1 EXHIBIT 10.26 REGISTRATION RIGHTS AGREEMENT THIS REGISTRATION RIGHTS AGREEMENT (the "Agreement"), dated as of July 19, 1999, is entered into by and between Towne Services, Inc., a Georgia corporation (the "Company"), and the shareholders of the Company named on the signature pages hereto (collectively, the "Shareholders" and each, a "Shareholder"). RECITALS: WHEREAS, the Company and Imaging Institute, Inc., a Minnesota corporation ("Imaging") have entered into an Agreement and Plan of Merger dated as of July 16, 1999 (the "Merger Agreement"), pursuant to which, among other things, the Company has agreed to issue to the Shareholders shares of the Company's common stock, without par value (the "Common Stock"), pursuant to the merger of Imaging with and into Merger Sub, a Georgia corporation and wholly-owned subsidiary of the Company; WHEREAS, the Shareholders will acquire as a result of the merger a total of 81,016 Shares of Common Stock; and WHEREAS, the Company and the Shareholders desire to provide for the rights of the Shareholders with respect to the registration of the shares of Common Stock to be received by the Shareholders pursuant to the Merger Agreement (the "Shares"); NOW, THEREFORE, in consideration of the mutual covenants and agreements set forth herein, and for other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties hereto, intending to be legally bound hereby, agree as follows: 1. Definitions. For purposes of this Agreement: (a) "Act" shall mean the United States Securities Act of 1933, as amended, or any similar U.S. federal statute enacted hereafter, and the rules and regulations of the Commission thereunder, all as the same shall be in effect from time to time; (b) "Commission" shall mean the United States Securities and Exchange Commission or any other U.S. federal agency at the time administering the Act; (c) The terms "register," "registered" and "registration" refer to a registration effected by preparing and filing a registration statement in compliance with the Act and the declaration or ordering of effectiveness of such registration statement by the Commission; (d) "Registrable Securities" shall mean shares of Common Stock issued or issuable to the Shareholders pursuant to the Merger Agreement and any Common Stock issued as a dividend or other distribution with respect to, or in exchange or replacement of, the foregoing but shall not include any other shares of Common Stock acquired by Shareholders other than the foregoing; 2 (e) "Holder" shall mean a Shareholder if the Shareholder continues to hold at least 50% of his or her Registrable Securities as of the date of this Agreement; provided, however, that any person who acquires any of the Registrable Securities in a distribution or transfer pursuant to a registration statement filed by the Company under the Act or pursuant to a sale under Rule 144, Regulation S or any other exemption from registration under the Act, shall not be considered a Holder; (f) "1934 Act" shall mean the United States Securities Exchange Act of 1934, as amended, or any similar U.S. federal statute enacted hereafter, and the rules and regulations of the Commission thereunder, all as the same shall be in effect from time to time; and (g) All other capitalized terms used herein but not otherwise defined shall have the meanings ascribed to them in the Merger Agreement. 2. Piggyback Registration. Subject to Section 8, if at any time during the 12-month period beginning on the date hereof the Company proposes to register any of its securities under the Act, either for its own account or for the account of other holders of Common Stock (other than on a Form S-8, Form S-4 or similar registration statement), in connection with the public offering of such securities solely for cash, on a registration form that would also permit the registration of Registrable Securities, the Company shall, with respect to any such registration, promptly give each Holder written notice of such proposal. Upon the written request of any Holder given within 15 days after mailing of any such notice by the Company, the Company shall use all commercially reasonable efforts to cause to be included in such registration under the Act all the Registrable Securities that each such Holder has requested be registered. 3. Obligations of the Company. Whenever required under this Agreement to use all commercially reasonable efforts to effect the registration of any Registrable Securities, the Company shall, as expeditiously as reasonably possible: (a) Prepare and file with the Commission a registration statement covering such Registrable Securities and use all commercially reasonable efforts to cause such registration statement to be declared effective by the Commission as expeditiously as possible and to keep such registration effective until the earlier of (i) the date when all Registrable Securities covered by the registration statement have been sold or (ii) 60 days from the effective date of the registration statement; provided, that before filing a registration statement or prospectus or any amendments or supplements thereto, the Company will furnish to each Holder of Registrable Securities covered by such registration statement and the underwriters, if any, copies of all such documents proposed to be filed (excluding exhibits, unless any such person shall specifically request exhibits), which documents will be subject to the review of such Holders and underwriters. The Company agrees that it will not file such registration