Document:

Form of Organizer Warrant Certificate

 Exhibit 10.3 
 DATED: ______________, 2007 
 _________ Shares 
  
 METRO BANCSHARES, INC. 
 ORGANIZER
STOCK PURCHASE WARRANT 
 TO PURCHASE SHARES OF 
 COMMON STOCK, $0.01 PAR VALUE PER SHARE 
 THIS AGREEMENT is made and entered into as of the ____ day
of ___________, 2007 by and between METRO BANCSHARES, INC., a Georgia corporation (the “Company”), and ____________ (the “Warrant Holder”). 
 W I T N E S S E T H 
 WHEREAS, the Warrant Holder has served as an organizer in the formation of the
Company and the formation and establishment of Metro Bank (the “Bank”), the wholly owned subsidiary of the Company; and 
 WHEREAS,
the Warrant Holder has purchased __________ shares of the Company’s common stock, $0.01 par value per share (the “Common Stock”), at a price of $10.00 per share; and 
 WHEREAS, the Warrant Holder will provide services to the Company as a director of the Company; and 
 WHEREAS, the Company, in recognition of the financial risk undertaken by the Warrant Holder in organizing the Bank and the Company, desires to issue to
the Warrant Holder the right to acquire additional shares of the Company’s Common Stock. 
 NOW, THEREFORE, in consideration of the
premises and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties to this Agreement agree as follows: 
 Section 1. Grant of Warrant. Subject to the terms, restrictions, limitations and conditions stated in this Agreement, the Company hereby grants to the Warrant Holder the right (the “Warrant”) to
purchase all or any part of an aggregate of _________ shares of the Common Stock, subject to adjustment in accordance with Section 6 of this Agreement. The number of shares of Common Stock which the Company grants the Warrant Holder the right
to purchase under this Agreement shall be no greater than one share for every $10.00 that the Warrant Holder put at risk during the organization of the Company and the Bank. 
 Section 2. Exercise Price. The price per share to be paid by the Warrant Holder for the shares of Common Stock subject to this Warrant shall be
$10.00, subject to adjustment as set forth in Section 6 of this Agreement (the price, as adjusted, is called the “Purchase Price”). 

 Metro Bancshares, Inc. 
 Organizer Stock Purchase Warrant 
 Dated                 
    , 2007 
 Page 2 
  

 Section 3. Term; Required Exercise; Restrictions on Exercise. 
  

	 	(a)	Term. The term for the exercise of this Warrant begins at 9:00 a.m., Eastern Time, on the date that the Company first issues its Common Stock (the “Issue Date”).
The term for the exercise of this Warrant ends at 5:00 p.m., Eastern Time (the “Expiration Time”) on the tenth anniversary of the Issue Date; 

  

	 	(b)	Required Exercise. Notwithstanding any other provision of this Agreement, if at any time while this Warrant is outstanding, (i) the Federal Deposit Insurance
Corporation, or (ii) the Georgia Department of Banking and Finance makes a formal capital call upon the Bank, the Warrant Holder will exercise this Warrant in whole or in part as may be needed for additional required capital, or the Warrant
shall be forfeited. The number of shares of Common Stock as to which the Warrant shall be exercised by each warrant holder to meet the capital call will be calculated pro rata on the basis of the number of shares of Common Stock subject to a Warrant
held by each warrant holder. The exercise price for shares of Common Stock purchased upon such exercise will be equal to the greater of the Exercise Price determined pursuant to Section 2 hereof or the then-current book value per share of the
Common Stock. Any portion of this Warrant not required to be exercised under the terms of any such capital call may be exercised under the original terms of this Warrant. 

  

	 	(c)	Restrictions on Exercise. No portion of the Warrant may be exercised (i) if the issuance of the shares of Common Stock upon such exercise would constitute a violation of
any applicable federal or state securities or banking laws or other law or regulation or (ii) unless the Company or the holder hereof, as applicable, obtains any approval or other clearance which the Company determines to be necessary or
advisable from the Federal Reserve Board, the Federal Deposit Insurance Corporation, the Georgia Department of Banking and Finance or any other state or federal banking regulatory agency with regulatory authority over the operation of Company or the
Bank. The Company may require representations and warranties from the Warrant Holder as required to comply with applicable laws or regulations, including the Securities Act of 1933, as amended (the “Act”) and state securities laws. In
addition, the Company shall not be obligated to deliver any shares of Common Stock pursuant to the exercise of any portion of the Warrant and shall have no obligation to settle such Warrants exercise unless a registration statement under the Act
with respect to the Shares is effective and a prospectus complying in all material respects with the Act (a “Prospectus”) is available for delivery by the Company. In the event that a registration statement with respect to the shares of
Common Stock underlying the Warrant is not effective under the Act or a Prospectus relating to such shares is not available for delivery by the Company, the Warrant Holder shall not be entitled to exercise any portion of the Warrant and the Warrant
may have no value and expire worthless. In no event will the Company be required to net cash settle the exercise of the Warrant. 

