Document:

EXHIBIT
      4.3

     

     

    21ST
      CENTURY HOLDING COMPANY

    

    

    6%
      SENIOR
      SUBORDINATED NOTE DUE JULY 31, 2006

    

    No.
      ______

    July
      31,
      2003

    $__________

    

    FOR
      VALUE
      RECEIVED, the undersigned, 21ST CENTURY HOLDING COMPANY (herein called the
      "Company"), a corporation organized and existing under the laws of the State
      of
      Florida , hereby promises to pay to [_____________________] or registered
      assigns, the principal sum of [______________] DOLLARS with interest (computed
      on the basis of a 360-day year of twelve 30-day months) (a) on the unpaid
      balance thereof at the rate of 6% per annum from the date hereof, payable
      quarterly beginning on October 31, 2003.

    

    This
      Note
      is one of a series of Senior Subordinated Notes (herein called the "Notes")
      issued pursuant to the Unit Purchase Agreement, dated as of July 31, 2003 (as
      from time to time amended, supplemented or modified, the "Unit Purchase
      Agreement"), between the Company and the respective Purchasers named therein
      and
      is entitled to the benefits thereof. Each holder of this Note will be deemed,
      by
      its acceptance hereof, (i) to have agreed to the confidentiality provisions
      set
      forth in Section 20 of the Unit Purchase Agreement and (ii) to have made the
      representations set forth in Section 6 of the Unit Purchase
      Agreement.

    

    Payments
      of principal of and interest on this Note are to be made, at the Company's
      option, in lawful money of the United States of America or, in whole or in
      part,
      by the issuance to the holder hereof of Interest Shares, as defined in and
      in
      accordance with the Unit Purchase Agreement.

    

    This
      Note
      is a registered Note and, as provided in the Unit Purchase Agreement, upon
      surrender of this Note for registration of transfer, duly endorsed, or
      accompanied by a written instrument of transfer duly executed, by the registered
      holder hereof or such holder's attorney duly authorized in writing, a new Note
      for a like principal amount will be issued to, and registered in the name of,
      the transferee. Prior to due presentment for registration of transfer, the
      Company may treat the person in whose name this Note is registered as the owner
      hereof for the purpose of receiving payment and for all other purposes, and
      the
      Company will not be affected by any notice to the contrary.

    

    The
      Company will make required prepayments of principal on the dates and in the
      amounts specified in the Unit Purchase Agreement. This Note is also subject
      to
      optional prepayment, in whole or from time to time in part, at the times and
      on
      the terms specified in the Unit Purchase Agreement, but not
      otherwise.

    

    If
      an
      Event of Default, as defined in the Unit Purchase Agreement, occurs and is
      continuing, the principal of this Note may be declared or otherwise become
      due
      and payable in the manner, at the price and with the effect provided in the
      Unit
      Purchase Agreement.

    

    Pursuant
      to the Subsidiary Guarantee dated as of July 31, 2003 (the "Subsidiary
      Guarantee"), certain subsidiaries of the Company have absolutely and
      unconditionally guaranteed payment in full of the principal of, and interest
      on
      this Note and the performance by the Company of all of its obligations contained
      in the Unit Purchase Agreement all as more fully set forth in said Subsidiary
      Guarantee.

    

    This
      Note
      shall be construed and enforced in accordance with, and the rights of the
      Company and the holder hereof shall be governed by, the law of the State of
      Florida, excluding the choice-of-law principles of such state that would require
      the application of the laws of a jurisdiction other than such
      state.

    

    
      	 	 	 
	 	21ST
              CENTURY
              HOLDING COMPANY
	 
 	 
 	 
 
	 	By:  	 
	 	
              
Richard
              A. Widdicombe, CEOEXHIBT
      4.4

    

    21ST
      CENTURY HOLDING COMPANY

    

    

    THIS
      WARRANT AND THE SECURITIES ISSUABLE UPON EXERCISE OF THIS WARRANT HAVE NOT
      BEEN
      REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE "SECURITIES ACT"),
      OR THE SECURITIES LAWS OF ANY STATE. THE SECURITIES REPRESENTED HEREBY ARE
      RESTRICTED AND MAY NOT BE SOLD, OFFERED FOR SALE, ASSIGNED, TRANSFERRED OR
      OTHERWISE DISPOSED OF, UNLESS REGISTERED PURSUANT TO THE PROVISIONS OF THE
      SECURITIES ACT AND APPLICABLE STATE SECURITIES LAWS OR AN OPINION OF COUNSEL,
      ACCEPTABLE TO THE COMPANY, IS OBTAINED STATING THAT SUCH DISPOSITION IS IN
      COMPLIANCE WITH AN AVAILABLE EXEMPTION FROM SUCH REGISTRATION.