statement or any amendment thereto or any prospectus or any supplement thereto (including any documents incorporated by reference therein) with the Commission if the information in such registration statement or prospectus concerning a particular selling Holder has changed and such Holder or the underwriters, if any, shall reasonably object; provided, that the Company may file and amend the registration statement under this clause if it removes the Holder and 3 any incorrect or outdated information from the registration statement before such filing or amendment. (b) Prepare and file with the Commission such amendments and post-effective amendments to such registration statement as may be necessary to keep such registration statement effective during the period referred to in Section 3(a) and to comply with the provisions of the Act with respect to the disposition of all securities covered by such registration statement, and cause the prospectus to be supplemented by any required prospectus supplement, and as so supplemented to be filed with the Commission pursuant to Rule 424 under the Act. (c) Furnish to the selling Holders such numbers of copies of such registration statement, each amendment thereto, the prospectus included in such registration statement (including each preliminary prospectus), each supplement thereto and such other documents as they may reasonably request in order to facilitate the disposition of Registrable Securities owned by them. (d) Use all commercially reasonable efforts to register and qualify the Registrable Securities under such other securities laws of such jurisdictions as shall be reasonably requested by any selling Holder and do any and all other acts and things which may be reasonably necessary or advisable to enable such selling Holder to consummate the disposition of the Registrable Securities owned by such Holder in such jurisdictions; provided that the Company shall not be required in connection therewith or as a condition thereto to qualify to transact business or to file a general consent to service of process in any such counties, states or jurisdictions; and provided further that (anything in this Agreement to the contrary notwithstanding with respect to the bearing of expenses) if any jurisdiction in which the Registrable Securities shall be qualified shall require that expenses incurred in connection with the qualification of the Registrable Securities in that jurisdiction be borne by selling shareholders, then such expenses shall be payable by the selling Holders pro rata, to the extent required by such jurisdiction, including but not limited to filing fees and expenses of counsel and other advisors and any commissions or discounts related to the registration of Registrable Securities in such other jurisdictions. (e) Promptly notify each selling Holder of such Registrable Securities at any time when a prospectus relating thereto is required to be delivered under the Act of the happening of any event as a result of which the prospectus included in such registration statement contains an untrue statement of a material fact or omits any fact necessary to make the statements therein not misleading and, at the request of any such Holder, the Company will prepare a supplement or amendment to such prospectus so that, as thereafter delivered to the purchasers of such Registrable Securities, such prospectus will not contain an untrue statement of a material fact or omit to state any fact necessary to make the statements therein not misleading. (f) Provide a transfer agent and registrar for all such Registrable Securities not later than the effective date of such registration statement. 4 (g) Promptly notify the Holders of Registrable Securities of the following events: (i) the filing of the prospectus or any prospectus supplement and the registration statement and any amendment or post-effective amendment thereto and, with respect to the registration statement or any post-effective amendment thereto, the declaration of the effectiveness of such documents, (ii) any requests by the Commission for amendments or supplements to the registration statement or the prospectus or for additional information, (iii) the issuance or threat of issuance by the Commission of any stop order suspending the effectiveness of the registration statement or the initiation of any proceedings for that purpose and (iv) the receipt by the Company of any notification with respect to the suspension of the qualification of the Registrable Securities for sale in any jurisdiction or the initiation or threat of initiation of any proceeding for such purpose. (h) Make every commercially reasonable effort to prevent the entry of any order suspending the effectiveness of the registration statement and obtain at the earliest possible moment the withdrawal of any such order, if entered. (i) Cooperate with the selling Holders of Registrable Securities and the underwriters, if any, to facilitate the timely preparation and delivery of certificates representing Registrable Securities to be sold and not bearing any restrictive legends, and enable such Registrable Securities to be in such lots and registered in such names as the underwriters may request at least two business days prior to any delivery of Registrable Securities to the underwriters. (j) Provide a CUSIP number for all Registrable Securities not later than the effective date of the registration statement. (k) Otherwise use all commercially reasonable efforts to comply with all applicable rules and regulations of the Commission. 