 Section 4. Exercise of Warrant. Subject to Section 3(c) above, the Warrant Holder may exercise this Warrant from time to time, in whole or in part, by delivering the following to the Company: 
  

	 	(a)	written notice of exercise specifying the number of shares of Common Stock with respect to which this Warrant is being exercised at such time; and 

  

 Metro Bancshares, Inc. 
 Organizer Stock Purchase Warrant 
 Dated                 
    , 2007 
 Page 3 
  

	 	(b)	a cashier’s or certified check payable to the Company for the full amount of the aggregate Purchase Price for the number of shares as to which this Warrant is being exercised
at such time. 

 The Warrant Holder must deliver the notice of exercise and the cashier’s or certified
check to the address of the Company as set forth in Section 10(a) of this Agreement or any other address that the Company requests. 
 Section 5. Issuance of Shares. Upon receipt of the items set forth in Section 4 of this Agreement, and subject to the terms of this Agreement, the Company shall deliver to the Warrant Holder stock certificates for the number of
shares specified in the notice to exercise, and shall register such shares in the name of the Warrant Holder. 
 Section 6.
Antidilution. 
  

	 	(a)	If, prior to the Expiration Time, the Company shall subdivide its outstanding shares of Common Stock into a greater number of shares, or declare and pay a dividend of its Common
Stock payable in additional shares of its Common Stock, the Purchase Price, as then in effect, shall be proportionately reduced, and the Company shall proportionately increase the number of shares of Common Stock then subject to exercise under this
Warrant (and not previously exercised). 

  

	 	(b)	If, prior to the Expiration Time, the Company shall combine its outstanding shares of Common Stock into a smaller number of shares, the Purchase Price, as then in effect, shall be
proportionately increased, and the Company shall proportionately reduce the number of shares of Common Stock then subject to exercise under this Warrant (and not previously exercised). 

 Section 7. Reorganization, Reclassification, Consolidation or Merger. If, prior to the Expiration Time, there shall be any reorganization or
reclassification of the Common Stock (other than a subdivision or combination of shares provided for in Section 6 of this Agreement), or any consolidation or merger of the Company with another entity, the Warrant Holder shall be entitled to
receive, during the remainder of the term of this Agreement and upon payment of the Purchase Price, the number of shares of stock or other securities or property of the Company or of the successor entity (or its parent company) resulting from such
consolidation or merger, as the case may be, to which a holder of the Common Stock, deliverable upon the exercise of this Warrant, would have been entitled upon such reorganization, reclassification, consolidation or merger; and in any case, the
Company shall make appropriate adjustments (as determined by the Board of Directors of the Company in its sole discretion) in the application of the provisions with respect to the rights and interests of the Warrant Holder so that the provisions set
forth in this Agreement (including the adjustment of the Purchase Price and the number of shares issuable upon the exercise of this Warrant) shall be applicable, as near as may reasonably be practicable, to any shares or other property thereafter
deliverable upon the exercise of this Warrant. 

 Metro Bancshares, Inc. 
 Organizer Stock Purchase Warrant 
 Dated                 
    , 2007 
 Page 4 
  

 Section 8. Transfer and Assignment. 
  

	 	(a)	The Warrant granted in this Agreement may not be transferred or sold unless the transfer is exempt from further regulatory approval or otherwise permissible under applicable law,
including state and federal securities laws. 

  

	 	(b)	Shares of Common Stock acquired by exercise of this Warrant granted in this Agreement may not be transferred or sold unless the transfer is exempt from further regulatory approval
or otherwise permissible under applicable law, including state and federal securities laws, and will bear a legend to this effect. 

