Exhibit
10.1


 


THIS
NOTE AND THE UNDERLYING SECURITIES HAVE BEEN ACQUIRED FOR INVESTMENT PURPOSES ONLY AND MAY NOT BE TRANSFERRED UNTIL (i) A REGISTRATION
STATEMENT UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”) SHALL HAVE BECOME EFFECTIVE WITH RESPECT
THERETO OR (ii) RECEIPT BY THE COMPANY OF AN OPINION OF COUNSEL REASONABLY SATISFACTORY TO THE COMPANY TO THE EFFECT THAT REGISTRATION
UNDER THE ACT IS NOT REQUIRED IN CONNECTION WITH SUCH PROPOSED TRANSFER NOR IS IN VIOLATION OF ANY APPLICABLE STATE SECURITIES
LAWS. THIS LEGEND SHALL BE ENDORSED UPON ANY NOTE ISSUED IN EXCHANGE FOR THIS NOTE.


 


DIGIPATH,
INC.


 


Amended
and Restated


8%
Secured Convertible Promissory Note


 


	$150,000	September
    30, 2020, as of
	 	November
    5, 2018 (the “Issue Date”)


 


FOR
VALUE RECEIVED, DIGIPATH, INC., a Nevada corporation (the “Company”) with its principal executive office
at 6450 Cameron Blvd., Suite 113, Las Vegas, Nevada 89118, promises to pay to the order of Nordhaven, LLC or its registered assigns
(the “Holder” or “Payee”), the principal amount of $150,000 (the “Principal Amount”),
on August 10, 2022 (the “Maturity Date”) or such earlier date as this Note is required or permitted to be repaid
as provided hereunder, and to pay interest to the Holder on the aggregate unconverted and then outstanding Principal Amount of
this Amended and Restated 8% Secured Convertible Promissory Note (this “Note”) in accordance with the provisions
hereof. This Note amends and restates an 8% Secured Convertible Promissory Note originally issued November 8, 2018.


 


This
Note shall not bear interest following September 30, 2020.


 


Each
payment by the Company pursuant to this Note shall be made without set-off or counterclaim and in immediately available funds.
The Company (i) waives presentment, demand, protest or notice of any kind in connection with this Note and (ii) agrees to pay
to the Holder of this Note, on demand, all costs and expenses (including reasonable and documented legal fees and expenses) incurred
in connection with the enforcement and collection of this Note.


 


This
Note is one of a series of Secured Convertible Promissory Notes of like tenor in the aggregate principal amount of $500,000 (together,
the “Notes”) originally issued pursuant to a Securities Purchase Agreement (the “Securities Purchase
Agreement”) entered into between the Company and the Payee, and is secured by a Security Agreement (the “Security
Agreement”) among the Company and CSW Ventures, LP, as agent (“Agent”) for the holders of the Notes
(the “Holders”), covering certain collateral (the “Collateral”), all as more particularly
described and provided therein, and is entitled to the benefits thereof. The Security Agreement and any and all other documents
executed and delivered by the Company to Agent under which the Agent or the Holders are granted liens on assets of the Company
in connection with the transactions contemplated by the Securities Purchase Agreement are collectively referred to as the “Security
Documents.”


 




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Unless
otherwise defined in this Note, capitalized terms used herein shall have the meanings set forth in the Note Purchase Agreement.


 


1.
Principal Repayment


 


A.
Optional Prepayment. At any time from
and after the Issue Date, the Company may prepay this Note, without premium or penalty, in whole or in part, with accrued interest
to the date of such prepayment on the amount prepaid.


 


B.
Notice of Prepayment. Before the Company
shall be permitted to prepay this Note pursuant to 1A hereof, the Company shall provide ten (10) days prior notice to the Payee
of its intent to make such prepayment, which notice shall state the date and amount of such prepayment (the “Prepayment
Date”). The Payee shall have the option at any time prior to the Prepayment Date to elect to convert this Note pursuant
to Section 5 below.


 


2.
[Intentionally Deleted].


