Common use of PLEASE COMPLETE THE FOLLOWING Clause in Contracts

PLEASE COMPLETE THE FOLLOWING. 1. If the exercise of this Warrant was solicited by National Securities Corporation please check the following box [ ] 2. The exercise of this Warrant was solicited by [ ] -------------------------- 3. If the exercise of this Warrant was not solicited, please check the following box [ ] Dated: ______________________ X____________________________ ____________________________ ____________________________ Address ____________________________ Social Security or Taxpayer Identification Number ____________________________ Signature Guaranteed

PLEASE COMPLETE THE FOLLOWING. 1. If the The exercise of this Warrant was solicited by National Securities Corporation please check the following box [ ] 2. The exercise of this Warrant was solicited by [ ] -------------------------- 3. If the exercise of this Warrant was not solicited, please check the following box [ ] Dated: ______________________ X____________________________ ____________________________ ____________________________ . [ ] 3. The exercise of this Warrant was not solicited. [ ] Dated: ---------------- ---------------------------------- ---------------------------------- ---------------------------------- Address ____________________________ --------------------------------- Social Security or Taxpayer Identification Number ____________________________ --------------------------------- Signature GuaranteedGuaranteed ---------------------------------