DELIVERY OPTIONS FOR SUBSCRIPTION RIGHTS CERTIFICATE Delivery other than in the manner or to the address listed below will not constitute valid delivery. If delivering by mail, hand or overnight courier:American Stock Transfer & Trust Company, LLCOperations CenterAttn: Reorganization Department6201 15th AvenueBrooklyn, New York 11219PLEASE PRINT ALL INFORMATION CLEARLY AND LEGIBLY.

EX-4.13 2 exhibit413_111313.htm FORM OF SUBSCRIPTION RIGHTS CERTIFICATE exhibit413_111313.htm
EXHIBIT 4.13
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

DELIVERY OPTIONS FOR SUBSCRIPTION RIGHTS CERTIFICATE
Delivery other than in the manner or to the address listed below will not constitute valid delivery.
If delivering by mail, hand or overnight courier:
American Stock Transfer & Trust Company, LLC
Operations Center
Attn: Reorganization Department
6201 15th Avenue
Brooklyn, New York 11219
PLEASE PRINT ALL INFORMATION CLEARLY AND LEGIBLY.
FORM 1-EXERCISE OF SUBSCRIPTION RIGHTS
   PLEASE PRINT ALL INFORMATION CLEARLY AND LEGIBLY      
FORM 3-DELIVERY TO DIFFERENT ADDRESS
  
           
 
SECTION 1: OFFERING INSTRUCTIONS (check the appropriate boxes)
 
IF YOU WISH TO SUBSCRIBE FOR YOUR FULL ENTITLEMENT OF
SUBSCRIPTION RIGHTS:
 
o I apply for ALL of my entitlement of new shares pursuant to the basic
subscription
     If you wish for the Common Stock underlying your subscription rights to be delivered to an address different from that shown on the face of this Subscription Rights Certificate, please enter the alternate address below, sign under Form 4 and have your signature guaranteed under Form 5.  
 
___________________________ x [_______ ] =__________________x $ [_______]=
no. of subscription rights)           (no. of new shares)           (per share)
     
______________________________________________________________
______________________________________________________________
_____________________________________________________________
  
           
 
         $____________________________
 
 
Example: If you own 1,000 shares of common stock, your basic
subscription right permits the purchase of [_______] shares.
(1,000 purchase rights/[____] = [___], with fractional shares rounded down
to the nearest whole number).
 
o In addition, I apply for additional shares pursuant to the
oversubscription privilege*
 
________________ x $[____] = $_______________
(no. of new shares)      (per share)
 
IF YOU DO NOT WISH TO APPLY FOR YOUR FULL ENTITLEMENT OF
SUBSCRIPTION RIGHTS:
 
o  I apply for  ________________ x $[____] = $_______________
(no. of new shares)         (per share)
 
Amount of check enclosed or
wire transmitted (for brokers, dealers and other nominees only):
 
 
$_______________________
 
IF YOU DO NOT WISH TO EXERCISE YOUR RIGHT TO SUBSCRIBE:
 
Please disregard this mailing.
    
FORM 4-SIGNATURE
 
 
TO SUBSCRIBE: I acknowledge that I have received the Prospectus for this Rights
Offering and I hereby irrevocably subscribe for the number of shares indicated
above on the terms and conditions specified in the Prospectus.
 
Signature(s): ____________________________________________________
 
IMPORTANT: The signature(s) must correspond with the name(s) as printed
on the reverse of this Subscription Rights Certificate in every particular, without
alteration or enlargement, or any other change whatsoever.
 
FORM 5-SIGNATURE GUARANTEE
 
 
This form must be completed if you have completed any portion of Form 3.
 
 
Signature Guaranteed: _____________________________________________
                      (Name of Bank or Firm)
By:_____________________________________________________________
       (Signature of Officer)
 
IMPORTANT: The signature(s) should be guaranteed by an eligible guarantor
institution (bank, stock broker, savings & loan association or credit union) with
membership in an approved signature guarantee medallion program pursuant
to Securities and Exchange Commission Rule 17Ad-15.
  
           
 
    * You can only participate in the oversubscription privilege if you have subscribed
     for your full entitlement of new shares pursuant to the basic subscription.
 
     METHOD OF PAYMENT (CHECK ONE)
 
 
¨
Check or bank draft payable to “American Stock Transfer & Trust
Company, LLC as Subscription Agent.”
 
¨
For brokers, dealers, and other nominees only: Wire transfer of
immediately available funds directly to the account maintained by
American Stock Transfer & Trust Company, LLC, as Subscription
Agent, for purposes of accepting subscriptions in this Rights Offering
at _______________________________, with reference to the rights
holder's name.
 
      FORM 2-ADDRESS OF PRINCIPAL PLACE OF RESIDENCE
     _______________________________________________________________
     _______________________________________________________________
     _______________________________________________________________