Type of Service Answer all questions:
Type of Business Circle the number that best describes your business or organization. If none of the categories apply, circle number 20 and provide a brief description.
Certification of Residency, etc Customer certifies that it is a resident of the United States and shall notify Bank of any changes in residency. Bank may rely upon this certification or the certification of such other facts as may be required to administer Bank's obligations hereunder. Customer shall indemnify Bank against all losses, liability, claims or demands arising directly or indirectly from any such certifications.
Residency The Buyer is a resident of the jurisdiction set forth immediately below the Buyer’s name on the signature pages hereto.
Type of Option This Option is a Non-Qualified Stock Option.