 Section 9. Notice of Adjustments. Within thirty (30) days following the determination of any adjustment provided for in Section 6 or Section 7 of this Agreement, the Company shall give written notice of such adjustment
to the Warrant Holder at the address set forth in Section 10(a) of this Agreement or such other address as the Warrant Holder may request. The notice shall state the Warrant Purchase Price as adjusted and the increased or decreased number of
shares purchasable upon the exercise of this Warrant and shall set forth in reasonable detail the method of calculation of each. 
 Section
10. Miscellaneous. 
  

	 	(a)	Notices. All notices, requests, demands and other communications required or permitted hereunder shall be in writing and shall be deemed to have been duly given when
delivered by hand, telegram or facsimile transmission, or if mailed, by postage prepaid first class mail, on the third business day after mailing, to the following address (or at such other address as a party may notify the other hereunder):

 To the Company: 
 Metro Bancshares, Inc. 
 7475 Douglas Boulevard 
 Douglasville, Georgia 30154 
 Attention: Corporate Secretary 
  
 To the Warrant Holder: 
  

					
	 	  		  	
			
	 	  		  	
			
	 	  		  	

  

	 	(b)	Reservation of Shares. The Company covenants that it has reserved and will keep available, solely for the purpose of issue upon the exercise of this Warrant, a sufficient
number of shares of Common Stock to permit the exercise hereof in full. 

  

	 	(c)	 Rights of Holders. No holder of this Warrant, as such, shall be entitled to vote or receive dividends with respect to the shares of Common Stock subject to
this Warrant or be deemed 

 Metro Bancshares, Inc. 
 Organizer Stock Purchase Warrant 
 Dated                 
    , 2007 
 Page 5 
  

	 	 
to be a shareholder of the Company for any purpose until such Common Stock has been issued. 

  

	 	(d)	Amendment. This Agreement shall constitute the entire agreement contemplated by the Company and the Warrant Holder and may be amended only by an instrument in writing
executed by the party against whom enforcement of the amendment is sought. 

  

	 	(e)	Counterparts. This Agreement may be executed in counterparts, each of which shall be deemed an original, but all of which shall constitute one and the same instrument.

  

	 	(f)	Governing Law. This Agreement shall be governed by and construed and enforced in accordance with the laws of the State of Georgia. 

  
 [Remainder of Page Intentionally Left Blank] 

 Metro Bancshares, Inc. 
 Organizer Stock Purchase Warrant 
 Dated                 
    , 2007 
 Page 6 
  

 IN WITNESS WHEREOF, the Company has caused this Warrant to be executed this ____ day of ______________,
2007, by its duly authorized officers. 
  

			
	METRO BANCSHARES, INC.
		
	By:	 	 
		 	Kenneth L. Barber, President and Chief Executive Officer

 ATTEST: 
  

			
	
		
	By:	 	 
		
	Name:	 	 
		
	Title:	 	 

 EXHIBIT A 
 [Subscription Form to Be Executed Upon Exercise of Warrant] 
  
 The undersigned registered holder or permitted assignee of such registered holder of the Warrant hereby (1) subscribes for ______ shares of Common Stock which the undersigned is entitled to purchase under the
terms of the Warrant, (2) makes the full cash payment therefor called for by the within Warrant, and (3) directs that the shares of Common Stock issuable upon exercise of said Warrant be issued as follows: 
  
  
  

			
	
	 
	(Name)
	
	 
	(Address)
		
	Signature	 	 

 Dated  _______________________ 
  
  
  
 NOTICE: The signature on this subscription form must correspond with the name as written upon the face of the Warrant in every particular, without alteration or
enlargement, or any change whatsoever, and must be guaranteed by a bank, other than a savings bank or trust company, or by a firm having membership on a registered national securities exchange.Form of Director Warrant Certificate

