Common use of To Be Executed Clause in Contracts

To Be Executed. By The Warrantholder If He Desires To Exercise The Warrant In Whole Or In Part: To: The undersigned, ____________________________, (Name of Warrantholder) (____________________________________________) (Please insert Social Security or other identifying number of subscriber) hereby irrevocably elects or exercises the right of purchase represented by the within Warrant for, and to purchase thereunder, __________ shares of Common Stock provided for therein and tenders payment herewith to the order of Alliance Pharmaceutical Corp. in the amount $__________. The undersigned requests that certificates for such shares of Common Stock be issued as follows: Name: Address: Deliver to: Address: and, if said number of shares of Common Stock shall not be all the shares of Common Stock purchasable hereunder, that a new Warrant for the balance remaining of the shares of Common Stock purchasable under the within Warrant be registered in the name of, and delivered to, the undersigned at the address states below: Address: Date: