EXHIBIT 4.1
COMMON STOCK | FORM E
| COMMON STOCK |
FORM OF CERTIFICATE FACE
Your document will be typeset with the following information. Mark any changes required and submit this form along with forms A thru D.
[Your Company Logo. Please refer to the instructions on form G for submitting artwork.]
COMPANY NAME
INCORPORATED UNDER THE LAWS OF THE STATE OF
CUSIP NUMBER SEE REVERSE FOR CERTAIN DEFINITIONS |
THIS CERTIFIES THAT
is the record holder of
FULLY PAID AND NON-ASSESSABLE SHARES OF COMMON STOCK, $ PAR VALUE PER SHARE, OF
COMPANY NAME
Transferable on the books of the Corporation in person or by duly authorized attorney upon surrender of this Certificate property endorsed. This Certificate is not valid until countersigned by the Transfer Agent and registered by the Registrar.
COUNTERSIGNED AND REGISTERED [TRANSFER AGENT] TRANSFER AGENT AND REGISTRAR | ||
BY | ||
AUTHORIZED |
WITNESS the facsimile seal of the Corporation and the facsimile signatures of its duly authorized officers.
DATED:
[FACSIMILE SEAL
TO APPEAR HERE]
[FACSIMILE SIGNATURE TO APPEAR HERE] [TITLE] | [FACSIMILE SIGNATURE TO APPEAR HERE] [TITLE] |
CONTINENTAL BANKNOTE
COMPANY, LLC
FORM F
FORM OF THE CERTIFICATE BACK
Your document will be typeset with the following information. Please mark any changes and/or inserts you require to the following text:
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*For Value received, set assign and transfer unto hereby | ||||||||||
PLEASE INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE | ||||||||||
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Shares | ||||||||||
of the represented by the within Certificate, and notes, hereby irrevocably constitute and appoint Stock | ||||||||||
Attorney | ||||||||||
to transfer the said stock on the ??? of the within named Corporation with full power of substitution ?? the premises | ||||||||||
Dated | ||||||||||
X | ||||||||||
X | ||||||||||
NOTICE | ?????????? | |||||||||
Signature(s) Guaranteed | ||||||||||
By | ||||||||||
THE SIGNATURES MUST BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (BANKS, STOCK BROKERS, SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN AN APPROVED SIGNATURE GUARANTEE ,MEDALLION PROGRAM) PURSUANT TO S.E.C. RULE 17?? 15 |