 Exhibit 10.4 
 DATED: ______________, 2007 
 _________ Shares 
  
 METRO BANCSHARES, INC. 
 DIRECTOR
STOCK PURCHASE WARRANT 
 TO PURCHASE SHARES OF 
 COMMON STOCK, $0.01 PAR VALUE PER SHARE 
 THIS AGREEMENT is made and entered into as of the ____ day
of ___________, 2007 by and between METRO BANCSHARES, INC., a Georgia corporation (the “Company”), and ____________ (the “Warrant Holder”). 
 W I T N E S S E T H 
 WHEREAS, the Warrant Holder has served as an organizer in the formation of the
Company and the formation and establishment of Metro Bank (the “Bank”), the wholly owned subsidiary of the Company; and 
 WHEREAS,
the Warrant Holder has purchased __________ shares of the Company’s common stock, $0.01 par value per share (the “Common Stock”), at a price of $10.00 per share; and 
 WHEREAS, the Warrant Holder will provide services to the Company as a director of the Company; and 
 WHEREAS, the Company, in recognition of the financial risk undertaken by the Warrant Holder in organizing the Bank and the Company and in order to
encourage the Warrant Holder’s continued involvement in the successful operation of the Company and the Bank, desires to issue to the Warrant Holder the right to acquire additional shares of the Company’s Common Stock. 
 NOW, THEREFORE, in consideration of the premises and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged,
the parties to this Agreement agree as follows: 
 Section 1. Grant of Warrant. Subject to the terms, restrictions, limitations and
conditions stated in this Agreement, the Company hereby grants to the Warrant Holder the right (the “Warrant”) to purchase all or any part of an aggregate of _________ shares of the Common Stock, subject to adjustment in accordance with
Section 6 of this Agreement. The aggregate number of shares of Common Stock which the Company grants the Warrant Holder the right to purchase under this Agreement shall be no greater than the number of shares of Common Stock subscribed by the
Warrant Holder upon organizing the Bank. 
 Section 2. Exercise Price. The price per share to be paid by the Warrant Holder for the
shares of Common Stock subject to this Warrant shall be $10.00, subject to adjustment as set forth in Section 6 of this Agreement (the price, as adjusted, is called the “Purchase Price”). 
  

 Metro Bancshares, Inc. 
 Director Stock Purchase Warrant 
 Dated                 
    , 2007 
 Page 2 
  

 Section 3. Term; Required Exercise; Vesting; Restrictions on Exercise. 
  

	 	(a)	Term. The term for the exercise of this Warrant begins at 9:00 a.m., Eastern Time, on the first anniversary of the date that the Company first issues its Common Stock (the
“Issue Date”). The term for the exercise of this Warrant ends at 5:00 p.m., Eastern Time (the “Expiration Time”) on the earlier of: 

  

	 	(i)	the tenth anniversary of the Issue Date; or 

  

	 	(ii)	90 days after the Warrant Holder ceases to serve as a director of the Company; provided, however, that if the Warrant Holder ceases to be a director because he is disabled or is
deceased, then the Warrant Holder (or his estate) will have until twelve months after the Warrant Holder ceases to serve as a director of the Company to exercise this Warrant. 

  

	 	(b)	Required Exercise. Subject to Section 3(d) below, if at any time while this Warrant is outstanding, (i) the Federal Deposit Insurance Corporation, or (ii) the
Georgia Department of Banking and Finance makes a formal capital call upon the Bank, the Warrant Holder will exercise this Warrant in whole or in part as may be needed for additional required capital, or the Warrant shall be forfeited. The number of
shares of Common Stock as to which the Warrant shall be exercised by each warrant holder to meet the capital call will be calculated pro rata on the basis of the number of shares of Common Stock subject to a Warrant held by each warrant holder. The
exercise price for shares of Common Stock purchased upon such exercise will be equal to the greater of the Exercise Price determined pursuant to Section 2 hereof or the then-current book value per share of the Common Stock. Any portion of this
Warrant not required to be exercised under the terms of any such capital call may be exercised under the original terms of this Warrant. 

  

	 	(c)	Vesting. The Warrant will vest in equal, annual one-fifth (1/5) increments over a period of five years, beginning on the first anniversary of the Issue Date. The vested
portion of the Warrant may be exercised in whole, or from time to time in part, at any time prior to the Expiration Time. In the event of permanent disability or death of the Warrant Holder, any unvested portion of the Warrant shall become fully
vested to the Warrant Holder (or his estate). 