 


3.
Covenants of Company.


 


A.
Affirmative Covenants. The Company covenants
and agrees that, so long as this Note shall be outstanding, unless it has otherwise obtained the prior written consent of Holders
of not less than 50% of the outstanding Principal Amount of the Notes (the “Required Holders”), it will perform
the obligations set forth in this Section 2A:


 


(i)
Taxes and Levies. The Company (and each
of its subsidiaries) will promptly pay and discharge all taxes, assessments, and governmental charges or levies imposed upon the
Company or upon its income and profits, or upon any of its property, before the same shall become delinquent, as well as all claims
for labor, materials and supplies which, if unpaid, might become a lien or charge upon such properties or any part thereof; provided,
however, that the Company shall not be required to pay and discharge any such tax, assessment, charge, levy or claim so
long as the validity thereof shall be contested in good faith by appropriate proceedings and the Company shall set aside on its
books adequate reserves in accordance with generally accepted accounting principles with respect to any such tax, assessment,
charge, levy or claim so contested;


 


(ii)
Maintenance of Existence. The Company
(and each of its subsidiaries) will do or cause to be done all things reasonably necessary to preserve and keep in full force
and effect its corporate existence, rights and franchises and comply with all laws applicable to the Company, except where the
failure to comply would not have a material adverse effect on the Company;


 




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(iii)
Maintenance of Property. The Company (and
each of its subsidiaries) will at all times reasonably maintain, preserve, protect and keep its property used or useful in the
conduct of its business in good repair, working order and condition (ordinary wear and tear excepted), and from time to time make
all needful and proper repairs, renewals, replacements and improvements thereto as shall be reasonably required in the conduct
of its business;


 


(iv)
Insurance. The Company (and each of its
subsidiaries) will, to the extent necessary for the operation of its business, keep adequately insured by financially sound reputable
insurers, all property of a character usually insured by similar corporations and carry such other insurance as is usually carried
by similar corporations;


 


(v)
Books and Records. The Company (and each
of its subsidiaries) will at all times keep true and correct books, records and accounts reflecting all of its business affairs
and transactions in accordance with GAAP. Such books and records shall be open at reasonable times and upon reasonable notice
to the inspection of the Payee or its agents;


 


(vi)
Notice of Certain Events. The Company
(and each of its subsidiaries) will give prompt written notice (with a description in reasonable detail) to the Payee of the occurrence
of any Event of Default or any event which, with the giving of notice or the lapse of time, would constitute an Event of Default;
and


 


B.
Negative Covenants. The Company covenants
and agrees that, so long as this Note shall be outstanding, unless it has otherwise obtained the prior written consent of the
Required Holders, it will perform the obligations set forth in this Section 3B:


 


(i)
Liquidation, Dissolution. The Company
will not (and will not permit any of its subsidiaries to) liquidate or dissolve, consolidate with, or merge into or with, any
other corporation or other entity, except that any wholly-owned subsidiary may merge with another wholly-owned subsidiary or with
the Company (so long as the Company is the surviving corporation and no Event of Default shall occur as a result thereof); provided,
however, such prior written consent shall not be required in connection with the consummation of any merger or change of control
transaction which results in prepayment of the Note pursuant to the terms of this Note;


 


(ii)
Sales of Assets. The Company will not
(nor permit any of its subsidiaries with respect to their assets and properties), other than in the ordinary course of business,
sell, transfer, lease or otherwise dispose of, or grant options, warrants or other rights with respect to, all or a substantial
part of its properties or assets material to the Company’s business to any person or entity; provided, however, such prior
written consent shall not be required in connection with licenses or other rights granted by the Company to a strategic partner,
licensee or distributor as approved by the Board of Directors of the Company (the “Board of Directors”);


 




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(iii)
Redemptions. The Company will not redeem
or repurchase any outstanding equity and/or debt securities of the Company (or its subsidiaries);


 


(iv)
Indebtedness. Company will hereafter not
create, incur, assume or suffer to exist, contingently or otherwise, any indebtedness which is not expressly subordinate in all
respects to the Notes, provided, that this covenant shall not apply to (A) capitalized leases, purchase money indebtedness
(secured solely by Liens on the equipment or assets leased or purchased), (B) accounts payable, or (C) other accrued expenses
incurred by the Company in the ordinary course of business;


 


(v)
Negative Pledge. Other than with respect
to the Notes, the Company will not (nor will it permit its subsidiaries to) hereafter create, incur, assume or suffer to exist
any mortgage, pledge, hypothecation, assignment, security interest, encumbrance, lien (statutory or other), preference, priority
or other security agreement or preferential arrangement of any kind or nature whatsoever (including any conditional sale or other
title retention agreement and any financing lease) (each, a “Lien”) upon any of its property, revenues or assets,
whether now owned or hereafter acquired, except any of the following (collectively, “Permitted Liens”):


