Exhibit 10.1

FORM OF NOTICE OF CONVERSION

TO:

VISUALANT, INCORPORATED

500 Union Street, Suite 420

Seattle, WA 98101

Attention: Chief Executive Officer or Chief Financial Officer

1.

The undersigned hereby converts principal of $______ and interest of $_____, all
due to the undersigned pursuant to the terms of the Subordinated Convertible
Promissory Note dated ____________ (the “Note”), into (a) ________ shares of the
Visualant, Incorporated’s (the “Company’s”) common stock (a conversion price of
$0.80 per share) (the “Shares”) and (b) a five-year warrant to purchase
_________ shares of the Company’s common stock at a price of $1.00 per share
(the “Warrant”). The effective date for the conversion will be November 30,
2016. Simultaneously with the conversion, the Note shall be surrendered to the
Company for cancellation and shall be of no further force or effect.

 

 

2.

Please issue (a) a certificate or certificates representing the Shares and (b)
the Warrant in the name of the undersigned or in such other name as is specified
below:

___________

__________

__________

_________

3.

The undersigned hereby represents and warrants that the  Shares and the Warrant
are being acquired for the account of the undersigned for investment and not
with a view to, or for resale, in connection with the distribution thereof, and
that the undersigned has no present intention of distributing or reselling such
shares and all representations and warranties of the undersigned set forth in
Section 3 of the Note and Warrant Purchase Agreement (the “Agreement”) are true
and correct as of the date hereof. Furthermore, the undersigned acknowledges
that the Shares and the Warrant will contain appropriate legends as set forth in
the Agreement.

______________________________

(Signature)

Name: ____________

November 30, 2016

(Date)

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