  

	 	(d)	 Restrictions on Exercise. No portion of the Warrant may be exercised (i) if the issuance of the shares of Common Stock upon such exercise would
constitute a violation of any applicable federal or state securities or banking laws or other law or regulation or (ii) unless the Company or the holder hereof, as applicable, obtains any approval or other clearance which the Company determines
to be necessary or advisable from the Federal Reserve Board, the Federal Deposit Insurance Corporation, the Georgia Department of Banking and Finance or any other state or federal banking regulatory agency with regulatory authority over the
operation of Company or the Bank. The Company may require representations and warranties from the Warrant Holder as required to comply with applicable laws or regulations, including the Securities Act of 1933, as amended (the “Act”) and
state securities laws. In addition, the Company shall not be obligated to deliver any shares of Common Stock pursuant to the exercise of any portion of the Warrant and shall have no obligation to settle such Warrants exercise unless a registration
statement under the Act 

 Metro Bancshares, Inc. 
 Director Stock Purchase Warrant 
 Dated                 
    , 2007 
 Page 3 
  

	 	 
with respect to the Shares is effective and a prospectus complying in all material respects with the Act (a “Prospectus”) is available for delivery
by the Company. In the event that a registration statement with respect to the shares of Common Stock underlying the Warrant is not effective under the Act or a Prospectus relating to such shares is not available for delivery by the Company, the
Warrant Holder shall not be entitled to exercise any portion of the Warrant and the Warrant may have no value and expire worthless. In no event will the Company be required to net cash settle the exercise of the Warrant.

 Section 4. Exercise of Warrant. Subject to Section 3(d), to the extent the Warrant has vested, the Warrant
Holder may exercise this Warrant from time to time, in whole or in part, by delivering the following to the Company: 
  

	 	(a)	written notice of exercise specifying the number of shares of Common Stock with respect to which this Warrant is being exercised at such time; and 

  

	 	(b)	a cashier’s or certified check payable to the Company for the full amount of the aggregate Purchase Price for the number of shares as to which this Warrant is being exercised
at such time. 

 The Warrant Holder must deliver the notice of exercise and the cashier’s or certified check to the
address of the Company as set forth in Section 10(a) of this Agreement or any other address that the Company requests. 
 Section 5.
Issuance of Shares. Upon receipt of the items set forth in Section 4 of this Agreement, and subject to the terms of this Agreement, the Company shall deliver to the Warrant Holder stock certificates for the number of shares specified in
the notice to exercise, and shall register such shares in the name of the Warrant Holder. 
 Section 6. Antidilution. 
  

	 	(a)	If, prior to the Expiration Time, the Company shall subdivide its outstanding shares of Common Stock into a greater number of shares, or declare and pay a dividend of its Common
Stock payable in additional shares of its Common Stock, the Purchase Price, as then in effect, shall be proportionately reduced, and the Company shall proportionately increase the number of shares of Common Stock then subject to exercise under this
Warrant (and not previously exercised). 

  

	 	(b)	If, prior to the Expiration Time, the Company shall combine its outstanding shares of Common Stock into a smaller number of shares, the Purchase Price, as then in effect, shall be
proportionately increased, and the Company shall proportionately reduce the number of shares of Common Stock then subject to exercise under this Warrant (and not previously exercised). 

 Section 7. Reorganization, Reclassification, Consolidation or Merger. If, prior to the Expiration Time, there shall be any reorganization or
reclassification of the Common Stock (other than a subdivision or combination of shares provided for in Section 6 of this Agreement), or any consolidation or merger of the Company with another entity, the Warrant Holder shall be entitled to
receive, during the remainder of the term of this Agreement and upon payment of the Purchase 

 Metro Bancshares, Inc. 
 Director Stock Purchase Warrant 
 Dated                 
    , 2007 
 Page 4 
  

 
Price, the number of shares of stock or other securities or property of the Company or of the successor entity (or its parent company) resulting from such
consolidation or merger, as the case may be, to which a holder of the Common Stock, deliverable upon the exercise of this Warrant, would have been entitled upon such reorganization, reclassification, consolidation or merger; and in any case, the
Company shall make appropriate adjustments (as determined by the Board of Directors of the Company in its sole discretion) in the application of the provisions with respect to the rights and interests of the Warrant Holder so that the provisions set
forth in this Agreement (including the adjustment of the Purchase Price and the number of shares issuable upon the exercise of this Warrant) shall be applicable, as near as may reasonably be practicable, to any shares or other property thereafter
deliverable upon the exercise of this Warrant. 
 Section 8. Transfer and Assignment. 
  