 


(a)
Liens granted to secure indebtedness incurred
(i) to finance the acquisition (whether by purchase or capitalized lease) of tangible assets or (ii) under equipment leases or
purchase money indebtedness, but in each case, only on the assets acquired with the proceeds of such indebtedness;


 


(b)
Liens for taxes, assessments or other governmental
charges or levies not at the time delinquent or thereafter payable without penalty or being contested in good faith by appropriate
proceedings and for which adequate reserves in accordance with GAAP shall have been set aside on its books;


 


(c)
Liens of carriers, warehousemen, mechanics, materialmen
and landlords incurred in the ordinary course of business for sums not overdue or being contested in good faith by appropriate
proceedings and for which adequate reserves in accordance with GAAP shall have been set aside on its books;


 


(d)
Liens incurred in the ordinary course of business
in connection with workers’ compensation, unemployment insurance or other forms of governmental insurance or benefits, or
to secure performance of tenders, statutory obligations, leases and contracts (other than for borrowed money) entered into in
the ordinary course of business or to secure obligations on surety or appeal bonds; and


 


(e)
Judgment Liens in existence less than 30 days
after notice of the entry thereof is forwarded to the Company or with respect to which execution has been stayed.


 




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(vi)
Transactions with Affiliates. The Company
will not (and will not permit any of its subsidiaries to) enter into any transaction after the Issue Date, including, without
limitation, the purchase, sale, lease or exchange of property, real or personal, the purchase or sale of any security, the borrowing
or lending of any money, or the rendering of any service, with any person or entity affiliated with the Company or any of its
subsidiaries (including officers, directors and shareholders owning five (5%) percent or more of the Company’s outstanding
capital stock), except in the ordinary course of and pursuant to the reasonable requirements of its business and upon fair and
reasonable terms not less favorable than would be obtained in a comparable arms-length transaction with any other person or entity
not affiliated with the Company as determined by the Board of Directors in good faith.


 


(vii)
Dividends. The Company will not declare
or pay any cash dividends or distributions on its outstanding capital stock.


 


(viii)
Proration of Payments. The Company shall
not make or permit any payment on account of principal or interest payable hereunder or any of the other Notes in excess of each
Holder’s pro rate share of payments then due under the Notes.


 


4.
Events of Default.


 


If
any of the following events shall occur for any reason whatsoever (and whether such occurrence shall be voluntary or involuntary
or come about or be effected by operation by law or otherwise) (each, an “Event of Default”):


 


(i)
Non-Payment of Obligations. The Company
shall default in the payment of the principal of this Note as and when the same shall become due and payable (whether by acceleration
or otherwise) or shall fail to pay accrued interest on this Note within five (5) business days of when the same shall become due
and payable (whether by acceleration or otherwise);


 


(ii)
Non-Performance of Affirmative Covenants.
The Company shall default in the due observance or performance of any covenant set forth in Section 3A, which default shall continue
uncured for thirty (30) days;


 


(iii)
Non-Performance of Negative Covenants.
The Company shall default in the due observance or performance of any covenant set forth in Section 3B, and, if capable of cure,
such default shall not have been cured within thirty (30) days;


 


(iv)
Bankruptcy, Insolvency, Etc. The Company
(or any of its subsidiaries) shall:


 


(a)
in any legal document admit in writing its inability
to pay its debts as they become due;


 


(b)
apply for, consent to, or acquiesce in, the appointment
of a trustee, receiver, sequestrator or other custodian for the Company or any of its property, or make a general assignment for
the benefit of creditors;


 




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(c)
in the absence of such application, consent or
acquiesce in, permit or suffer to exist the appointment of a trustee, receiver, sequestrator or other custodian for the Company
or for any part of its property;


 


(d)
permit or suffer to exist the commencement of
any bankruptcy, reorganization, debt arrangement or other case or proceeding under any bankruptcy or insolvency law, or any dissolution,
winding up or liquidation proceeding, in respect of the Company, and, if such case or proceeding is not commenced by the Company
or converted to a voluntary case, such case or proceeding shall be consented to or acquiesced in by the Company or shall result
in the entry of an order for relief; or


 


(e)
take any corporate or other action authorizing,
or in furtherance of, any of the foregoing;


 


(v)
Cross-Default. The Company shall default
in the payment when due, after the expiration of any applicable grace period, of any amount payable under any other obligation
of the Company for money borrowed in excess of $100,000;


