PURCHASE FORM Sample Clauses

PURCHASE FORM. The undersigned hereby irrevocably elects to exercise the within Warrant as to________ Shares and hereby makes payment of $________ in payment of the actual exercise price thereof.

PURCHASE FORM. To: Mayor’s Jewelers, Inc. The undersigned irrevocably exercises the Warrant for the purchase of shares (subject to adjustment) of Common Stock of Mayor’s Jewelers, Inc., for the Warrant and herewith makes payment of $ (the “Exercise Price”) through the following method: • such payment of the Exercise Price being in cash or by certified or official bank check payable to the order of Mayor’s Jewelers, Inc. or • such payment of the Exercise Price made by surrendering of such additional part of the Warrant having an aggregate Spread (as such term is defined in the Warrant Agreement) equal to the aggregate Exercise Price, all at the Exercise Price and on the terms and conditions specified in the within the Warrant Agreement therein referred to, surrenders the Warrant and all right, title and interest therein to Mayor’s Jewelers, Inc. and directs (subject to Section 9 of the Warrant Agreement) that the shares of Common Stock deliverable upon the exercise of such Warrant be registered or placed in the name and at the address specified below and delivered thereto. The undersigned hereby certifies to Mayor’s Jewelers, Inc. that it is, at the time of exercise of the Warrant, an “accredited investor” as defined in Rule 501(a) of the Securities Act of 1933, as amended. Date: , (Signature of Owner)1 (Street Address) (City) (State) (Zip Code) Securities and/or check to be issued to: Please insert social security or identifying number: Name: Street Address: City, State and Zip Code:

PURCHASE FORM. The undersigned hereby irrevocably elects to exercise the Warrant represented by this Warrant Certificate to the extent of _____ shares of Common Stock, par value $.001 per share, of Alfacell Corporation, and hereby makes payment of $_______ in payment of the actual exercise price thereof.

PURCHASE FORM. To Be Executed By The Warrant Holder

PURCHASE FORM. Dated ____________________

PURCHASE FORM. To: __________________ __________________ __________________ The undersigned pursuant to the provisions set forth in the attached Warrant, hereby irrevocably elects to purchase ___________ shares of the Common Stock (the "Common Stock") covered by such Warrant and herewith makes payment of $_______, representing the full purchase price for such shares at the price per share provided for in such Warrant. The undersigned understands and acknowledges the terms and restrictions on the right to transfer or dispose of the Common Stock set forth in Section 6 of the attached Warrant, which the undersigned has carefully reviewed. The undersigned consents to the placing of a legend on its certificate for the Common Stock referring to such restrictions and the placing of stop transfer orders until the Common Stock may be transferred in accordance with the terms of such restrictions. By:_________________________________ Name:_______________________________ Title:______________________________ Date:_______________________________ ANNEX C METHOD FOR DETERMINING PRIVATE VALUATION OF ISSUER

PURCHASE FORM. The undersigned pursuant to the provisions set forth in the attached Warrant (No. ______) hereby irrevocably elects to purchase ____ shares of Warrant Shares covered by such Warrant and herewith makes payment of __________ representing the full purchase price for such shares of Warrant Shares at the price per share of Warrant Share provided for in such Warrant.

PURCHASE FORM. (To be executed upon exercise of Warrant) The undersigned hereby irrevocably elects to exercise _________ Warrants evidenced by this Warrant Certificate, and herewith tenders in payment for such exercise payment of the Exercise Price in full, in the form of a certified check payable to the order of Houston Biotechnology Incorporated in the amount of $_______, all in accordance with the terms hereof. The undersigned requests that the Warrant Shares or other securities receivable upon exercise be in fully registered form and registered in such name and delivered, together with any other property receivable upon exercise, as specified below. If said number of Warrants exercised is less than all of the Warrants evidenced hereby, the undersigned requests that a new Warrant Certificate representing the remaining Warrants evidenced hereby be issued and delivered as set forth below. Issue to: ______________________________________________ (Name) ______________________________________________ (Address, including zip code) ______________________________________________ (Social security or other identifying number) Deliver to: ______________________________________________ (Name) ______________________________________________ (Address, including zip code) Dated: ___________________ ____________________________________ (Insert social security or other identifying number of Holder) Signature: ____________________ NOTE: Signature must conform in all respects to name of Holder as specified on the face of this Warrant Certificate in every particular, without alteration or enlargement or any change whatsoever, unless this Warrant Certificate has been assigned.

PURCHASE FORM. Dated: The undersigned hereby irrevocably elects to exercise the within Warrant to the extent of purchasing _________ shares of Warrant Stock, and hereby makes payment of $________ in payment of the actual exercise price thereof.