	 	(a)	During the Warrant Holder’s lifetime, this Warrant and any rights under this Agreement shall be exercisable only by the Warrant Holder (or by the Warrant Holder’s guardian
or legal representative, should one be appointed). Except assignments or transfers of the vested portion of this Warrant made by will or under the laws of descent and distribution, this Warrant or any rights under this Agreement may not be assigned,
transferred, pledged or hypothecated in any way (whether by operation of law or otherwise) and shall not be subject to execution, attachment or similar process. Any attempted assignment, transfer, pledge, hypothecation or other disposition of this
Warrant except as provided for in this Section 8 shall be null and void and without legal effect. 

  

	 	(b)	Shares of Common Stock acquired by exercise of this Warrant granted in this Agreement may not be transferred or sold unless the transfer is exempt from further regulatory approval
or otherwise permissible under applicable law, including state and federal securities laws, and will bear a legend to this effect. 

 Section 9. Notice of Adjustments. Within thirty (30) days following the determination of any adjustment provided for in Section 6 or Section 7 of this Agreement, the Company shall give written notice of such adjustment
to the Warrant Holder at the address set forth in Section 10(a) of this Agreement or such other address as the Warrant Holder may request. The notice shall state the Warrant Purchase Price as adjusted and the increased or decreased number of
shares purchasable upon the exercise of this Warrant and shall set forth in reasonable detail the method of calculation of each. 
 Section
10. Miscellaneous. 
  

	 	(a)	Notices. All notices, requests, demands and other communications required or permitted hereunder shall be in writing and shall be deemed to have been duly given when
delivered by hand, telegram or facsimile transmission, or if mailed, by postage prepaid first class mail, on the third business day after mailing, to the following address (or at such other address as a party may notify the other hereunder):

 To the Company: 
 Metro Bancshares, Inc. 
 7475 Douglas Boulevard 
  

 Metro Bancshares, Inc. 
 Director Stock Purchase Warrant 
 Dated                 
    , 2007 
 Page 5 
  

 Douglasville, Georgia 30154 
 Attention: Corporate Secretary 
  
 To
the Warrant Holder: 
  

					
	 	  		  	
			
	 	  		  	
			
	 	  		  	

  

	 	(b)	Reservation of Shares. The Company covenants that it has reserved and will keep available, solely for the purpose of issue upon the exercise of this Warrant, a sufficient
number of shares of Common Stock to permit the exercise hereof in full. 

  

	 	(c)	Rights of Holders. No holder of this Warrant, as such, shall be entitled to vote or receive dividends with respect to the shares of Common Stock subject to this Warrant or be
deemed to be a shareholder of the Company for any purpose until such Common Stock has been issued. 

  

	 	(d)	Amendment. This Agreement shall constitute the entire agreement contemplated by the Company and the Warrant Holder and may be amended only by an instrument in writing
executed by the party against whom enforcement of the amendment is sought. 

  

	 	(e)	Counterparts. This Agreement may be executed in counterparts, each of which shall be deemed an original, but all of which shall constitute one and the same instrument.

  

	 	(f)	Governing Law. This Agreement shall be governed by and construed and enforced in accordance with the laws of the State of Georgia. 

  
 [Remainder of Page Intentionally Left Blank] 

 Metro Bancshares, Inc. 
 Director Stock Purchase Warrant 
 Dated                 
    , 2007 
 Page 6 
  

 IN WITNESS WHEREOF, the Company has caused this Warrant to be executed this ____ day of ______________,
2007, by its duly authorized officers. 
  

			
	METRO BANCSHARES, INC.
		
	By:	 	 
		 	Kenneth L. Barber, President and Chief Executive Officer

 ATTEST: 
  

			
	
		
	By:	 	 
		
	Name:	 	 
		
	Title:	 	 

 EXHIBIT A 
 [Subscription Form to Be Executed Upon Exercise of Warrant] 
 The undersigned registered holder or permitted
assignee of such registered holder of the Warrant hereby (1) subscribes for ______ shares of Common Stock which the undersigned is entitled to purchase under the terms of the Warrant, (2) makes the full cash payment therefor called for by
the within Warrant, and (3) directs that the shares of Common Stock issuable upon exercise of said Warrant be issued as follows: 
  

			
	
	
	 
	(Name)
	
	 
	(Address)
		
	Signature	 	 

 Dated  ___________________ 
  
  
  
 NOTICE: The signature on this subscription form must correspond with the name as written upon the face of the Warrant in every particular, without alteration or
enlargement, or any change whatsoever, and must be guaranteed by a bank, other than a savings bank or trust company, or by a firm having membership on a registered national securities exchange.

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