 


(vi)
Cross-Acceleration. Any other indebtedness
for borrowed money of the Company (or any of its subsidiaries) in an aggregate principal amount exceeding $100,000 shall be duly
declared to be or shall become due and payable prior to the stated maturity thereof or shall not be paid as and when the same
becomes due and payable including any applicable grace period;


 


(vii)
Other Breaches, Defaults. The Company
shall default or be in breach of any term or provision of this Note, any other Transaction Document (as defined in the Note Purchase
Agreement), in any material respect, for a period of thirty (30) days, or any material representation or warranty made by the
Company to the Payee in any Transaction Document shall be materially false or misleading; or


 


(viii)
Security Documents. The Security Documents
shall cease to create a valid and perfected Lien in and to any material Collateral;


 


then,
and in any such event, the Required Holders shall, by notice to the Company, take or cause to be taken any or all of the following
actions, without prejudice to the rights of Payee to enforce its claims against the Company: (1) declare the principal of and
any accrued interest and all other amounts payable under this Note to be due and payable, whereupon the same shall become, forthwith
due and payable without presentment, demand, protest or other notice of any kind, all of which are hereby waived by the Company,
(2) proceed to enforce or cause to be enforced any remedies provided under the Security Agreement, and (3) exercise any other
remedies available at law or in equity, either by suit in equity or by action at law, or both, whether for specific performance
of any covenant or other agreement contained in this Note; provided, that upon the occurrence of any Event of Default referred
to in Section 4(v) then (without prejudice to the rights and remedies specified in clause (3) above) automatically, without notice,
demand or any other act by any Holder, the principal of and any accrued interest and all other amounts payable under this Note
shall become immediately due and payable without presentment, demand, protest or other notice of any kind, all of which are hereby
expressly waived by the Company, anything contained in this Note to the contrary notwithstanding. No remedy conferred in this
Note upon any Holder is intended to be exclusive of any other remedy, and each and every such remedy shall be cumulative and shall
be in addition to every other remedy conferred herein or now or hereinafter existing at law or in equity or by statute or otherwise.


 




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5.
Conversion of Note.


 


A.
Optional Conversion. The Holder of this
Note shall have the option, at any time and from time to time, prior to the date on which the Company makes payment in full of
the Principal Amount of this Note in accordance herewith, all accrued interest thereon and all other amounts due and payable thereunder
to convert all or any portion of the outstanding Principal Amount of this Note plus all accrued and unpaid interest thereon (such
Principal Amount and accrued and unpaid interest to be so converted the “Conversion Amount”) into shares of
common stock, par value $0.001 per share (“Common Stock”), of the Company at an initial conversion price per
share equal to $0.03 per share (the “Conversion Price”), subject to adjustment as provided in subsection 5E
below. The shares of Common Stock issuable upon conversion of this Note at the Conversion Price are referred to herein as the
“Conversion Shares.”


 


B.
Conversion Limitation. Notwithstanding
anything contained herein to the contrary, the Holder shall not be entitled to convert pursuant to the terms of this Note an amount
that would be convertible into that number of Conversion Shares which would exceed the difference between the number of shares
of Common Stock beneficially owned by such Holder and 4.99% of the outstanding shares of Common Stock of the Company. For the
purposes of the immediately preceding sentence, beneficial ownership shall be determined in accordance with Section 13(d) of the
Securities Exchange Act of 1934, as amended, and Regulation 13d-3 thereunder. The Holder may void the Conversion Share limitation
described in this Section 5B upon 65 days prior notice to the Company or without any notice requirement upon an Event of Default.


 


C.
Mechanics of Conversion.


 


(i)
Before the Holder of this Note shall be entitled
to convert this Note into shares of Common Stock pursuant to Section 5A, such holder shall give written notice to the Company
in the form attached hereto as Annex A (“Conversion Notice”), at its principal corporate office, by
email, facsimile or otherwise, of the election to convert the same and shall state therein the Conversion Amount and the name
or names in which the certificate or certificates for shares of Common Stock are to be issued. On or before the third (3rd) business
day following the date of receipt of a Conversion Notice, the Company shall (A) if legends are not required to be placed on certificates
of Common Stock pursuant to the then existing provisions of Rule 144 of the Securities Act of 1933 (“Rule 144”)
and provided that the Company’s transfer agent is participating in the Depository Trust Company’s (“DTC”)
Fast Automated Securities Transfer Program, credit such aggregate number of shares of Common Stock to which the Holder shall be
entitled to the Holder’s or its designee’s balance account with DTC, or (B) if the Company’s transfer agent
is not participating in the DTC Fast Automated Securities Transfer Program, issue and deliver to the address as specified in the
Conversion Notice, a certificate, registered in the name of the Holder or its designee, for the number of shares of Common Stock
to which the Holder shall be entitled which certificates shall not bear any restrictive legends unless required pursuant the Rule
144.


