON STOCK CERTIFICATE(S) REPRESENTING THE LISN SHARES AND LISN JUNIOR NOTES OR BY PERSON(S) AUTHORIZED TO BECOME REGISTERED HOLDER(S) BY CERTIFICATE(S) AND DOCUMENTS TRANSMITTED HEREWITH.) TRANSMITTAL OF LISN SHARES SPECIFIC AGREEMENT TO EXCHANGE NOTES SIGN HERE SIGN HERE The undersigned agrees to all of the The undersigned hereby agrees to terms above, other than those exchange the LISN Junior Notes (as exclusively relating to the LISN defined above) pursuant to the Note Junior Notes, including by making Exchange Agreement. the representations and warranties set forth above. IF THE UNDERSIGNED IS AN INDIVIDUAL: IF THE UNDERSIGNED IS AN INDIVIDUAL: ------------------------------------ ------------------------------------ Print Name Print Name ------------------------------------ ------------------------------------ Signature Signature IF THE UNDERSIGNED IS A CORPORATION, IF THE UNDERSIGNED IS A CORPORATION, PARTNERSHIP OR TRUST: PARTNERSHIP OR TRUST: Donaxx X. Xxxxx Xxxcting Donaxx X. Xxxxx Xxxcting Small Business Trust Small Business Trust ------------------------------------ ------------------------------------ Name of Entity Name of Entity /s/ DONAXX X. XXXXX /s/ DONAXX X. XXXXX ------------------------------------ ------------------------------------ Signature Signature Print Name: Donaxx X. Xxxxx Print Name: Donaxx X. Xxxxx ------------------------- ------------------------- Title: Trustee Title: Trustee ------------------------------ ------------------------------ Taxpayer I.D. No.: Taxpayer I.D. No.: 34-7000000 34-7000000 ------------------------------------ ------------------------------------ Telephone Number: Telephone Number:

Appears in 1 contract

Samples: Agreement and Plan of Reorganization (Natg Holdings LLC)

Telephone Number. AddressFax Number (if available) ________________________________ Fax Number (if available) _________________________________ E-Mail (if available) ________________________________ E-Mail (if available) __________________________________ (Signature) ________________________________ (Signature of Additional Subscriber) ACCEPTED this ___ day of _________ 2014, on behalf of the Company. By: ------------------------------- ------------------------------- ------------------------------- _________________________________ Name: Title: [SIGNATURE PAGE FOR SUBSCRIPTION AGREEMENT] EXECUTION BY SUBSCRIBER WHICH IS AN ENTITY (MUST BE SIGNED BY REGISTERED HOLDER(S) EXACTLY AS NAME(S) APPEAR(S) ON STOCK CERTIFICATE(S) REPRESENTING THE ORIUS COMMON OR BY PERSON(S) AUTHORIZED TO BECOME REGISTERED HOLDER(S) BY CERTIFICATE(S) AND DOCUMENTS TRANSMITTED HEREWITHCorporation, Partnership, LLC, Trust, Etc.) 124 SIGNATURE JOINDER TO REORGANIZATION AGREEMENT AND TRANSMITTAL OF ORIUS COMMON The undersigned agrees to be bound by the terms _____________________________________________________________________________ Name of Entity (Please Print) Date of Incorporation or Organization: State of Principal Office: Federal Taxpayer Identification Number: ____________________________________________ Office Address ____________________________________________ City, State and Zip Code ____________________________________________ Telephone Number ____________________________________________ Fax Number (if available) ____________________________________________ E-Mail (if available) By: _________________________________ Name: Title: [seal] Attest: _________________________________ (If Entity is a Corporation) _________________________________ _________________________________ Address ACCEPTED this ____ day of __________ 2014, on behalf of the Reorganization Agreement and agrees to Company. By: _________________________________ Name: Title: [SIGNATURE PAGE FOR SUBSCRIPTION AGREEMENT] INVESTOR QUESTIONNAIRE MARATHON PATENT GROUP, INC. (THE “COMPANY”) ACCREDITED INVESTOR CERTIFICATION For Individual Investors Only (all Individual Investors must INITIAL where appropriate): Initial _____ I have an individual net worth, or joint net worth with my spouse, as of the provisions thereofdate hereof (excluding, for the purpose of net worth calculation, the value of such person’s or persons’ primary residence, after deducting any mortgage securing such primary residence) in excess of $1 million. Initial _____ I have had an annual gross income for the past two years of at least $200,000 (or $300,000 jointly with my spouse) and expect my income (or joint income, as well as appropriate) to reach the terms and agreements abovesame level in the current year. Initial _____ I am a director or executive officer of the Company. For Non-Individual Investors (all Non-Individual Investors must INITIAL where appropriate): Initial _____ The investor certifies that it is a partnership, and makes corporation, limited liability company or business trust that is 100% owned by persons who meet at least one of the representations and warranties criteria for Individual Investors set forth above. SIGN HERE -------------------------------- IF THE UNDERSIGNED IS AN INDIVIDUAL: EXCEPTIONS SCHEDULE -------------------------------- DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Print Name -------------------------------- -------------------------------- // DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Signature -------------------------------- Address: 401 Xx Xxxxx Xx. ------------------------------ -------------------------------- Beavxx Xxx, XX 00000 ------------------------------ -------------------------------- ------------------------------ -------------------------------- If the Undersigned Initial _____ The investor certifies that it is a Corporationpartnership, Partnership corporation, limited liability company or Trustany organization described in Section 501(c)(3) of the Internal Revenue Code, Nevada or similar business trust that has total assets of at least $5 million and was not formed for the purpose of investing the Company. Initial _____ The investor certifies that it is an employee benefit plan within the meaning of the Employee Retirement Income Security Act of 1974, whose investment decision is made by a plan fiduciary (as defined in ERISA §3(21)) that is a bank, savings and loan association, insurance company or registered investment adviser. Initial _____ The investor certifies that it is an employee benefit plan whose total assets exceed $5,000,000 as of the date of this Agreement. Initial _____ The undersigned certifies that it is a self-directed employee benefit plan whose investment decisions are made solely by persons who meet either of the criteria for Individual Investors. Initial _____ The investor certifies that it is a U.S. bank, U.S. savings and loan association or other similar U.S. institution acting in its individual or fiduciary capacity. Initial _____ The undersigned certifies that it is a broker-dealer registered pursuant to §15 of the Securities Exchange Act of 1934. Initial _____ The investor certifies that it is an organization described in §501(c)(3) of the Internal Revenue Code with total assets exceeding $5,000,000 and not formed for the specific purpose of investing in the Company. Initial _____ The investor certifies that it is a trust with total assets of at least $5,000,000, not formed for the specific purpose of investing in the Company, and whose purchase is directed by a person with such knowledge and experience in financial and business matters that he is capable of evaluating the merits and risks of the prospective investment. Initial _____ The investor certifies that it is a plan established and maintained by a state or its political subdivisions, or any agency or instrumentality thereof, for the benefit of its employees, and which has total assets in excess of $5,000,000. Initial _____ The investor certifies that it is an insurance company as defined in §2(13) of the Securities Act, or a registered investment company. Initial _____ An investment company registered under the Investment Company Act of 1940 or a business development company as defined in Section 2(a)(48) of that Act. Initial _____ A Small Business Investment Company licensed by the U.S. Small Business Administration under Section 301(c) or (d) of the Small Business Investment Act of 1958. Initial _____ A private business development company as defined in Section 202(a)(22) of the Investment Advisers Act of 1940. Date: ---------------------------------------- Name of Entity ---------------------------------------- Signature Print Rule 506 “Bad Actor” Questionnaire Date: _________________________________ Name: ----------------------------- Title: ----------------------------------_________________________________ This Questionnaire is being furnished to you to obtain information in connection with an offering (the “Offering”) of securities by Marathon Patent Group, Inc. (the “Issuer”) under Rule 506 of the Securities Act of 1933 (the “Securities Act”). As used in this Questionnaire, “you” also refers to any entity on whose behalf you are responding.