    

    

    
      	
              Dated
                as of _________, 2003

            	
              No.
                W-

            

    

    

    21ST
      CENTURY HOLDING COMPANY

    

    (INCORPORATED
      UNDER THE LAWS OF THE STATE OF FLORIDA)

    

    REDEEMABLE
      WARRANT FOR THE PURCHASE OF SHARES OF COMMON STOCK

    

    FOR
      VALUE
      RECEIVED, 21st Century Holding Company, a Florida corporation (the "Company"),
      hereby certifies that ______________________, his (her/its) successors and
      assigns (the "Holder"), is the owner of such number of warrants (the "Warrants")
      as set forth in Section 1 hereof. Each Warrant initially entitles the Holder,
      subject to the provisions hereof, to purchase from the Company at any time
      and
      from time to time on and after the date hereof until 5:00 p.m. Florida local
      time on the Expiration Date (as described in Section 3 herein), one-half fully
      paid and non-assessable share of Common Stock (as defined below) at the Exercise
      Price per share of Common Stock (as described in

    Section
      2
      herein) on the terms and conditions hereinafter set forth.

    

    The
      term
      "Common Stock" means the Common Stock, par value $0.01 per share, of the Company
      as constituted on the date hereof (the "Base Date"). The number of shares of
      Common Stock to be received upon the exercise of this warrant certificate may
      be
      adjusted from time to time as hereinafter set forth. The shares of Common Stock
      deliverable upon such exercise, and as adjusted from time to time, are
      hereinafter referred to as "Warrant Shares." The term "Other Securities" means
      any other equity or debt securities that may be issued by the Company in
      addition thereto or in substitution for the Warrant Shares. The term "Company"
      means and includes the corporation named above as well as any immediate
      successor corporation resulting from a reorganization.

    

    Upon
      receipt by the Company of documentation reasonably satisfactory to it of the
      loss, theft, destruction or mutilation of this warrant certificate, and (in
      the
      case of loss, theft or destruction) of reasonably satisfactory indemnification,
      and upon surrender and cancellation of this warrant certificate, if mutilated,
      the Company shall execute and deliver a new warrant certificate of like tenor
      and date. Any such new warrant certificate executed and delivered shall
      constitute an additional contractual obligation on the part of the Company,
      whether or not this warrant certificate so lost, stolen, destroyed or mutilated
      shall be at any time enforceable by anyone.

    

    The
      Holder agrees with the Company that this warrant certificate is issued, and
      all
      the rights hereunder shall be held subject to, all of the conditions,
      limitations and provisions set forth herein.

    

    1.
      NUMBER
      OF WARRANTS. The Holder is the owner of a number of warrants equal to two times
      the quotient of the aggregate principal amount of the 6% Senior Subordinated
      Notes the Holder has purchased pursuant to the terms of the Unit Purchase
      Agreement (as hereinafter defined) and the Exercise Price.

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

    

    2.
      EXERCISE PRICE. The Exercise Price shall equal 115% of the weighted-average
      volume price for the Common Stock on Nasdaq as reported by Bloomberg Financial
      Markets ("Bloomberg") for the 60 consecutive trading days after the date of
      the
      Closing as set forth in the Unit Purchase Agreement; provided, however, that
      in
      no event shall the Exercise Price be greater than $25.00 per share nor lower
      than $15.00 per share. No later than 15 business days after the expiration
      date
      of the 60-day period set forth above, the Company shall mail a notice to the
      Holder, first class, postage prepaid, at such Holder's latest address as shall
      appear on the records of the Company or the Company's Warrant Agent (as
      hereinafter defined), if any, setting forth the Exercise Price and the number
      of
      Warrants determined in accordance with Sections 1 and 2 hereof.

    

    3.
      EXERCISE OF WARRANT. This warrant certificate may be exercised in whole or
      in
      part, at any time, or from time to time during the period commencing on the
      date
      hereof and expiring three years after the date hereof (the "Expiration Date").
      The Warrants must be exercised so as to purchase one full Warrant
      Share.

    

    4.
      NOTICE
      OF EXERCISE. Exercise of the Warrants shall be effected in any such case by
      presentation and surrender of this warrant certificate to the Company at its
      principal office, at the office of its stock transfer agent or any other warrant
      agent designated by the Company (the "Warrant Agent") if any, with the Warrant
      Exercise Form, a form of which is attached hereto as Exhibit A, duly executed
      and accompanied by payment (either in cash or by certified or official bank
      check, payable to the order of the Company) of the Exercise Price for the number
      of Warrant Shares specified in such form and instruments of transfer, if
      appropriate, duly executed by the Holder or its duly authorized attorney. If
      this warrant certificate should be exercised in part only, the Company shall,
      upon surrender of this warrant certificate for cancellation, execute and deliver
      a new warrant certificate evidencing the rights of the Holder thereof to
      purchase the balance of the Warrant Shares purchasable hereunder. Upon receipt
      by the Company of this warrant certificate, together with the Exercise Price,
      at
      its office, or by the Warrant Agent at its office, in proper form for exercise,
      the Holder shall be deemed to be the Holder of record of the shares of Common
      Stock issuable upon such exercise, notwithstanding that the stock transfer
      books
      of the Company shall then be closed or that certificates representing such
      shares of Common Stock shall not then be actually delivered to the Holder.
      The
      Company shall pay any and all documentary stamp or similar issue or transfer
      taxes payable in respect of the issue or delivery of shares of Common Stock
      on
      exercise of this warrant certificate, but in no event shall the Company be
      responsible or liable for income taxes or transfer taxes upon the issuance
      or
      transfer of the Warrants or the Warrant Shares.

