Exhibit 4.3



 Exhibit 4.3 

 

	
	












 DELIVERY OPTIONS FOR RIGHTS CERTIFICATE 

By Mail, Hand or Overnight Courier: 
 Registrar & Transfer Company 
 10 Commerce Drive 

Cranford, New Jersey 07016 
 Attention: Reorg/Exchange Department 
 Delivery to an address other than the
address listed above will not constitute valid delivery. 
 Delivery by facsimile will not constitute valid delivery. 

PLEASE PRINT ALL INFORMATION CLEARLY AND LEGIBLY. 

 


 SECTION 1 
 IF YOU WISH TO SUBSCRIBE FOR YOUR FULL SUBSCRIPTION PRIVILEGE OR A PORTION THEREOF: 
 Basic
Subscription Right 
  

													
	I exercise	 	  
	 	rights	 	x	 	   1.665 
	 	=	 	  

		 	(no. of your rights)	 		 		 	(ratio)	 		 	(total no. of your new shares)

 Therefore, I apply for: 
  

													
	  
	 	x	 	$	 	
            1.50     
       
	 	=	 	$	 	  

	(no. of new shares)	 		 	(subscription price)	 		 	(amount enclosed)

 Over-Subscription Privilege 
 If you fully exercise your Basic Subscription Right and wish to subscribe for additional shares up to the total number of unsubscribed shares, you may exercise your Over-Subscription Privilege. If
sufficient shares of Common Stock are available, the Company will seek to honor the over-subscription requests in full 
 The maximum number
of unsubscribed shares: 
  

											
	  
	 	-	 	  
	 	=	 	  
	 	shares
	(total offered shares)	 		 	   (total number of
   your new shares)
	 		 	(maximum unsubscribed shares)

 Therefor, I apply for: 
  

													
	  
	 	X	 	$	 	 1.50
	 	=	 	$	 	  

	 (no. of oversubscription

shares applied for)
	 		 		 	(subscription price)	 		 		 	(additional amount enclosed)

  

					
	Total Amount Enclosed: $	 	  

		  		 	(Sum of Basic Plus Over-Subscription Amounts)

  

	 ̈	Check drawn on a U.S. bank payable to “Registrar and Transfer Company,” as Subscription Agent. 


 

	 ̈	Wire transfer directly to the segregated account maintained by Registrar and Transfer Company, as Subscription Agent. 


TO SUBSCRIBE: I acknowledge that I have received the prospectus for this offering and I hereby irrevocably subscribe for the number of shares indicated
above on the terms and conditions specified in the prospectus. I hereby agree that if I fail to pay for the shares of Common Stock for which I have subscribed, the Company may exercise its legal remedies against me. 

 

	
	  

	Signature(s) of Subscriber(s)


                     Indicate, by initialing
In the provided blank, that you are aware of the absence of deposit insurance covering the securities being sold pursuant to this Subscription Certificate. 
 IMPORTANT: THE SIGNATURE(S) MUST CORRESPOND IN EVERY PARTICULAR, WITHOUT ALTERATION, WITH THE NAME(S) AS PRINTED ON THE REVERSE OF THIS SUBSCRIPTION CERTIFICATE. 

If signature is by trustee(s), executor(s), administrator(s), guardian(s), attorney(s)-in-fact, agent(s), officer(s) of a corporation or another acting
in a fiduciary or representative capacity, please provide the following information (please print). See the instructions. 
  

			
	Name(s):	 	  


  

			
	Capacity (Full Title):	 	  


  

			
	Taxpayer ID # or Social Security #:	 	  


 

 SECTION 2 
 SPECIAL ISSUANCE OR DELIVERY INSTRUCTIONS FOR SUBSCRIPTION RIGHTS HOLDERS: 
 (a) To be completed
ONLY if the certificate representing the Common Stock is to be issued in a name other than that of the registered holder. (See the Instructions.) DO NOT FORGET TO COMPLETE THE GUARANTEE OF SIGNATURE(S) SECTION BELOW. 

ISSUE COMMON STOCK TO: 
  
   
  
 (Please Print Name) 
  
   
  
 (Print Full Address) 
  

  
  

(Social Security # or Tax ID #) 

(b) To be completed ONLY If the certificate representing the Common Stock is to be sent to an address other than that shown on the front of this
certificate. (See the Instructions.) DO NOT FORGET TO COMPLETE THE GUARANTEE OF SIGNATURE(S) SECTION BELOW 
  
   
  
 (Please Print Name) 
  
   
  
 (Print Full Address) 
  
   
  
 (Social Security # or Tax ID #) 
 GUARANTEE OF SIGNATURE(S) 

YOU MUST HAVE YOUR SIGNATURE GUARANTEED IF YOU WISH TO HAVE YOUR SHARES DELIVERED TO AN ADDRESS OTHER THAN YOUR OWN OR TO A SHAREHOLDER OTHER THAN THE
REGISTERED HOLDER. 
 Your signature must be guaranteed by an Eligible Guarantor Institution, as defined in Rule 17Ad-15 of the Securities
Exchange Act of 1934, as amended. These generally include (a) a commercial bank or trust company, (b) a member firm of a domestic stock exchange, or (c) a credit union. 

 

			
	Signature:	 	  

		 	(Name of Bank or Firm)

  

			
	By:	 	  

		 	(Signature of Officer)

 
 

  

	
	FULL PAYMENT FOR THE SHARES MUST ACCOMPANY THIS FORM AND MUST BE MADE IN UNITED STATES DOLLARS BY PERSONAL CHECK DRAWN UPON A UNITED STATES BANK OR WIRE TRANSFER PAYABLE TO
REGISTRAR AND TRANSFER COMPANY.