 




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(ii)
All Common Stock which may be issued upon conversion
of the Note will, upon issuance, be duly issued, fully paid and non-assessable and free from all taxes, liens, and charges with
respect to the issuance thereof.


 


D.
Authorized Shares. At all times the Company
shall have authorized and shall have reserved a sufficient number of shares of Common Stock to provide for the conversion of the
Notes at the then effective Conversion Price. Without limiting the generality of the foregoing, if, at any time, the Conversion
Price is decreased, the number of shares of Common Stock authorized and reserved for issuance upon the conversion of this Note
shall be proportionately increased.


 


E.
Anti-Dilution Provisions. The Conversion
Price in effect at any time and the number and kind of securities issuable upon the conversion of this Note shall be subject to
adjustment from time to time upon the happening of certain events as follows:


 


(i)
In case the Company shall hereafter (i) declare
a dividend or make a distribution on its outstanding shares of Common Stock in shares of Common Stock, (ii) subdivide or reclassify
its outstanding shares of Common Stock into a greater number of shares, or (iii) combine or reclassify its outstanding shares
of Common Stock into a smaller number of shares, the Conversion Price in effect at the time of the record date for such dividend
or distribution or of the effective date of such subdivision, combination or reclassification shall be adjusted so that it shall
equal the price determined by multiplying the Conversion Price by a fraction, the denominator of which shall be the number of
shares of Common Stock outstanding after giving effect to such action, and the numerator of which shall be the number of shares
of Common Stock outstanding immediately prior to such action. Such adjustment shall be made successively whenever any event listed
above shall occur.


 


(ii)
Whenever the Conversion Price is adjusted pursuant
to Subsection (i) above, the number of Conversion Shares issuable upon conversion of this Note shall simultaneously be adjusted
by multiplying the number of Conversion Shares initially issuable upon conversion of this Note by the Conversion Price in effect
on the date hereof and dividing the product so obtained by the Conversion Price, as adjusted.


 


(iii)
In case of any reorganization, reclassification
or change of the Common Stock (including any such reorganization, reclassification or change in connection with a consolidation
or merger in which the Company is the continuing entity), or any consolidation of the Company with, or merger of the Company with
or into, any other entity (other than a consolidation or merger in which the Company is the continuing entity), or of any sale
of the properties and assets of the Company as, or substantially as, an entirety to any other person or entity, this Note shall
thereafter be convertible into the kind and amount of stock or other securities or property receivable upon such reorganization,
reclassification, change, consolidation, merger or sale by a Holder of the number of shares of Common Stock into which this Note
would have been converted prior to such transaction. The provisions of this subsection (iii) shall similarly apply to successive
reorganizations, reclassifications, changes, consolidations, mergers or sales immediately prior to such reorganization, reclassification,
change, consolidation, merger or sale.


 




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6.
Amendments and Waivers.


 


The
provisions of this Note may from time to time be amended, modified or supplemented, if such amendment, modification or supplement
is in writing and consented to by the Company and the Required Holders; provided, however, that no such amendment,
modification or waiver:


 


(i)
which would modify this Section 6A, change the definition of “Required Holders”, extend the Maturity Date for more
than 120 days, or subject the Holder under each Note to any additional obligations shall be made without the consent of the Holder
of each Note, or


 


(ii)
which would reduce the amount of any payment of principal of or interest on any Principal Amount payable hereunder (or reduce
the Principal Amount of or rate of interest payable hereunder) shall be made without the consent of the Holder of each Note so
affected.


 


A.
No failure or delay on the part of the Payee
in exercising any power or right under this Note shall operate as a waiver thereof, nor shall any single or partial exercise of
any such power or right preclude any other or further exercise thereof or the exercise of any other power or right. No notice
to or demand on the Company in any case shall entitle it to any notice or demand in similar or other circumstances. No waiver
or approval by the Payee shall, except as may be otherwise stated in such waiver or approval, be applicable to subsequent transactions.
No waiver or approval hereunder shall require any similar or dissimilar waiver or approval thereafter to be granted hereunder.


