Exhibit 10.12 




        


        THE SECURITIES EVIDENCED BY THIS CERTIFICATE HAVE NOT BEEN REGISTERED UNDER THE U.S. SECURITIES ACT, AS AMENDED, OR ANY OTHER APPLICABLE SECURITIES LAWS AND HAVE BEEN ISSUED IN RELIANCE UPON AN EXEMPTION FROM THE REGISTRATION REQUIREMENTS OF THE SECURITIES ACT AND SUCH
        OTHER SECURITIES LAWS. NEITHER THIS SECURITY NOR ANY INTEREST OR PARTICIPATION HEREIN MAY BE SOLD, ASSIGNED, TRANSFERRED, PLEDGED, ENCUMBERED, OR OTHERWISE DISPOSED OF, EXCEPT PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT UNDER THE SECURITIES ACT OR AN OPINION OF COUNSEL REASONABLY SATISFACTORY TO THE CORPORATION THAT SUCH REGISTRATION IS NOT REQUIRED PURSUANT TO A VALID EXEMPTION THEREFROM UNDER THE
        SECURITIES ACT.

         

        Issue Date: _______________, 2007

         

         


        SERIES 2007 NON-REDEEMABLE WARRANT TO PURCHASE SHARES OF COMMON STOCK

         

        OF

         

        DISABOOM, INC.


        


        THIS CERTIFIES that, for value received, ___________ is entitled to purchase from DISABOOM, INC., a Colorado corporation (the “Corporation”), subject to the terms and conditions hereof, _________ shares (the “Warrant Shares”) of common stock, $0.0001 per share par value (the “Common
        Stock”). This warrant, together with all warrants hereafter issued in exchange or substitution for this warrant, is referred to as the “Warrant” and the holder of this Warrant is referred to as the “Holder.” The number of Warrant Shares is subject to adjustment as hereinafter provided. Notwithstanding anything to the contrary contained herein, this Warrant shall expire at 5:00pm MST on
        __[INSERT DATE THREE YEARS FROM ISSUE]________, 2010 (the “Termination Date”).


        


        1. Exercise of Warrants. The Holder may, at any time on or after the Issue Date and prior to
        the Termination Date, exercise this Warrant in whole or in part at an exercise price per share equal to $1.00 per share, subject to adjustment as provided herein (the “Warrant Price”), by the surrender of this Warrant (properly endorsed) at the principal office of the Corporation, or at such other agency or office of the Corporation in the United States of America as the Corporation may
        designate by notice in writing to the Holder at the address of such Holder appearing on the books of the Corporation, and by payment to the Corporation of the Warrant Price in lawful money of the United States by check or wire transfer for each share of Common Stock being purchased. Upon any partial exercise of this Warrant, there shall be executed and issued to the Holder a new Warrant in respect of the shares of Common Stock as to which this Warrant shall not have been exercised. In
        the event of the exercise of the rights represented by this Warrant, a certificate or certificates for the Warrant Shares so purchased, as applicable, registered in the name of the Holder, shall be delivered to the Holder hereof within three business days after the rights represented by this Warrant shall have been so
        exercised.


        


        2. Reservation of Warrant Shares. The Corporation agrees that, prior to the expiration of this
        Warrant, it will at all times have authorized and in reserve, and will keep available, solely for issuance or delivery upon the exercise of this Warrant, the number of Warrant Shares as from time to time shall be issuable by the Corporation upon the exercise of this Warrant.


         


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        3. No Stockholder Rights. This Warrant shall not entitle the holder hereof to any voting rights
        or other rights as a stockholder of the Corporation.


        


        4. Transferability of Warrant. Prior to the Termination Date and subject to compliance with applicable laws, this Warrant and all rights
        hereunder are transferable, in whole or in part, at the office or agency of the Corporation by the Holder in person or by duly authorized attorney, upon surrender of this Warrant together with the Assignment Form annexed hereto properly endorsed for transfer.


        


        5. Certain Adjustments. With respect to any rights that Holder has to exercise this Warrant and convert into shares of Common Stock,
        Holder shall be entitled to the following adjustments:


        


                          (a)     Reclassification, Recapitalization,
        etc. If the Corporation at any time shall, by subdivision, combination or reclassification of securities, recapitalization, automatic conversion, or other similar event affecting the number or character of outstanding shares of Common Stock, or otherwise, change any of the securities as to which purchase rights under this Warrant exist into the same or a different number of the Corporation’s
        securities of any other class or classes, this Warrant shall thereafter represent the right to acquire such number and kind of securities as would have been issuable as the result of such change with respect to the securities that were subject to the purchase rights under this Warrant immediately prior to such subdivision, combination, reclassification or other change.

         


        (b)     Split or Combination of Common Stock and Stock Dividend. In case the Corporation shall at any time
        subdivide, redivide, recapitalize, split (forward or reverse) or change its outstanding shares of Common Stock into a greater number of shares or declare a dividend upon its Common Stock payable solely in shares of Common Stock, the Warrant Price shall be proportionately reduced and the number of Warrant Shares proportionately increased. Conversely, in case the outstanding shares of Common Stock of the Corporation shall be combined into a smaller number of shares, the Warrant Price
        shall be proportionately increased and the number of Warrant Shares proportionately reduced. Notwithstanding the foregoing, in no event will the Warrant Price be reduced below the par value of the Common Stock.


