PLEASE INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE

EX-4.1 4 dex41.htm FORM OF STOCK CERTIFICATE FOR COMMON STOCK Form of Stock Certificate for Common Stock

Exhibit 4.1

 

Exhibit 4.1

Number Shares

FT

FLEETCOR TECHNOLOGIES, INC.

INCORPORATED UNDER THE LAWS

OF THE STATE OF DELAWARE

SEE REVERSE FOR CERTAIN DEFINITIONS CUSIP 339041 10 5

This Certifies that is the record holder of

FULLY PAID AND NONASSESSABLE SHARES OF COMMON STOCK, $0.001 PAR VALUE, OF FLEETCOR TECHNOLOGIES, INC.

transferable on the books of the Corporation by the holder hereof in person or by duly authorized attorney upon surrender of this certificate properly endorsed. This certificate is not valid until countersigned by the Transfer Agent and registered by the Registrar. WITNESS the facsimile signatures of the Corporation’s duly authorized officers.

Dated:

SECRETARY

CHAIRMAN

COUNTERSIGNED AND REGISTERED:

AMERICAN STOCK TRANSFER & TRUST COMPANY, LLC

(New York, NY)

TRANSFER AGENT AND REGISTRAR

BY:

AUTHORIZED SIGNATURE

©SECURITY-COLUMBIAN BANKNOTE COMPANY

The Corporation shall furnish without charge to each stockholder who so requests a statement of the powers, designations, preferences and relative, participating, optional or other special rights of each class of stock of the Corporation or series thereof and the qualifications, limitations or restrictions of such preferences and/or rights .. Such requests shall be made to the Corporations Secretary at the principal office of the Corporation.

The following abbreviations, when used in the inscription on the face of this certificate, shall be construed as though they were written out in full according to applicable laws or regulations:

 

TEN COM    —   as tenants in common       UNIF GIFT MIN ACT    —         Custodian     
TEN ENT    —   as tenants by the entireties             (Cust)       (Minor)
JT TEN    —   as joint tenants with right of survivorship and not as tenants in common             under Uniform Gifts to Minors
                 Act     
                 (State)
           UNIF TRF MIN ACT    —         Custodian (until age        )
                 (Cust)        
                      under Uniform Transfers
                 (Minor)        
                 to Minors Act     
                    (State)
Additional abbreviations may also be used though not in the above list.        

FOR VALUE RECEIVED,                                                       hereby sell, assign and transfer unto

 

PLEASE INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE

 

      

    

    

      

    

 

(PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE, OF ASSIGNEE)

    

 

    

 

    

 

    Shares
of the common stock represented by the within Certificate, and do hereby irrevocably constitute and appoint

    

 

    Attorney
to transfer the said stock on the books of the within named Corporation with full power of substitution in the premises.

 

Dated                                                                                

   

 

     

 

    NOTICE:  

THE SIGNATURE(S ) TO THIS ASSIGNMENT MUST CORRESPOND WITH THE NAME(S) AS WRITTEN UPON THE FACE OF THE CERTIFICATE IN EVERY PARTICULAR, WITHOUT ALTERATION OR ENLARGEMENT OR ANY CHANGE WHATEVER.

Signature(s) Guaranteed      
By  

 

  
THE SIGNATURE(S) SHOULD BE GUARANTEED BY AN ELIGIBLE GUARANTOR IN SITUATION (BANKS, STOCKBROKERS, SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN AN APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM), PURSUANT TO S.E.C. RULE 17Ad-15.