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S-1/A Filing
Minim (MINM) S-1/AIPO registration (amended)
Filed: 19 Nov 10, 12:00am
BOX 1. ¨ | Please do not exercise Subscription Rights for shares of Common Stock. |
BOX 2. ¨ | Please exercise Subscription Rights for me (us) and purchase shares of the Common Stock as set forth below. |
NUMBER OF SHARES YOU’D LIKE TO BUY | PAYMENT | |||
Shares purchased with Basic Subscription Rights* | ____________ | x $.25/share = | $___________ | (line 1) |
Shares requested for Oversubscription Rights Purchase** | ____________ | x $.25/share | $___________ | (line 2) |
TOTAL PAYMENT REQUIRED = (sum of line 1 and line 2) | $___________ |
BOX 3a. ¨ | I (we) certify that the purchase of shares of Common Stock pursuant to the Subscription Rights (basic or oversubscription) will not result in my (our) owning either directly or indirectly, of record or beneficially, more than 99,000 shares of Common Stock. |
BOX 3b. ¨ | The purchase of shares pursuant to the Subscription Rights (whether basic or oversubscription) would Result in my (our) owning, either directly or indirectly, of record or beneficially, more than 99,000 shares of Common Stock. |
BOX 4a. ¨ | Payment in the following amount is enclosed: $___________________ (This amount must equal the amount shown in “Total payment required” of Box 2 above) |
BOX 4b. ¨ | Please deduct payment from the following account as follows: |
Type of Account: | Account No.: | ||||
(Bank or Brokerage Account) | |||||
Routing No.: | |||||
Amount to be deducted: $ |
Signature | Date | ||
Please type or print name(s) |
a) | Check Box 2 and fill out the table shown in Box 2. |
b) | Check Box 3a or 3b. |
c) | Check Box 4a or 4b. |
d) | If you check box 4b, please provide the requested information. |
e) | Sign and date this form and mail it to your broker, custodian bank or other nominee that holds your shares. |