Appears in 1 contract

Samples: Form of Subscription Agreement (Marathon Patent Group, Inc.)

Telephone Number. Address: ------------------------------- ------------------------------- ------------------------------- (MUST BE SIGNED BY REGISTERED HOLDER(S) EXACTLY AS NAME(S) APPEAR(S) ON STOCK CERTIFICATE(S) REPRESENTING THE ORIUS COMMON OR BY PERSON(S) AUTHORIZED TO BECOME REGISTERED HOLDER(S) BY CERTIFICATE(S) AND DOCUMENTS TRANSMITTED HEREWITH.) 124 See Attached Share Identification Rider to Joinder Agreement. 118 SIGNATURE JOINDER TO REORGANIZATION AGREEMENT AND TRANSMITTAL OF ORIUS COMMON The undersigned agrees to be bound by the terms of the Reorganization Agreement and agrees to all of the provisions thereof, as well as the terms and agreements above, and makes the representations and warranties set forth above. SIGN HERE -------------------------------- IF THE UNDERSIGNED IS AN INDIVIDUAL: EXCEPTIONS SCHEDULE -------------------------------- DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Print Name -------------------------------- -------------------------------- // DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Signature -------------------------------- Address: 401 Xx Xxxxx Xx. ------------------------------ -------------------------------- Beavxx Xxx------------------------------ -------------------------------- ------------------------------ -------------------------------- If the Undersigned is a Corporation, Partnership or Trust: WILLXXX XXXXXX XXXXXX XXXST ---------------------------------------- Name of Entity /s/ WILLXXX XXXXXX XXXXXX XXXST ---------------------------------------- Signature Print Name: WILLXXX XXXXXX ----------------------------- Title: Trustee ---------------------------------- Taxpayer I.D. No.: ###-##-#### ---------------------- Telephone Number: 561-000-0000 ----------------------- Address: 1401 Xxxxx Xxx ------------------------------- Suite 400 ------------------------------- West Palm Xxxxx XX 00000 ------------------------------- (MUST BE SIGNED BY REGISTERED HOLDER(S) EXACTLY AS NAME(S) APPEAR(S) ON STOCK CERTIFICATE(S) REPRESENTING THE ORIUS COMMON OR BY PERSON(S) AUTHORIZED TO BECOME REGISTERED HOLDER(S) BY CERTIFICATE(S) AND DOCUMENTS TRANSMITTED HEREWITH.) See Attached Share Identification Rider to Joinder Agreement. 119 SIGNATURE JOINDER TO REORGANIZATION AGREEMENT AND TRANSMITTAL OF ORIUS COMMON The undersigned agrees to be bound by the terms of the Reorganization Agreement and agrees to all of the provisions thereof, as well as the terms and agreements above, and makes the representations and warranties set forth above. SIGN HERE -------------------------------- IF THE UNDERSIGNED IS AN INDIVIDUAL: EXCEPTIONS SCHEDULE -------------------------------- ROBEXX X. XXXXXX ---------------------------------------- -------------------------------- Print Name -------------------------------- -------------------------------- /s/ ROBEXX X. XXXXXX ---------------------------------------- -------------------------------- Signature -------------------------------- Address: 320 00xx Xxx ------------------------------ -------------------------------- Molixx XX 00000 ------------------------------ -------------------------------- ------------------------------ -------------------------------- If the Undersigned is a Corporation, Partnership or Trust: ---------------------------------------- Name of Entity ---------------------------------------- Signature Print Name: ----------------------------- Title: ----------------------------------

Appears in 1 contract

Samples: Agreement and Plan of Reorganization (Natg Holdings LLC)

Telephone Number. Address: ------------------------------- ------------------------------- ------------------------------- (MUST BE SIGNED BY REGISTERED HOLDER(S) EXACTLY AS NAME(S) APPEAR(S) ON STOCK CERTIFICATE(S) REPRESENTING THE ORIUS COMMON OR BY PERSON(S) AUTHORIZED TO BECOME REGISTERED HOLDER(S) BY CERTIFICATE(S) AND DOCUMENTS TRANSMITTED HEREWITH.) 124 147 SIGNATURE JOINDER TO REORGANIZATION AGREEMENT AND TRANSMITTAL OF ORIUS COMMON The undersigned agrees to be bound by the terms of the Reorganization Agreement and agrees to all of the provisions thereof, as well as the terms and agreements above, and makes the representations and warranties set forth above. SIGN HERE -------------------------------- IF THE UNDERSIGNED IS AN INDIVIDUAL: EXCEPTIONS SCHEDULE -------------------------------- DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Print Name -------------------------------- -------------------------------- // DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Signature -------------------------------- Address: 401 Xx Xxxxx Xx. ------------------------------ -------------------------------- Beavxx Xxx, XX 00000 ------------------------------ -------------------------------- ------------------------------ -------------------------------- If the Undersigned is a Corporation, Partnership or Trust: JERRX X. XXXX & XABRX X. XXXX XXXSTEES OF THE JERRX X. XXXX XXX SABRX X. XXXX XXXING TRUST ---------------------------------------- Name of Entity /s/ JERRX X. XXXX ---------------------------------------- Signature Print Name: JERRX X. XXXX ----------------------------- Title: ----------------------------------Trustee ---------------------------------- Taxpayer I.D. No.: ###-##-#### ---------------------- Telephone Number: 636-000-0000 ----------------------- Address: 1854 Xxxxx Xxx. ------------------------------- O'Faxxxx, XX ------------------------------- 63366 ------------------------------- (MUST BE SIGNED BY REGISTERED HOLDER(S) EXACTLY AS NAME(S) APPEAR(S) ON STOCK CERTIFICATE(S) REPRESENTING THE ORIUS COMMON OR BY PERSON(S) AUTHORIZED TO BECOME REGISTERED HOLDER(S) BY CERTIFICATE(S) AND DOCUMENTS TRANSMITTED HEREWITH.) 148 SIGNATURE JOINDER TO REORGANIZATION AGREEMENT AND TRANSMITTAL OF ORIUS COMMON The undersigned agrees to be bound by the terms of the Reorganization Agreement and agrees to all of the provisions thereof, as well as the terms and agreements above, and makes the representations and warranties set forth above. SIGN HERE -------------------------------- IF THE UNDERSIGNED IS AN INDIVIDUAL: EXCEPTIONS SCHEDULE --------------------------------