 


B.
To the extent that the Company makes a payment
or payments to the Payee, and such payment or payments or any part thereof are subsequently for any reason invalidated, set aside
and/or required to be repaid by the Payee to a trustee, receiver or any other party under any bankruptcy law, state or federal
law, common law or equitable cause, then to the extent of such recovery, the obligation or part thereof originally intended to
be satisfied, and all rights and remedies therefor, shall be revived and continued in full force and effect as if such payment
had not been made by the Payee or such enforcement or setoff had not occurred.


 


7.
Miscellaneous.


 


A.
Parties in Interest. All covenants, agreements
and undertakings in this Note binding upon the Company or the Payee shall bind and inure to the benefit of its successors and
permitted assigns of the Company and the Payee, respectively, whether so express or not.


 


B.
Governing Law. This Note shall be governed by and construed in accordance with the laws of the State of Nevada without
regard to the conflicts of laws principles thereof.


 


C.
Waiver of Jury Trial. THE PAYEE AND THE COMPANY HEREBY KNOWINGLY, VOLUNTARILY AND INTENTIONALLY WAIVE ANY RIGHTS THEY MAY
HAVE TO A TRIAL BY JURY IN RESPECT OF ANY LITIGATION BASED HEREON, OR ARISING OUT OF, UNDER, OR IN CONNECTION WITH THIS NOTE OR
ANY OTHER DOCUMENT OR INSTRUMENT EXECUTED AND DELIVERED IN CONNECTION HEREWITH OR ANY COURSE OF CONDUCT, COURSE OF DEALING, STATEMENTS
(WHETHER VERBAL OR WRITTEN) OR ACTIONS OF THE PAYEE OR THE COMPANY. THIS PROVISION IS A MATERIAL INDUCEMENT FOR THE PAYEE’S
PURCHASING THIS NOTE.


 




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IN
WITNESS WHEREOF, this Note has been executed and delivered on the date specified above by the duly authorized representative of
the Company.


 


	 	DIGIPATH,
    INC.
	 	 
	 	By:	/s/
    Todd Peterson
	 	Name: 	Todd
    Peterson
	 	Title:	Chief
    Financial Officer


 


This
Amended and Restated Note dated September 30, 2020 has been accepted by the undersigned in replacement for the 8% Secured Convertible
Promissory Note dated November 5, 2018, which will be returned to the Company for cancellation if in the possession of the undersigned.


 


	NORDHAVEN,
    LLC	 
	 	 
	By:	/s/
    Kenneth Perego, II	 
	Name: 	Kenneth
    Perego, II	 
	Title:
    	 	 


 




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ANNEX
A


 


CONVERSION
NOTICE


 


The
undersigned hereby elects to convert principal and/or interest under the Amended and Restated 8% Senior Secured Convertible Promissory
Note dated September 30, 2020, (the “Note”) of Digipath, Inc., a Nevada corporation (the “Company”),
into shares of common stock (the “Common Stock”), of the Company according to the conditions hereof and the
Note, as of the date written below. If shares of Common Stock are to be issued in the name of a person other than the undersigned,
the undersigned will pay all transfer taxes payable with respect thereto and is delivering herewith such certificates and opinions
as reasonably requested by the Company in accordance therewith. No fee will be charged to the holder for any conversion, except
for such transfer taxes, if any.


 


By
the delivery of this Notice of Conversion the undersigned represents and warrants to the Company that its ownership of the Common
Stock does not exceed the amounts specified under Section 5B of the Note, as determined in accordance with Section 13(d) of the
Securities Exchange Act of 1934, as amended.


 


	Conversion
    calculations:	 
	 	Date
    to Effect Conversion: _________________________
	 	 
	 	Principal
    Amount of Note to be Converted: _____________
	 	 
	 	Amount
    of Interest of Note to be Converted: ____________
	 	 
	 	Number
    of shares of Common Stock to be issued:
	 	 
	 	______________________________________________
	 	 
	 	Signature:
    ______________________________________
	 	 
	 	Name:
    _________________________________________
	 	 
	 	Address
    for Delivery of Common Stock Certificates: 
	 	______________________________________________
	 	______________________________________________
	 	 
	 	Or
	 	 
	 	DWAC
    Instructions:
	 	 
	 	Broker
    No: ___________________
	 	Account
    No: __________________








 




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