        


        6. Legend and Stop Transfer Orders. Unless the Warrant Shares have been registered under the Securities Act, upon exercise of any part
        of the Warrant, the Corporation shall instruct its transfer agent to enter stop transfer orders with respect to such Warrant Shares, and all certificates or instruments representing the Warrant Shares shall bear on the face thereof substantially the following legend:


        


        THE SECURITIES EVIDENCED BY THIS CERTIFICATE HAVE NOT BEEN REGISTERED UNDER THE U.S. SECURITIES ACT, AS AMENDED, OR ANY OTHER APPLICABLE SECURITIES LAWS AND HAVE BEEN ISSUED IN RELIANCE UPON AN EXEMPTION FROM THE REGISTRATION REQUIREMENTS OF THE SECURITIES ACT AND SUCH OTHER SECURITIES LAWS. NEITHER THIS SECURITY
        NOR ANY INTEREST OR PARTICIPATION HEREIN MAY BE SOLD, ASSIGNED, TRANSFERRED, PLEDGED, ENCUMBERED, OR OTHERWISE DISPOSED OF, EXCEPT PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT UNDER THE SECURITIES ACT OR AN OPINION OF COUNSEL REASONABLY SATISFACTORY TO THE CORPORATION THAT SUCH REGISTRATION IS NOT REQUIRED PURSUANT TO A VALID EXEMPTION THEREFROM UNDER THE SECURITIES ACT.

         


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        7. Miscellaneous. This Warrant shall be governed by and construed in accordance with the laws of the State of Colorado. All the
        covenants and provisions of this Warrant by or for the benefit of the Corporation shall bind and inure to the benefit of its successors and assigns hereunder. Nothing in this Warrant shall be construed to give to any person or corporation other than the Corporation and the holder of this Warrant any legal or equitable right, remedy or claim under this Warrant. This Warrant shall be for the sole and exclusive benefit of the Corporation and the holder of this Warrant. The section headings
        herein are for convenience only and are not part of this Warrant and shall not affect the interpretation hereof. Upon receipt of evidence satisfactory to the Corporation of the loss, theft, destruction or mutilation of this Warrant, and of indemnity reasonably satisfactory to the Corporation, if lost, stolen or destroyed, and upon surrender and cancellation of this Warrant, if mutilated, the Corporation shall execute and deliver to the Holder a new Warrant of like date, tenor and
        denomination.


        


        IN WITNESS WHEREOF, the Corporation has caused this Warrant to be executed by its duly authorized officers this ___ day of ____________ 2007.


        


        DISABOOM, INC.


        


        By:        _________                         


        Title:                        _________       


         


         


         


         


         


         


         


        
            

        


         


        


        WARRANT EXERCISE FORM

         

        To Be Executed by the Holder in Order to Exercise Warrant

         


        To:      Disaboom, Inc.

                   7730 E. Bellview Avenue, Suite A-306

                  Greenwood Village, Colorado 80111

         

             Attention: President

         


        Dated: ___________________


         


        The undersigned, pursuant to the provisions set forth in the attached Warrant No. ______, hereby irrevocably elects to purchase _________ shares of the Common Stock of Disaboom, Inc. covered by such Warrant. 


        The undersigned herewith makes payment of the full purchase price for such shares at the price per share provided for in such Warrant. Such payment takes the form of $______ in lawful money of the United States.


        The undersigned hereby requests that certificates for the Warrant Shares purchased hereby be issued in the name of:


        


        
                                                                 

         


        
                                                                 

        (please print or type name and address)

         


        
                                                                                 
                

        (please insert social security or other identifying number)


        


        and be delivered as follows:

         


                                                        
                


        


                                                      
                  


        (please print or type name and address)

         


        
                                                                                    
             


        (please insert social security or other identifying number)

         

        and if such number of shares of Common Stock shall not be all the shares evidenced by this Warrant Certificate, that a new Warrant for the balance of such shares be registered in the name of, and delivered to, Holder.


         


        ___________________________________


        Signature of Holder


        


        SIGNATURE GUARANTEE:


         


        


        ___________________________________


         


         

        

        
            

        


        ASSIGNMENT FORM


        


        (To assign the foregoing warrant, execute

        this form. Do not use this form to exercise the warrant.)


        


        FOR VALUE RECEIVED, the foregoing Warrant and all rights evidenced thereby are hereby assigned to


        


        ________________________________________________________________ whose address is

         

        ______________________________________________________________________________

         

        ______________________________________________________________________________

         

         

         

                                          


         Dated: _____________________, _______

         

         

                       Holder's Signature:     __________________________________________

         

                       Holder's Address:     __________________________________________

                       

                                      __________________________________________

         

         

         

        


        Signature Guaranteed: ___________________________________________

         

          

         


        NOTE: The signature to this Assignment Form must correspond with the name as it appears on the face of the Warrant, without alteration or enlargement or any change whatsoever, and must be signature guaranteed. Officers of corporations and those acting in a fiduciary or other representative capacity should file
        proper evidence of authority to assign the foregoing Warrant.