Appears in 1 contract

Samples: Agreement and Plan of Reorganization (Natg Holdings LLC)

Telephone Number. Address: ------------------------------- ------------------------------- ------------------------------- (MUST BE SIGNED BY REGISTERED HOLDER(S) EXACTLY AS NAME(S) APPEAR(S) ON STOCK CERTIFICATE(S) REPRESENTING THE ORIUS COMMON OR BY PERSON(S) AUTHORIZED TO BECOME REGISTERED HOLDER(S) BY CERTIFICATE(S) AND DOCUMENTS TRANSMITTED HEREWITH.) 124 162 SIGNATURE JOINDER TO REORGANIZATION AGREEMENT AND TRANSMITTAL OF ORIUS COMMON The undersigned agrees to be bound by the terms of the Reorganization Agreement and agrees to all of the provisions thereof, as well as the terms and agreements above, and makes the representations and warranties set forth above. SIGN HERE -------------------------------- IF THE UNDERSIGNED IS AN INDIVIDUAL: EXCEPTIONS SCHEDULE -------------------------------- DOUGXXX XXXXXXX Not an Accredited Investor. ---------------------------------------- -------------------------------- Print Name -------------------------------- -------------------------------- // DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Signature -------------------------------- Address: 401 Xx Xxxxx Xx. ------------------------------ -------------------------------- Beavxx Xxx, XX 00000 ------------------------------ -------------------------------- ------------------------------ -------------------------------- If the Undersigned is a Corporation, Partnership or Trust: THE WILLXXX XXXXXX XXXXXX XXXEVOCABLE FAMILY TRUST ---------------------------------------- Name of Entity John X. Xxxxx ---------------------------------------- Signature Print Name: John X. Xxxxx, Xxustee ----------------------------- Title: Trustee ----------------------------------

Appears in 1 contract

Samples: Agreement and Plan of Reorganization (Natg Holdings LLC)

Telephone Number. Address: ------------------------------- ------------------------------- ------------------------------- Address: ------------------------------------ ------------------------------------ ------------------------------------ ------------------------------------ ------------------------------------ ------------------------------------ (MUST BE SIGNED BY REGISTERED HOLDER(S) EXACTLY AS NAME(S) APPEAR(S) ON STOCK CERTIFICATE(S) REPRESENTING THE ORIUS COMMON LISN SHARES AND LISN JUNIOR NOTES OR BY PERSON(S) AUTHORIZED TO BECOME REGISTERED HOLDER(S) BY CERTIFICATE(S) AND DOCUMENTS TRANSMITTED HEREWITH.) 124 SIGNATURE JOINDER TO REORGANIZATION AGREEMENT AND TRANSMITTAL OF ORIUS COMMON LISN SHARES SPECIFIC AGREEMENT TO EXCHANGE NOTES SIGN HERE SIGN HERE The undersigned agrees to be bound by the terms of the Reorganization Agreement and agrees to all of the provisions thereof, as well as the The undersigned hereby agrees to terms and agreements above, and makes other than those exchange the LISN Junior Notes (as exclusively relating to the LISN defined above) pursuant to the Note Junior Notes, including by making Exchange Agreement. the representations and warranties set forth above. SIGN HERE -------------------------------- IF THE UNDERSIGNED IS AN INDIVIDUALWILLXX XXXXX & XARTNERS II, L.P. WILLXX XXXXX & XARTNERS II, L.P. By: EXCEPTIONS SCHEDULE -------------------------------- DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Print Name Willxx Xxxxx & Xartners Management By: Willxx Xxxxx & Xartners Management II, L.P. XX, X.L.C. Its: General Partner Its: General Partner By: Willxx Xxxxx & Xartners II, L.L.C. By: Willxx Xxxxx & Xartners II, L.L.C By: /s/ Robexx X. Xxxxxxxxxx By: /s/ Robexx X. Xxxxxxxxxx -------------------------------- -------------------------------- // DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Signature -------------------------------- Address: 401 Xx Xxxxx Xx. ------------------------------ -------------------------------- Beavxx Xxx, XX 00000 ------------------------------ -------------------------------- ------------------------------ -------------------------------- If the Undersigned is a Corporation, Partnership or Trust: ---------------------------------------- Name of Entity ---------------------------------------- Signature Print Name: ----------------------------- Robexx X. Xxxxxxxxxx Name: Robexx X. Xxxxxxxxxx Xxxle: Managing Director Title: ----------------------------------Managing Director Taxpayer I.D. No.: Taxpayer I.D. No.: ------------------------------------ ------------------------------------

Appears in 1 contract

Samples: Agreement and Plan of Reorganization (Natg Holdings LLC)

Telephone Number. Address: ------------------------------- ------------------------------- ------------------------------- Address: ------------------------------------ ------------------------------------ ------------------------------------ ------------------------------------ ------------------------------------ ------------------------------------ (MUST BE SIGNED BY REGISTERED HOLDER(S) EXACTLY AS NAME(S) APPEAR(S) ON STOCK CERTIFICATE(S) REPRESENTING THE ORIUS COMMON LISN SHARES AND LISN JUNIOR NOTES OR BY PERSON(S) AUTHORIZED TO BECOME REGISTERED HOLDER(S) BY CERTIFICATE(S) AND DOCUMENTS TRANSMITTED HEREWITH.) 124 SIGNATURE JOINDER TO REORGANIZATION AGREEMENT AND 189 TRANSMITTAL OF ORIUS COMMON LISN SHARES SPECIFIC AGREEMENT TO EXCHANGE NOTES SIGN HERE SIGN HERE The undersigned agrees to be bound by the terms of the Reorganization Agreement and agrees to all of the provisions thereof, as well as the The undersigned hereby agrees to terms and agreements above, and makes other than those exchange the LISN Junior Notes (as exclusively relating to the LISN defined above) pursuant to the Note Junior Notes, including by making Exchange Agreement. the representations and warranties set forth above. SIGN HERE -------------------------------- IF THE UNDERSIGNED IS AN INDIVIDUAL: EXCEPTIONS SCHEDULE -------------------------------- DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Print Name -------------------------------- -------------------------------- // DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Signature -------------------------------- Address: 401 Xx Xxxxx Xx. ------------------------------ -------------------------------- Beavxx XxxFLEET EQUITY PARTNERS VI, XX 00000 ------------------------------ -------------------------------- ------------------------------ -------------------------------- If the Undersigned is a CorporationL.P. FLEET EQUITY PARTNERS VI, Partnership or Trust: ---------------------------------------- L.P. ------------------------------------ ------------------------------------ Name of Entity ---------------------------------------- Name of Entity /s/ /s/ ------------------------------------ ------------------------------------ Signature Signature Print Name: ----------------------------- GREGXXX X. XXXX Print Name: GREGXXX X. XXXX ------------------------- ------------------------- Title: ----------------------------------Vice President Title: Vice President Fleet Growth Resources II, Inc. Fleet Growth Resources II, Inc. General Partner General Partner ------------------------------ ------------------------------ Taxpayer I.D. No.: Taxpayer I.D. No.: ------------------------------------ ------------------------------------

