Account Registration Information. Delivery Instructions as set forth below: (Name) (Name) (Account Reference, if applicable) (Account Reference, if applicable) (Address) (Address, including Zip Code) (Contact Name) (Telephone Number) Number and kind of securities of the Corporation held, if any: State whether Subscriber is an insider* of the Corporation: Yes o No o
Account Registration Information. As above ☒ or: Delivery Instructions: As above ☒ or: (Name) (Name) (Account Reference, if applicable) (Account Reference, if applicable) (Address, including Postal Code) (Address, including Postal Code) (Contact Name) (Contact Telephone Number)
Account Registration Information. Delivery Instructions as set forth below: NBCN Inc. ITF FCMI Financial Corporation FCMI FINANCIAL CORPORATION (Name) (Name) 2L-EE01-E (Account Reference, if applicable) (Account Reference, if applicable) 1410-1010, de la Gauchetiere Xx. Xxxx Xxxxx 000, XXX Xxxxx, 000 Xxx Xxxxxx Xxxxxxxx, Xxxxxx X0X 0X0 Xxxxxxx, Xxxxxxx X0X 0X0 (Address, including Postal or Zip Code) (Address) (Contact Name) (Telephone Number) TERMS AND CONDITIONS OF SUBSCRIPTION FOR UNITS
Examples of Account Registration Information in a sentence
Settlement Date: ___, 2009 Total Settlement Amount: $ Account Registration Information: Delivery Instructions as set forth below: (Name) (Name) (Account Reference, if applicable) (Account Reference, if applicable) (Address) (Address, including Postal Code) (Contact Name) (Telephone Number) Lifevantage Corporation By: Name: Xxxxx X.
More Definitions of Account Registration Information
Account Registration Information. Delivery Instructions as set forth below: Alnylam Pharmaceuticals, Inc. x Same as registered address, or (Name) (Name) (Account Reference, if applicable) 000 Xxxxx Xxxxxx, Xxxxxxxxx, XX 00000 (Account Reference, if applicable) (Address, including Postal/Zip Code) Number and kind of Shares of the Corporation held, if any: (Address) (Contact Name) (Telephone Number) TERMS AND CONDITIONS OF SUBSCRIPTION FOR
Account Registration Information. Delivery Instructions as set forth below: _____________________________________________ [ ] Same as Subscriber’s address, or (Name) _____________________________________________ _____________________________________________ (Account Reference, if applicable) (Name) _____________________________________________ _____________________________________________ (Address, including Postal Code) (Account Reference, if applicable) _____________________________________________ (Address) _____________________________________________ (Contact Name) (Telephone Number) OTHER INFORMATION TO BE COMPLETED BY EACH SUBSCRIBER
Account Registration Information. Delivery Instructions as set forth below: (Name) (Name) (Account Reference, if applicable) (Account Reference, if applicable) (Address, including Postal Code) (Address) (Contact Name) (Telephone Number) TERMS AND CONDITIONS OF SUBSCRIPTION FOR UNITS
Account Registration Information. DELIVERY INSTRUCTIONS AS SET FORTH BELOW: --------------------------------- ----------------------------------------- XXXXXXX, SACHS & CO. XXXXXXX, XXXXX & CO. --------------------------------- ----------------------------------------- (Name) (Name) PACIFIC ENERGY RESOURCES LTD. ATTN: XXXXXX XXXXX --------------------------------- ----------------------------------------- (Account Reference, if applicable) (Account Reference, if applicable) 00 XXXXX XX., XXXXX 00 ----------------------------------------- (Address) XXX XXXX, XXX XXXX 00000 (212)357-5126 -------------------------------- ----------------------------------------- (Address, including Zip Code) (Contact Name) (Telephone Number) Number and kind of securities of State whether Subscriber is an insider* of the Corporation held, if any: the Corporation: -------------------------------- Yes [ ] No [x]
Account Registration Information. Delivery Instructions as set forth below: (Name) (Name) (Account Reference, if applicable) (Account Reference, if applicable) (Address) (Address, including Postal Code) (Contact Name) (Telephone Number) Lifevantage Corporation By: Name: Xxxxx X. Xxxxx Title: Chief Executive Officer Date: , 2009 Exhibit C Form of Warrant THIS WARRANT AND THE UNDERLYING SECURITIES HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”). THEY MAY NOT BE SOLD, OFFERED FOR SALE, PLEDGED OR HYPOTHECATED IN THE ABSENCE OF AN EFFECTIVE REGISTRATION STATEMENT AS TO SUCH SECURITIES UNDER THE ACT OR AN OPINION OF COUNSEL SATISFACTORY TO THE COMPANY THAT SUCH REGISTRATION IS NOT REQUIRED. LIFEVANTAGE CORPORATION FORM OF WARRANT TO PURCHASE COMMON STOCK No. CW-[ ] , 2009 Void After , 2012 This Certifies That, for value received, , with its principal office at , or assigns (the “Holder” or “Purchaser”), is entitled to subscribe for and purchase at the Exercise Price (defined below) from Lifevantage Corporation, a Colorado corporation, with its principal office at 00000 X. Xxxxxxxx Court, Suite 301, San Diego, California 92127 (the “Company”), [ ] shares of Common Stock of the Company (the “Common Stock”), as provided herein. This Warrant is one of a series of similar warrants dated on or about ___, 2009 (collectively, the “Warrants”) referred to in, and is executed and delivered in connection with, those certain Subscription Agreements, dated on or about _________ ___, 2009 and executed by the Company and the Holder, among others (as the same may from time to time be amended, modified or supplemented or restated, the “Subscription Agreements”). Additional rights and obligations of the Holder and the Company are set forth in the Subscription Agreement.
Account Registration Information. Delivery Instructions as set forth below: [ ] Same as registered address, or Name Name Account Registration/Reference Address Address Contact Name Telephone Number
Account Registration Information. Xxxxx Xxxx Investment Management Limited (Name) (Account Reference, if applicable) 0/X Xxxxxxx Xxxxxxx 11, Hei Wo Street, North Point, Hong Kong (Address, including Postal Code) Delivery Instructions as set forth below: Xxxxx Xxxx Investment Management Limited (Name) (Account Reference, if applicable) 0/X Xxxxxxx Xxxxxxx 00, Xxx Xx Xxxxxx, Xxxxx Xxxxx, Xxxx Xxxx (Address) Shi-Ming Du 000 000 00000 (Contact Name) (Telephone Number) Chilco River Holdings, Inc. Convertible Debenture -- Subscription Agreement SUBSCRIPTION AGREEMENT FOR CONVERTIBLE DEBENTURES OF CHILCO RIVER HOLDINGS, INC. (a Nevada corporation)