4. Termination of Registration. Notwithstanding any other provision in this Agreement, at any time before or after the filing of a registration statement, the Company may, in its sole discretion, abandon or terminate such registration without the consent of or any liability to the Holders. 5. Furnish Information. It shall be a condition precedent to the obligations of the Company to take any action pursuant to this Agreement that the Holders shall furnish to the Company such information regarding them, the Registrable Securities held by them, and the intended method of disposition of such Registrable Securities as the Company shall reasonably request and as shall be required or, in the opinion of the Company, reasonably necessary, in connection with the action to be taken by the Company. 6. Suspension of Disposition of Registrable Securities. Each selling Holder of Registrable Securities agrees by acquisition of such Registrable Securities that, upon receipt of any notice from the Company of the happening of any event of the kind described in Section 3(e) hereof, such Holder will forthwith discontinue disposition of Registrable Securities until such Holder's receipt of copies of a supplemented or amended prospectus contemplated by Section 3(e) hereof, or until it is advised in writing (the "Advice") by the Company that the use of the prospectus may be resumed, and has received copies of any additional or supplemental 5 filings which are incorporated by reference in the prospectus, and, if so directed by the Company, such Holder will deliver to the Company (at the expense of the Company) all copies, other than permanent file copies then in such Holder's possession, of the prospectus covering such Registrable Securities current at the time of receipt of such notice. In the event the Company shall give any such notice, the time periods mentioned in Section 3(a) hereof shall be extended by the number of days during the period from and including the date of the giving of such notice pursuant to Section 3(e) hereof to and including the date when each selling Holder of Registrable Securities shall have received the copies of the supplemented or amended prospectus contemplated by Section 3(e) hereof or the Advice. 7. Expenses of Registration. All expenses incurred in connection with a registration pursuant to this Agreement (excluding underwriters' discounts and commissions and costs and expenses and costs and expenses described in Section 3(d)), including all registration and qualification fees, printing and accounting fees, and fees and disbursements of counsel for the Company, shall be borne by the Company. 8. Underwriting Requirements; Priorities. (a) The Company shall select the investment banker(s) and manager(s) to administer the offering, if any. If the managing underwriters advise the Company in writing that in their opinion the number of securities requested to be included in such registration pursuant to this Agreement exceeds the number which can be sold at the desired price in such offering, the Company will include in such registration (i) first, all of the securities the Company proposes to sell, (ii) second, the number of Registrable Securities requested to be included, which in the opinion of such underwriters can be sold, pro rata among the respective Holders of Registrable Securities requesting such registration on the basis of the number of shares of Registrable Securities owned by each such Holder and (iii) third, all other securities requested to be included in such registration. (b) No person may participate in any underwritten registration hereunder unless such person (i) agrees to sell such person's securities on the basis provided in any underwriting arrangements approved by the persons entitled hereunder to approve such arrangements and (ii) completes and executes all questionnaires, powers of attorney, indemnities, underwriting agreements and other documents required under the term of such underwriting arrangements. 9. Termination of the Company's Obligations. (a) The Company shall not be obligated to register or include in any registration Registrable Securities that any Holder has requested to be registered if the Company shall furnish such Holder with a written opinion of counsel reasonably satisfactory to such Holder, that all Registrable Securities that such Holder holds may be publicly offered, sold and distributed without registration under the Act pursuant to Rule 144, Regulation S or other exemption from registration promulgated by the Commission under the Act (whether or not subject to applicable volume limitations thereunder). 6 (b) The Company shall not be obligated to register or include in any registration Registrable Securities of any Holder who has had an opportunity to sell Registrable Securities pursuant to Section 2 of this Agreement within the preceding 120 days; (c) With a view to making available to the Holders the benefits of Rule 144 promulgated under the Act and any other rule or regulation of the Commission that may at any time permit a Holder to sell securities of the Company to the public without registration, the Company agrees to use all commercially reasonable efforts to: (i) file with the Commission in a timely manner all reports and other documents required of the Company under the Act and the 1934 Act at any time after it is subject to such registration requirements; and (ii) furnish to any Holder so long as such Holder owns any of the Registrable Securities forthwith