Appears in 1 contract

Samples: Agreement and Plan of Reorganization (Natg Holdings LLC)

Telephone Number. AddressVat NO - if not registered for VAT please state PHYSICAL ADDRESS (chosen domicilium citandi et executandi) _____________________________________________________________ CODE EVENT PARTICULARS EVENT NAME DATE OF EVENT ESTIMATED NUMBER OF GUESTS DETAILS OF HIRE TIME EVENT START ________________________ INTERVAL(S) _____________________ EVENT END ____________________ REQUESTED SET UP TIME (subject to availability and additional fees) SET UP START ________________________ SET UP END ____________________ EVENT SPACE 46 or more pax 11 to 45 pax Meeting room (up to 10 pax) EVENT TYPE BREAKFAST LUNCH BANQUET COCKTAIL EVENT SET-UP THEATRE STYLE SEATED RECEPTION STANDING RECEPTION EVENT PURPOSE _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ How did you hear about the JSE Venue? By signing this Booking form, the Contracted User acknowledges and confirms that they have received, rea and understoon the following documents: ------------------------------- ------------------------------- ------------------------------- (MUST BE SIGNED BY REGISTERED HOLDER(S) EXACTLY AS NAME(S) APPEAR(S) ON STOCK CERTIFICATE(S) REPRESENTING THE ORIUS COMMON OR BY PERSON(S) AUTHORIZED TO BECOME REGISTERED HOLDER(S) BY CERTIFICATE(S) AND DOCUMENTS TRANSMITTED HEREWITH.) 124 SIGNATURE JOINDER TO REORGANIZATION AGREEMENT AND TRANSMITTAL OF ORIUS COMMON The undersigned agrees to be bound by the terms of the Reorganization Agreement JSE Event and agrees to all of the provisions thereof, as well as the Resource Guide Preferred Service Provider Schedule Price Schedule JSE venue hire terms and agreements aboveconditions FOR CUSTOMER SIGNED ____________________________ ___________________________ DESIGNATION ______________________________________ DATE ______________________________________ NAME (who warrants that he/she is duly authorised) FOR JSE LIMITED SIGNED ____________________________ ____________________________ Director: Marketing and Corporate Affairs ______________________________________ DATE ______________________________________ NAME (who warrants that she is duly authorised) JSE EVENT RESOURCE GUIDE We look forward to supporting you in hosting a successful Event. To aid you in the planning process for your Event, we have compiled the following information. Capitalised terms used but not defined in this Event Resource Guide shall have the same meaning as in the Terms and makes the representations and warranties set forth above. SIGN HERE -------------------------------- IF THE UNDERSIGNED IS AN INDIVIDUAL: EXCEPTIONS SCHEDULE -------------------------------- DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Print Name -------------------------------- -------------------------------- // DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Signature -------------------------------- Address: 401 Xx Xxxxx Xx. ------------------------------ -------------------------------- Beavxx Xxx, XX 00000 ------------------------------ -------------------------------- ------------------------------ -------------------------------- If the Undersigned is a Corporation, Partnership or Trust: ---------------------------------------- Name of Entity ---------------------------------------- Signature Print Name: ----------------------------- Title: ----------------------------------Conditions.

Appears in 1 contract

Samples: www.jse.co.za

Telephone Number. Address: ------------------------------- ------------------------------- ------------------------------- (MUST BE SIGNED BY REGISTERED HOLDER(S) EXACTLY AS NAME(S) APPEAR(S) ON STOCK CERTIFICATE(S) REPRESENTING THE ORIUS COMMON OR BY PERSON(S) AUTHORIZED TO BECOME REGISTERED HOLDER(S) BY CERTIFICATE(S) AND DOCUMENTS TRANSMITTED HEREWITH.) 124 164 SIGNATURE JOINDER TO REORGANIZATION AGREEMENT AND TRANSMITTAL OF ORIUS COMMON The undersigned agrees to be bound by the terms of the Reorganization Agreement and agrees to all of the provisions thereof, as well as the terms and agreements above, and makes the representations and warranties set forth above. SIGN HERE -------------------------------- IF THE UNDERSIGNED IS AN INDIVIDUAL: EXCEPTIONS SCHEDULE -------------------------------- DOUGXXX RICHXXX XXXXXXX Not an Accredited Investor ---------------------------------------- -------------------------------- Print Name -------------------------------- -------------------------------- // DOUGXXX /s/ RICHXXX XXXXXXX ---------------------------------------- -------------------------------- Signature -------------------------------- Address: 401 1954 Xxxxxxxx Xx Xxxxx Xx. ------------------------------ -------------------------------- Beavxx XxxElizxxxxx, XX 00000 ------------------------------ -------------------------------- ------------------------------ -------------------------------- If the Undersigned is a Corporation, Partnership or Trust: ---------------------------------------- Name of Entity ---------------------------------------- Signature Print Name: ----------------------------- Title: ----------------------------------

Appears in 1 contract

Samples: Agreement and Plan of Reorganization (Natg Holdings LLC)

Telephone Number. Address: ------------------------------- ------------------------------- ------------------------------- (MUST BE SIGNED BY REGISTERED HOLDER(S) EXACTLY AS NAME(S) APPEAR(S) ON STOCK CERTIFICATE(S) REPRESENTING THE ORIUS COMMON OR BY PERSON(S) AUTHORIZED TO BECOME REGISTERED HOLDER(S) BY CERTIFICATE(S) AND DOCUMENTS TRANSMITTED HEREWITH.) 124 153 SIGNATURE JOINDER TO REORGANIZATION AGREEMENT AND TRANSMITTAL OF ORIUS COMMON The undersigned agrees to be bound by the terms of the Reorganization Agreement and agrees to all of the provisions thereof, as well as the terms and agreements above, and makes the representations and warranties set forth above. SIGN HERE -------------------------------- IF THE UNDERSIGNED IS AN INDIVIDUAL: EXCEPTIONS SCHEDULE -------------------------------- DOUGXXX XXXXXXX Not an Accredited Investor ---------------------------------------- -------------------------------- Print Name -------------------------------- -------------------------------- // DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Signature -------------------------------- Address: 401 Xx Xxxxx Xx. ------------------------------ -------------------------------- Beavxx Xxx, XX 00000 ------------------------------ -------------------------------- ------------------------------ -------------------------------- If the Undersigned is a Corporation, Partnership or Trust: Zachxxx Xxxlxx Xxxxxx Child Trust ---------------------------------------- Name of Entity John X. Xxxxx ---------------------------------------- Signature Print Name: John X. Xxxxx, Xxustee ----------------------------- Title: Trustee ----------------------------------

Appears in 1 contract

Samples: Agreement and Plan of Reorganization (Natg Holdings LLC)

Telephone Number. Address: ------------------------------- ------------------------------- ------------------------------- Address: ------------------------------------ ------------------------------------ ------------------------------------ ------------------------------------ ------------------------------------ ------------------------------------ (MUST BE SIGNED BY REGISTERED HOLDER(S) EXACTLY AS NAME(S) APPEAR(S) ON STOCK CERTIFICATE(S) REPRESENTING THE ORIUS COMMON LISN SHARES AND LISN JUNIOR NOTES OR BY PERSON(S) AUTHORIZED TO BECOME REGISTERED HOLDER(S) BY CERTIFICATE(S) AND DOCUMENTS TRANSMITTED HEREWITH.) 124 191 SIGNATURE JOINDER TO REORGANIZATION AGREEMENT AND TRANSMITTAL OF ORIUS COMMON LISN SHARES SPECIFIC AGREEMENT TO EXCHANGE NOTES SIGN HERE SIGN HERE The undersigned agrees to be bound by the terms of the Reorganization Agreement and agrees to all of the provisions thereof, as well as the The undersigned hereby agrees to terms and agreements above, and makes other than those exchange the LISN Junior Notes (as exclusively relating to the LISN defined above) pursuant to the Note Junior Notes, including by making Exchange Agreement. the representations and warranties set forth above. SIGN HERE -------------------------------- IF THE UNDERSIGNED IS AN INDIVIDUAL: EXCEPTIONS SCHEDULE -------------------------------- DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Print Name -------------------------------- -------------------------------- // DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Signature -------------------------------- Address: 401 Xx Xxxxx Xx. ------------------------------ -------------------------------- Beavxx Xxx, XX 00000 ------------------------------ -------------------------------- ------------------------------ -------------------------------- If the Undersigned is a Corporation, Partnership or Trust: ---------------------------------------- KENNXXX XXXZA PARTNERS KENNXXX XXXZA PARTNERS ------------------------------------ ------------------------------------ Name of Entity ---------------------------------------- Name of Entity /s/ GREGXXX X. XXXX /s/ GREGXXX X. XXXX ------------------------------------ ------------------------------------ Signature Signature Print Name: ----------------------------- GREGXXX X. XXXX Print Name: GREGXXX X. XXXX ------------------------- ------------------------- Title: ----------------------------------General Partner Title: General Partner ------------------------------ ------------------------------ Taxpayer I.D. No.: Taxpayer I.D. No.: ------------------------------------ ------------------------------------

Appears in 1 contract

Samples: Agreement and Plan of Reorganization (Natg Holdings LLC)

Telephone Number. Address: ------------------------------- ------------------------------- ------------------------------- Address: ------------------------------------ ------------------------------------ ------------------------------------ ------------------------------------ ------------------------------------ ------------------------------------ (MUST BE SIGNED BY REGISTERED HOLDER(S) EXACTLY AS NAME(S) APPEAR(S) ON STOCK CERTIFICATE(S) REPRESENTING THE ORIUS COMMON LISN SHARES AND LISN JUNIOR NOTES OR BY PERSON(S) AUTHORIZED TO BECOME REGISTERED HOLDER(S) BY CERTIFICATE(S) AND DOCUMENTS TRANSMITTED HEREWITH.) 124 194 SIGNATURE JOINDER TO REORGANIZATION AGREEMENT AND TRANSMITTAL OF ORIUS COMMON LISN SHARES SPECIFIC AGREEMENT TO EXCHANGE NOTES SIGN HERE SIGN HERE The undersigned agrees to be bound by the terms of the Reorganization Agreement and agrees to all of the provisions thereof, as well as the The undersigned hereby agrees to terms and agreements above, and makes other than those exchange the LISN Junior Notes (as exclusively relating to the LISN defined above) pursuant to the Note Junior Notes, including by making Exchange Agreement. the representations and warranties set forth above. SIGN HERE -------------------------------- IF THE UNDERSIGNED IS AN INDIVIDUALWILLXX XXXXX & XARTNERS DUTCH, L.P. WILLXX XXXXX & XARTNERS DUTCH, L.P. By: EXCEPTIONS SCHEDULE -------------------------------- DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Print Name -------------------------------- -------------------------------- // DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Signature -------------------------------- AddressWillxx Xxxxx & Xartners II, L.P. By: 401 Xx Willxx Xxxxx Xx. ------------------------------ -------------------------------- Beavxx Xxx& Xartners II, XX 00000 ------------------------------ -------------------------------- ------------------------------ -------------------------------- If the Undersigned is a CorporationL.P. Its: General Partner Its: General Partner By: Willxx Xxxxx & Xartners II, Partnership or TrustL.L.C. By: ---------------------------------------- Name of Entity ---------------------------------------- Signature Print Willxx Xxxxx & Xartners II, L.L.C. /s/ ROBEXX X. XXXXXXXXXX /s/ ROBEXX X. XXXXXXXXXX ------------------------------------ ------------------------------------ Name: ----------------------------- Robexx X. Xxxxxxxxxx Name: Robexx X. Xxxxxxxxxx Xxxle: Managing Director Title: ----------------------------------Managing Director Taxpayer I.D. No.: Taxpayer I.D. No.: ------------------------------------ ------------------------------------

Appears in 1 contract

Samples: Agreement and Plan of Reorganization (Natg Holdings LLC)