upon request a written statement by the Company that it has complied with the reporting requirements the 1934 Act (at any time for which it remains subject to such reporting requirements), a copy of the most recent annual or quarterly report of the Company, and such other reports and documents so filed by the Company as may be reasonably requested by any Holder in availing any Holder of any rule or regulation of the Commission permitting the selling of any such securities without registration. (d) The rights of the Holders and the obligations of the Company under this Agreement shall expire on the first anniversary of the Closing Date. 10. Lockup Agreement. Each Holder agrees that upon the request of the underwriters managing any underwritten offering of the Company' securities, not to sell, make any short sale of, pledge, grant any option for the purchase of or otherwise dispose of any Registrable Securities (other than those included in the registration) without the prior written consent of the Company or such underwriters, as the case may be, for a period of up to 180 days following the offering. 11. Indemnification. In the event any Registrable Securities are included in a registration statement under this Agreement: (a) To the full extent permitted by law, the Company will indemnify and hold harmless each Holder requesting or joining in a registration, each director, officer, partner, employee, or agent for such Holder, any underwriter (as defined in the Act) for such Holder, and each person, if any, who controls such Holder or underwriter within the meaning of the Act, against any losses, claims, damages or liabilities, joint or several, to which they may become subject under the Act and applicable state securities laws insofar as such losses, claims, damages or liabilities (or actions in respect thereof) arise out of or are based on any untrue or alleged untrue statement of any material fact contained in such registration statement, including any preliminary prospectus or final prospectus contained therein or any amendments or supplements thereto, or arise out of or are based upon the omission or alleged omission to state therein a material fact required to be stated therein in light of the circumstances under which they were made or necessary to make the statements therein not misleading or arise out of any violation by the Company of any rule or regulation promulgated under the Act applicable to the 7 Company and relating to action or inaction required of the Company in connection with any such registration; and will reimburse each such person or entity for any legal or other expenses reasonably incurred by them in connection with investigating or defending any such loss, claim, damage, liability, or action; provided, however, that the indemnity agreement contained in this Section 11(a) shall not apply to amounts paid in settlement of any such loss, claim, damage, liability, or action if such settlement is effected without the consent of the Company (which consent shall not be unreasonably withheld) nor shall the Company be liable in any such case for any such loss, claim, damage, liability or action to the extent that it arises out of or is based upon an untrue statement or alleged untrue statement or omission or alleged omission made in connection with such registration statement, preliminary prospectus, final prospectus, or amendments or supplements thereto, in reliance upon and in conformity with written information furnished expressly for use in connection with such registration by or on behalf of any such Holder, underwriter or controlling person. (b) To the full extent permitted by law, each Holder requesting or joining in a registration under this Agreement will indemnify and hold harmless the Company, each of its directors, each of its officers who have signed the registration statement, each person, if any, who controls the Company within the meaning of the Act, and any underwriter for the Company (within the meaning of the Act), each other selling Holder and each person, if any, who controls such other selling Holder within the meaning of Section 15 of the Act against any losses, claims, damages or liabilities, joint or several, to which the Company or any such director, officer, controlling person or underwriter may become subject, under the Act and applicable state securities laws, insofar as such losses, claims, damages or liabilities (or actions in respect thereof) arise out of or are based upon any untrue statement or alleged untrue statement of any material fact contained in such registration statement, including any preliminary prospectus or final prospectus contained therein or any amendments or supplements thereto, or arise out of or are based upon the omission or alleged omission to state therein a material fact required to be stated therein or necessary to make the statements therein not misleading in light of the circumstances, in each case to the extent that such untrue statement or alleged untrue statement or omission or alleged omission was made in such registration statement, preliminary or final prospectus, or amendments or supplements thereto, in reliance upon and in conformity with written information furnished by such Holder expressly for use in connection with such registration; and each such Holder will reimburse any legal or other expenses reasonably incurred by the Company or any such director, officer, controlling person or underwriter in connection with investigating or defending any such loss, claim, damage, liability or action; provided, however, that the indemnity agreement contained in this Section 11(b) shall not apply to amounts paid in settlement of any such loss, claim, damage, liability or action if such settlement is effected without the consent of such Holder (which consent shall not be unreasonably withheld). (c) In no event shall the liability of the Company or any selling Holder of Registrable Securities hereunder be greater than the dollar amount of the proceeds received by such Holder, or, in the case of the Company, the proceeds received by all Holders, upon the sale of the Registrable Securities giving rise to such indemnification obligation. 