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Telephone Number. Dated: Dated: -------------------------------------------- -------------------------------------------- -------------------------------------------- -------------------------------------------- Taxpayer Identification or Social Security Taxpayer Identification or Social Security Number Number (NOTE: Signature(s) must be guaranteed if required by Instructions 2 and 5. This Letter of Transmittal must be signed by the registered holder(s) exactly as the name(s) appear(s) on Certificate(s) for the Senior Discount Notes hereby tendered or on a security position listing, or by any person(s) authorized to become the registered holder(s) by endorsements and documents transmitted herewith, including such opinions of counsel, certifications and other information as may be required by the Company or the Trustee for the Senior Discount Notes to comply with the restrictions on transfer applicable to the Senior Discount Notes. If signature is by an attorney-in-fact, executor, administrator, trustee, guardian, officer of a corporation or another acting in a fiduciary capacity or representative capacity, please set forth the signer's full title. See Instructions 2 and 5. Please complete substitute Form W-9 below.) 6 7 -------------------------------------------------------------------------------- GUARANTEE OF SIGNATURE(S) (IF REQUIRED -- SEE INSTRUCTIONS 2 AND 5) Signature(s) Guaranteed by an Eligible Institution: Date: AUTHORIZED SIGNATURE Name of Eligible Institution Guaranteeing Signature: Address: ------------------------------- ------------------------------- ------------------------------- Capacity (MUST BE SIGNED BY REGISTERED HOLDER(S) EXACTLY AS NAME(S) APPEAR(S) ON STOCK CERTIFICATE(S) REPRESENTING THE ORIUS COMMON OR BY PERSON(S) AUTHORIZED TO BECOME REGISTERED HOLDER(S) BY CERTIFICATE(S) AND DOCUMENTS TRANSMITTED HEREWITH.) 124 SIGNATURE JOINDER TO REORGANIZATION AGREEMENT AND TRANSMITTAL OF ORIUS COMMON The undersigned agrees to be bound by the terms of the Reorganization Agreement and agrees to all of the provisions thereof, as well as the terms and agreements above, and makes the representations and warranties set forth above. SIGN HERE -------------------------------- IF THE UNDERSIGNED IS AN INDIVIDUALfull title): Telephone Number: EXCEPTIONS SCHEDULE -------------------------------- DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Print Name -------------------------------- -------------------------------- // DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Signature -------------------------------- Address: 401 Xx Xxxxx Xx. ------------------------------ -------------------------------- Beavxx Xxx, XX 00000 ------------------------------ -------------------------------- ------------------------------ -------------------------------- If the Undersigned is a Corporation, Partnership or Trust: ---------------------------------------- Name of Entity ---------------------------------------- Signature Print Name: ----------------------------- Title: ----------------------------------------------------------------------------------------------------------------------------------

Appears in 1 contract

Samples: Knology Holdings Inc /Ga

Telephone Number. Address: ------------------------------- ------------------------------- ------------------------------- (MUST BE SIGNED BY REGISTERED HOLDER(S) EXACTLY AS NAME(S) APPEAR(S) ON STOCK CERTIFICATE(S) REPRESENTING THE ORIUS COMMON OR BY PERSON(S) AUTHORIZED TO BECOME REGISTERED HOLDER(S) BY CERTIFICATE(S) AND DOCUMENTS TRANSMITTED HEREWITH.) 124 165 SIGNATURE JOINDER TO REORGANIZATION AGREEMENT AND TRANSMITTAL OF ORIUS COMMON The undersigned agrees to be bound by the terms of the Reorganization Agreement and agrees to all of the provisions thereof, as well as the terms and agreements above, and makes the representations and warranties set forth above. SIGN HERE /s/ SEAN XXXRXXX XXXXXX -------------------------------- IF THE UNDERSIGNED IS AN INDIVIDUAL: EXCEPTIONS SCHEDULE -------------------------------- DOUGXXX XXXXXXX SEAN XXXRXXX XXXXXX ---------------------------------------- -------------------------------- Print Name -------------------------------- -------------------------------- // DOUGXXX XXXXXXX /s/ SEAN XXXRXXX XXXXXX ---------------------------------------- -------------------------------- Signature -------------------------------- Address: 401 Xx Xxxxx Xx1527 XX 0xx Xxx. ------------------------------ -------------------------------- Beavxx XxxBoca Xxxxx, XX 00000 ------------------------------ -------------------------------- ------------------------------ -------------------------------- If the Undersigned is a Corporation, Partnership or Trust: ---------------------------------------- Name of Entity ---------------------------------------- Signature Print Name: ----------------------------- Title: ----------------------------------

Appears in 1 contract

Samples: Agreement and Plan of Reorganization (Natg Holdings LLC)

Telephone Number. Address: ------------------------------- ------------------------------- ------------------------------- (MUST BE SIGNED BY REGISTERED HOLDER(S) EXACTLY AS NAME(S) APPEAR(S) ON STOCK CERTIFICATE(S) REPRESENTING THE ORIUS COMMON OR BY PERSON(S) AUTHORIZED TO BECOME REGISTERED HOLDER(S) BY CERTIFICATE(S) AND DOCUMENTS TRANSMITTED HEREWITH.) 124 149 SIGNATURE JOINDER TO REORGANIZATION AGREEMENT AND TRANSMITTAL OF ORIUS COMMON The undersigned agrees to be bound by the terms of the Reorganization Agreement and agrees to all of the provisions thereof, as well as the terms and agreements above, and makes the representations and warranties set forth above. SIGN HERE -------------------------------- IF THE UNDERSIGNED IS AN INDIVIDUAL: EXCEPTIONS SCHEDULE -------------------------------- DOUGXXX JOSEXX XXXXXXX Not an Accredited Investor ---------------------------------------- -------------------------------- Print Name -------------------------------- -------------------------------- // DOUGXXX /s/ JOSEXX XXXXXXX ---------------------------------------- -------------------------------- Signature -------------------------------- Address: 401 Xx Xxxxx Xx. 22101 Pickxxxx ------------------------------ -------------------------------- Beavxx XxxDetrxxx, XX 00000 ------------------------------ -------------------------------- ------------------------------ -------------------------------- If the Undersigned is a Corporation, Partnership or Trust: ---------------------------------------- Name of Entity ---------------------------------------- Signature Print Name: ----------------------------- Title: ----------------------------------

Appears in 1 contract

Samples: Agreement and Plan of Reorganization (Natg Holdings LLC)

Telephone Number. Address: ------------------------------- ------------------------------- ------------------------------- (MUST BE SIGNED BY REGISTERED HOLDER(S) EXACTLY AS NAME(S) APPEAR(S) ON STOCK CERTIFICATE(S) REPRESENTING THE ORIUS COMMON OR BY PERSON(S) AUTHORIZED TO BECOME REGISTERED HOLDER(S) BY CERTIFICATE(S) AND DOCUMENTS TRANSMITTED HEREWITH.) 124 See Attached Share Identification Rider to Joinder Agreement. 168 SIGNATURE JOINDER TO REORGANIZATION AGREEMENT AND TRANSMITTAL OF ORIUS COMMON The undersigned agrees to be bound by the terms of the Reorganization Agreement and agrees to all of the provisions thereof, as well as the terms and agreements above, and makes the representations and warranties set forth above. SIGN HERE /s/ Barbxxx Xxx Xxxxxx -------------------------------- IF THE UNDERSIGNED IS AN INDIVIDUAL: EXCEPTIONS SCHEDULE -------------------------------- DOUGXXX XXXXXXX Barbxxx Xxx Xxxxxx ---------------------------------------- -------------------------------- Print Name -------------------------------- -------------------------------- // DOUGXXX XXXXXXX Barbxxx Xxx Xxxxxx ---------------------------------------- -------------------------------- Signature -------------------------------- Address: 401 Xx Xxxxx Xx. 17760 Xxxxxxx Xxx Xxx ------------------------------ -------------------------------- Beavxx XxxBoca Xxxxx, XX 00000 ------------------------------ -------------------------------- ------------------------------ -------------------------------- If the Undersigned is a Corporation, Partnership or Trust: ---------------------------------------- Name of Entity ---------------------------------------- Signature Print Name: ----------------------------- Title: ----------------------------------