8 (d) Promptly after receipt by an indemnified party under this Section 11 of notice of the commencement of any action or knowledge of a claim that would, if asserted, give rise to a claim for indemnity hereunder, such indemnified party will, if a claim in respect thereof is to be made against any indemnifying party under this Section 11, notify the indemnifying party in writing of the commencement thereof or knowledge thereof and the indemnifying party shall have the right to participate in, and, to the extent the indemnifying party so desires, jointly with any other indemnifying party similarly noticed, to assume the defense thereof with counsel mutually satisfactory to the parties. The failure to notify an indemnifying party promptly of the commencement of any such action or of the knowledge of any such claim, if prejudicial to his ability to defend such action, shall relieve such indemnifying party of any liability to the indemnified party under this Section 11, but the omission so to notify the indemnifying party will not relieve him of any liability that he may have to any indemnified party otherwise than under this Section 11. 12. Put Right. (a) Holders of Registrable Shares other than Lori R. Frank and Jerry L. Bucher shall have the right, for the seven (7) days immediately following the first anniversary of the Closing Date (the "ANNIVERSARY DATE"), to put their Registrable Shares to the Company if the average closing price per share of the Parent Common Stock as reported on the Nasdaq National Market ("NASDAQ") for the ten (10) consecutive trading days ending on the Anniversary Date (the "ANNIVERSARY VALUE") is less than $9.50 per share of the Parent Common Stock. In such a case, each Holder shall have the right to cause the Company to repurchase the total number of Registrable Securities held by such Holder at a price of $9.50 per share. (b) Each Holder desiring to exercise the put right in paragraph (a) shall deliver to the Company, in accordance with Section 15, an Exercise Notice in the form attached hereto as Exhibit A within seven (7) days following the Anniversary Date. Such Exercise Notice shall state the number of Registrable Securities to be repurchased by the Company from the Holder (the "REPURCHASE SHARES"). Upon receipt of such notice, the Company will notify the transfer agent for the Parent Common Stock that the number of Repurchase Shares shall be removed from the aggregate holdings of such Holder in the stock records of the Company and transferred to the treasury of the Company. The Company shall also pay the Holder, by wire transfer or check mailed to the most current address given by such Holder in accordance with the provisions of Section 15, an amount equal to (i) $9.50 multiplied by (ii) the number of Repurchase Shares. (c) In no event shall the rights provided to Holders pursuant to this Section 12 be exercisable if the exercise of such rights would adversely affect any transaction being contemplated by the Company that is intended to be accounted for as a pooling of interests at the time such rights become exercisable; provided, however, that any exercise rights so affected by a pooling transaction shall become exercisable in accordance with this Section 12 upon the cessation of the restrictions imposed by such pooling transaction. 9 13. Remedies. In addition to being entitled to exercise all rights provided in this Agreement and the Merger Agreement as well as all rights granted by law, including recovery of damages, the Company and each Holder of Registrable Securities will be entitled to specific performance of its rights under this Agreement. 14. Amendments and Waivers. The provisions of this Agreement, including the provisions of this sentence, may not be amended, modified or supplemented, and waivers or consents to departures from the provisions hereof may not be given, unless the Company has obtained the written consent of Holders of at least a majority of the outstanding Registrable Securities, voting together as a single class. 15. Notices. All notices and other communications provided for or permitted hereunder shall be made in writing by personal delivery, by internationally recognized overnight courier (with charges prepaid) or by telecopy (with telephone confirmation) as follows: (a) if to a Holder of Registrable Securities, at the most current address given by such Holder to the Company in accordance with the provisions of this Section 15, which address initially is, with respect to the Shareholders, the address set forth in the Merger Agreement, with a copy (which shall not constitute notice) to the Shareholders' respective counsel as identified therein; and (b) if to the Company, initially at its address set forth in the Merger Agreement and thereafter at such other address, notice of which is given in accordance with the provisions of this Section 15, with a copy (which shall not constitute notice) to the Company's counsel as identified in the Merger Agreement. (c) All such notices and communications shall be deemed to have been duly given or made when personally delivered, the day of guaranteed delivery by such overnight courier service or when transmitted to the specified telecopy number and confirmed by telephone, in each case addressed to the respective parties as set forth above. 