Appears in 1 contract

Samples: Agreement and Plan of Reorganization (Natg Holdings LLC)

Telephone Number. Address: ------------------------------- ------------------------------- ------------------------------- Address: ------------------------------------ ------------------------------------ ------------------------------------ ------------------------------------ ------------------------------------ ------------------------------------ (MUST BE SIGNED BY REGISTERED HOLDER(S) EXACTLY AS NAME(S) APPEAR(S) ON STOCK CERTIFICATE(S) REPRESENTING THE ORIUS COMMON LISN SHARES AND LISN JUNIOR NOTES OR BY PERSON(S) AUTHORIZED TO BECOME REGISTERED HOLDER(S) BY CERTIFICATE(S) AND DOCUMENTS TRANSMITTED HEREWITH.) 124 192 SIGNATURE JOINDER TO REORGANIZATION AGREEMENT AND TRANSMITTAL OF ORIUS COMMON LISN SHARES SPECIFIC AGREEMENT TO EXCHANGE NOTES SIGN HERE SIGN HERE The undersigned agrees to be bound by the terms of the Reorganization Agreement and agrees to all of the provisions thereof, as well as the The undersigned hereby agrees to terms and agreements above, and makes other than those exchange the LISN Junior Notes (as exclusively relating to the LISN defined above) pursuant to the Note Junior Notes, including by making Exchange Agreement. the representations and warranties set forth above. SIGN HERE -------------------------------- IF THE UNDERSIGNED IS AN INDIVIDUALIf the Undersigned is an Individual: EXCEPTIONS SCHEDULE -------------------------------- DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- If the Undersigned is an Individual: ------------------------------------ ------------------------------------ Print Name -------------------------------- -------------------------------- // DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Print Name ------------------------------------ ------------------------------------ Signature -------------------------------- Address: 401 Xx Xxxxx Xx. ------------------------------ -------------------------------- Beavxx XxxSignature If the Undersigned is a Corporation, XX 00000 ------------------------------ -------------------------------- ------------------------------ -------------------------------- If the Undersigned is a Corporation, Partnership or Trust: ---------------------------------------- Partnership or Trust: INDOSUEZ LISN PARTNERS INDOSUEZ LISN PARTNERS ------------------------------------ ------------------------------------ Name of Entity ---------------------------------------- Name of Entity /s/ MICHXXX XXXXX X. GXXXXXXXX /s/ MICHXXX XXXXX X. GXXXXXXXX ------------------------------------ ------------------------------------ Signature Signature Print Name: ----------------------------- MICHXXX XXXXX X. GXXXXXXXX Print Name: MICHXXX XXXXX X. GXXXXXXXX ------------------------- ------------------------- Title: ----------------------------------Vice Presidents of Indosvez Title: Vice Presidents of Indosuez CM IX, Xxc. CM IX, Xxc., Managing General Partner Managing General Partner ------------------------------ ------------------------------ Taxpayer I.D. No.: Taxpayer I.D. No.: ------------------------------------ ------------------------------------

Appears in 1 contract

Samples: Agreement and Plan of Reorganization (Natg Holdings LLC)

Telephone Number. AddressFacsimile Number: ------------------------------- ------------------------------- ------------------------------- ------------------------------------------------------ Authorization: --------------------------------------------------------- By: -------------------------------------------------------------------- Title: ----------------------------------------------------------------- Dated: Account Number (MUST BE SIGNED BY REGISTERED HOLDER(Sif electronic book entry transfer): -------------------- EXHIBIT A-2 (To be Executed by Holder in order to Convert Note) EXACTLY AS NAME(SDEFAULT CONVERSION NOTICE FOR SENIOR SUBORDINATED CONVERTIBLE NOTE The undersigned, as Holder of the Medtronic Senior Subordinated Convertible Note of HORIZON MEDICAL PRODUCTS, INC. (the "Borrower"), in the outstanding principal amount of $ (the "Note"), hereby elects to convert $ of the outstanding principal amount of the Note into shares of Company Common Stock, par value $___ per share (the "Company Common Stock") APPEAR(S) ON STOCK CERTIFICATE(S) REPRESENTING THE ORIUS COMMON OR BY PERSON(S) AUTHORIZED TO BECOME REGISTERED HOLDER(S) BY CERTIFICATE(S) AND DOCUMENTS TRANSMITTED HEREWITH.) 124 SIGNATURE JOINDER TO REORGANIZATION AGREEMENT AND TRANSMITTAL OF ORIUS COMMON of the Borrower, according to the conditions of the Note, as of the date written below. The undersigned agrees to be bound by the terms of the Reorganization Agreement and agrees to all of the provisions thereof, as well as the terms and agreements above, and makes confirms that the representations and warranties set forth abovecontained in Section 4A of the Note Purchase Agreement entered into in connection with the initial issuance of the Note are true and correct as to the undersigned as of the date hereof. SIGN HERE -------------------------------- IF THE UNDERSIGNED IS AN INDIVIDUALDate of Conversion: EXCEPTIONS SCHEDULE -------------------------------- DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Print Name -------------------------------- -------------------------------- // DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Signature -------------------------------- ---------------------------------------------------- Principal Amount of Notes to be converted: ----------------------------- Tax ID Number (If applicable): ----------------------------------------- Please confirm the following information: Conversion Price: ------------------------------------------------------ Number of shares of Company Common Stock to be issued: ----------------- Please issue the Company Common Stock into which the Notes are being converted and, if applicable, any check drawn on an account of the Borrower in the following name and to the following address: Issue to: ----------------------------------------------------------------------- Address: 401 Xx Xxxxx Xx. ------------------------------ -------------------------------- Beavxx Xxx, XX 00000 ------------------------------ -------------------------------- ------------------------------ -------------------------------- If the Undersigned is a Corporation, Partnership or Trust------------------------------------------------------------------------ Telephone Number: ---------------------------------------- Name of Entity ---------------------------------------- Signature Print Name--------------------------------------------------------------- Facsimile Number: ----------------------------- --------------------------------------------------------------- Authorization: ------------------------------------------------------------------ By: ----------------------------------------------------------------------------- Title: ------------------------------------------------------------------------------------------------------------ Dated: Account Number (if electronic book entry transfer): ----------------------------- Transaction Code Number (if electronic book entry transfer): --------------------

Appears in 1 contract

Samples: Note Purchase Agreement (Horizon Medical Products Inc)

Telephone Number. Address: ------------------------------- ------------------------------- ------------------------------- Address: ------------------------------------ ------------------------------------ ------------------------------------ ------------------------------------ ------------------------------------ ------------------------------------ (MUST BE SIGNED BY REGISTERED HOLDER(S) EXACTLY AS NAME(S) APPEAR(S) ON STOCK CERTIFICATE(S) REPRESENTING THE ORIUS COMMON LISN SHARES AND LISN JUNIOR NOTES OR BY PERSON(S) AUTHORIZED TO BECOME REGISTERED HOLDER(S) BY CERTIFICATE(S) AND DOCUMENTS TRANSMITTED HEREWITH.) 124 190 SIGNATURE JOINDER TO REORGANIZATION AGREEMENT AND TRANSMITTAL OF ORIUS COMMON LISN SHARES SPECIFIC AGREEMENT TO EXCHANGE NOTES SIGN HERE SIGN HERE The undersigned agrees to be bound by the terms of the Reorganization Agreement and agrees to all of the provisions thereof, as well as the The undersigned hereby agrees to terms and agreements above, and makes other than those exchange the LISN Junior Notes (as exclusively relating to the LISN defined above) pursuant to the Note Junior Notes, including by making Exchange Agreement. the representations and warranties set forth above. SIGN HERE -------------------------------- IF THE UNDERSIGNED IS AN INDIVIDUAL: EXCEPTIONS SCHEDULE -------------------------------- DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Print Name -------------------------------- -------------------------------- // DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Signature -------------------------------- Address: 401 Xx Xxxxx XxFLEET VENTURE RESOURCES, INC. ------------------------------ -------------------------------- Beavxx XxxFLEET VENTURE RESOURCES, XX 00000 ------------------------------ -------------------------------- ------------------------------ -------------------------------- If the Undersigned is a Corporation, Partnership or Trust: ---------------------------------------- INC. ------------------------------------ ------------------------------------ Name of Entity ---------------------------------------- Name of Entity /s/ /s/ ------------------------------------ ------------------------------------ Signature Signature Print Name: ----------------------------- GREGXXX X. XXXX Print Name: GREGXXX X. XXXX ------------------------- ------------------------- Title: ----------------------------------Vice President Title: Vice President ------------------------------ ------------------------------ Taxpayer I.D. No.: Taxpayer I.D. No.: ------------------------------------ ------------------------------------

Appears in 1 contract

Samples: Agreement and Plan of Reorganization (Natg Holdings LLC)

Telephone Number. Address: ------------------------------- ------------------------------- ------------------------------- (MUST BE SIGNED BY REGISTERED HOLDER(S) EXACTLY AS NAME(S) APPEAR(S) ON STOCK CERTIFICATE(S) REPRESENTING THE ORIUS COMMON OR BY PERSON(S) AUTHORIZED TO BECOME REGISTERED HOLDER(S) BY CERTIFICATE(S) AND DOCUMENTS TRANSMITTED HEREWITH.) 124 169 SIGNATURE JOINDER TO REORGANIZATION AGREEMENT AND TRANSMITTAL OF ORIUS COMMON C-155 The undersigned agrees to be bound by the terms of the Reorganization Agreement and agrees to all of the provisions thereof, as well as the terms and agreements above, and makes the representations and warranties set forth above. SIGN HERE -------------------------------- IF THE UNDERSIGNED IS AN INDIVIDUAL: EXCEPTIONS SCHEDULE -------------------------------- DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Print Name -------------------------------- -------------------------------- // DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Signature -------------------------------- Address: 401 Xx Xxxxx Xx. ------------------------------ -------------------------------- Beavxx Xxx, XX 00000 ------------------------------ -------------------------------- ------------------------------ -------------------------------- If the Undersigned is a Corporation, Partnership or Trust: The Rosexxxxx Xxxxxxxxxx Xxxevocable Trust Agreement ---------------------------------------- Name of Entity /s/ NORMX XXXXXXXX ---------------------------------------- Signature Print Name: NORMX XXXXXXXX ----------------------------- Title: Trustee ----------------------------------

Appears in 1 contract

Samples: Agreement and Plan of Reorganization (Natg Holdings LLC)

Telephone Number. Federal Tax ID No.: ---------------------------------------- Tenant acknowledges and agrees that all tenant improvements Landlord is obligated to make to the Premises, if any, have been completed to Tenant's satisfaction, that Tenant has accepted possession of the Premises, and that as of the date hereof there exist no offsets or defenses to the obligations of Tenant under the Lease. TENANT Jabil Circuit, Inc., a Delaware corporation By: ---------------------------------------- ---------------------------------------- (PRINT NAME) Its: --------------------------------------- (PRINT TITLE) By: --------------------------------------- --------------------------------------- (PRINT NAME) Its: -------------------------------------- (PRINT TITLE) EXHIBIT C Form of HazMat Certificate General Information Name of Responding Company: ---------------------------------------------------- Mailing Address: --------------------------------------------------------------- Signature: --------------------------------------------------------------------- Title: Phone: --------------------------------- -------------------------------- Date: Age of Facility: Length of Occupancy: ---------- ---------- -------------- Major products manufactured and/or activities conducted on the property: ------------------------------------------------------------------------------- ------------------------------------------------------------------------------- Type of Business Activity(ies): Hazardous Materials Activities: ------------------------------- ------------------------------- ------------------------------- (MUST BE SIGNED BY REGISTERED HOLDER(Scheck all that apply) EXACTLY AS NAME(S(check all that apply) APPEAR(S) ON STOCK CERTIFICATE(S) REPRESENTING THE ORIUS COMMON OR BY PERSON(S) AUTHORIZED TO BECOME REGISTERED HOLDER(S) BY CERTIFICATE(S) machine shop degreasing --------- --------- light assembly chemical/etching/milling --------- --------- research and development wastewater treatment --------- --------- product service or repair painting --------- --------- photo processing striping --------- --------- automotive service and repair cleaning --------- --------- manufacturing printing --------- --------- warehouse analytical lab --------- --------- integrated/printed circuit plating --------- --------- chemical/pharmaceutical product chemical/missing/synthesis --------- --------- silkscreen --------- lathe/mill machining --------- deionizer water product --------- photo masking --------- wave solder --------- metal finishing --------- HAZARDOUS MATERIALS/WASTE HANDLING AND DOCUMENTS TRANSMITTED HEREWITH.) 124 SIGNATURE JOINDER TO REORGANIZATION AGREEMENT AND TRANSMITTAL OF ORIUS COMMON The undersigned agrees to be bound by the terms of the Reorganization Agreement and agrees to all of the provisions thereof, as well as the terms and agreements above, and makes the representations and warranties set forth above. SIGN HERE -------------------------------- IF THE UNDERSIGNED IS AN INDIVIDUAL: EXCEPTIONS SCHEDULE -------------------------------- DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Print Name -------------------------------- -------------------------------- // DOUGXXX XXXXXXX ---------------------------------------- -------------------------------- Signature -------------------------------- Address: 401 Xx Xxxxx Xx. ------------------------------ -------------------------------- Beavxx Xxx, XX 00000 ------------------------------ -------------------------------- ------------------------------ -------------------------------- If the Undersigned is a Corporation, Partnership or Trust: ---------------------------------------- Name of Entity ---------------------------------------- Signature Print Name: ----------------------------- Title: ----------------------------------STORAGE

Appears in 1 contract

Samples: Wastewater Treatment (Jabil Circuit Inc)

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