16. Counterparts. This Agreement may be executed in any number of counterparts and by the parties hereto in separate counterparts, each of which when so executed shall be deemed to be an original and all of which taken together shall constitute one and the same agreement. 17. Headings. The headings in this Agreement are for convenience of reference only and shall not limit or otherwise affect the meaning hereof. 18. Governing Law. THIS AGREEMENT SHALL BE GOVERNED BY AND CONSTRUED IN ACCORDANCE WITH THE LAWS OF THE UNITED STATES OF AMERICA AND THE STATE OF GEORGIA, EXCLUDING CHOICE OF LAW PRINCIPLES. The Company and the Shareholders irrevocably consent to the exclusive jurisdiction and venue of the courts of any county in the State of Georgia and the United States Federal District Court of Georgia, in any judicial proceeding brought to enforce this Agreement. The parties agree that any forum other than the State of Georgia is an inconvenient forum and that a 10 lawsuit (or non-compulsory counterclaim) brought by one party against another party, in a court of any jurisdiction other than the State of Georgia should be forthwith dismissed or transferred to a court located in the State of Georgia. 19. Severability. In the event that any one or more of the provisions contained herein, or the application thereof in any circumstance, is held invalid, illegal or unenforceable, the validity, legality and enforceability of any such provision in every other respect and of the remaining provisions contained herein shall not be affected or impaired thereby. 20. Entire Agreement. This Agreement is intended by the parties as a final expression of their agreement and intended to be a complete and exclusive statement of the agreement and understanding of the parties hereto in respect of the subject matter contained herein. There are no restrictions, promises, warranties or undertakings, other than those set forth or referred to herein with respect to the registration rights granted by the Company with respect to the Company Stock. This Agreement supersedes all prior agreements and understandings between the parties with respect to such subject matter. 21. No Assignment; Parties Benefited. The rights provided the Holders under this Agreement are not transferable. If any Registrable Securities are sold, exchanged, encumbered or otherwise transferred in any manner, the rights provided the Holder of such Registrable Securities pursuant to this Agreement shall immediately terminate as to all such transferred shares. Neither party may assign their rights, duties or obligations under this Agreement without the express written consent of the other party. Any attempted assignment without such written consent shall be null and void. Nothing in this Agreement, express or implied, is intended to confer upon any third party any rights, remedies, obligations or liabilities. 11 The parties have executed this Registration Rights Agreement as of the date first above written. TOWNE SERVICES, INC. By: /s/ Bruce F. Lowthers ---------------------------- Name: Bruce F. Lowthers Title: Secretary and CFO SHAREHOLDERS /s/ Lori R. Frank -------------------------------- Name: Lori R. Frank /s/ Jerry L. Bucher -------------------------------- Name: Jerry L. Bucher /s/ Russell L. Bengston -------------------------------- Name: Russell L. Bengston /s/ Mark J. Mollers -------------------------------- Name: Mark J. Mollers /s/ Ron Randall -------------------------------- Name: Ron Randall /s/ Paul Frank -------------------------------- Name: Paul Frank /s/ Edna Frank -------------------------------- Name: Edna Frank /s/ Pierce A. McNally -------------------------------- Name: Pierce A. McNally /s/ Judson Bemis, Jr. -------------------------------- Name: Judson Bemis, Jr. /s/ Stephen L. Becher -------------------------------- Name: Stephen L. Becher /s/ Steve Schewe -------------------------------- Name: Steve Schewe 12 Dakota County Capital, LLC By: /s/ Steven C. King ----------------------------- Name: Steven C. King Title: President Kenneth E. Dawkins Trust By: /s/ Kenneth E. Dawkins ---------------------------- Name: Kenneth E. Dawkins Title: Trustee Cardinal Capital, LLC By: /s/ Terry Adams ---------------------------- Name: Terry Adams Title: Managing Director 13 EXERCISE NOTICE Pursuant to that certain Registration Rights Agreement, dated as of July __, 1999, by and among Towne Services, Inc. (the "Company") and the shareholders listed on the signature pages thereto (the "Agreement"), the undersigned hereby causes this Exercise Notice to be delivered to the Company in accordance with Section 12 of such Agreement and certifies that the information contained herein is true and correct to the knowledge of the undersigned. Shareholder Name: ___________________ Aggregate Number of Registrable Securities Owned: _____________ Amount of Repurchase Shares Requested: ______________ Dollar Value for such Repurchase Shares:__________________ Duly executed this ____ day of _____, 2000. -------------------------------- Name: -------------------------------- Date