    

    5.
      REDEMPTION RIGHTS. The Warrants may be redeemed, in whole or in part, at any
      time or from time to time, at the Company's sole option, commencing a year
      from
      the date hereof at a redemption price of $0.01 per Warrant Shares; provided,
      however, that before any such call for redemption of the Warrants the
      weighted-average volume price for the Company's Common Stock quoted on the
      Nasdaq National Market ("Nasdaq") shall have for 20 consecutive trading days
      ending not more than 10 days prior to the notice of redemption been in excess
      of
      150% of the Exercise Price, as such may be adjusted from time to time.
Redemption
      of the Warrants may only occur upon 30 days' prior written notice to the Holder,
      such notice to include certification of the trading price of the Company's
      Common Stock on Nasdaq as reported by Bloomberg. If the Company exercises its
      right to redeem the Warrants, in whole or in part, it shall mail a notice of
      redemption to the Holder, first class, postage prepaid, not later than the
      30th
      day before the date fixed for redemption, at such Holder's last address as
      shall
      appear on the records of the Company or the Company's Warrant Agent, if any.
      Any
      notice mailed in the manner provided herein shall be conclusively presumed
      to
      have been duly given whether or not the Holder receives such notice. The notice
      of redemption shall specify the redemption price, the date fixed for redemption,
      the place where the warrant certificate shall be delivered and the redemption
      price shall be paid, and that the right to exercise the Warrants shall terminate
      at 5:00 p.m. Florida local time on the business day immediately preceding the
      date fixed for redemption. The date fixed for the redemption of the Warrants
      shall be the Redemption Date. Any right to exercise a Warrant shall terminate
      at
      5:00 p.m. Florida local time on the business day immediately preceding the
      Redemption Date. On and after the Redemption Date, the Holder shall have no
      further rights except to receive, upon surrender of a certificate evidencing
      Warrants duly endorsed or accompanied by a written instrument or instruments
      of
      redemption in form satisfactory to the Company, the redemption price of $0.01,
      without interest, per Warrant Shares.

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

     

    6.
      RESERVATION OF SHARES. The Company will at all times reserve for issuance and
      delivery upon exercise of this warrant certificate all shares of Common Stock
      or
      other shares of capital stock of the Company (and Other Securities) from time
      to
      time receivable upon exercise of this warrant certificate. All such shares
      (and
      Other

    

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

    Securities)
      shall be duly authorized and, when issued upon such exercise, shall be validly
      issued, fully paid and non-assessable and free of all preemptive
      rights.

    

    7.
      FRACTIONAL SHARES. No fractional shares or script representing fractional shares
      shall be issued upon the exercise of the Warrants, but the Company shall pay
      the
      Holder an amount equal to the fair market value of such fractional share of
      Common Stock in lieu of each fraction of a share otherwise called for upon
      any
      exercise of the Warrants, as determined by the Board of Directors of the
      Company.

    

    8.
      EXCHANGE, TRANSFER, ASSIGNMENT OR LOSS OF WARRANT. This warrant certificate
      is
      exchangeable, without expense, at the option of the Holder, upon presentation
      and surrender hereof to the Company or at the office of its Warrant Agent,
      if
      any, for other warrant certificates of different denominations, entitling the
      Holder to purchase in the aggregate the same number of shares of Common Stock
      purchasable hereunder. Upon surrender of this warrant certificate to the Company
      or at the office of its Warrant Agent, if any, with an appropriate form of
      assignment duly executed and funds sufficient to pay any transfer tax, the
      Company shall, without charge, execute and deliver a new warrant certificate
      in
      the name of the assignee named in such instrument of assignment and this warrant
      certificate shall promptly be canceled. This warrant certificate may be divided
      or combined with other warrant certificates that carry the same rights upon
      presentation hereof at the office of the Company or at the office of its Warrant
      Agent, if any, together with a written notice specifying the names and
      denominations in which new warrant certificates are to be issued and signed
      by
      the Holder hereof.

    

    9.
      RIGHTS
      OF THE HOLDER. The Holder shall not, by virtue hereof, be entitled to any rights
      as a shareholder in the Company, either at law or in equity, and the rights
      of
      the Holder are limited to those expressed in this warrant
      certificate.

    

    10.
      ANTI-DILUTION PROVISIONS.

    

    10.1
      ADJUSTMENT FOR RECAPITALIZATION. If the Company shall at any time subdivide
      its
      outstanding shares of Common Stock (or Other Securities at the time receivable
      upon the exercise of the Warrants) by recapitalization, reclassification or
      split-up thereof, or if the Company shall declare a stock dividend or distribute
      shares of Common Stock to its shareholders, the number of shares of Common
      Stock
      subject to this warrant certificate immediately prior to such subdivision shall
      be proportionately increased and the Exercise Price shall be proportionately
      decreased, and if the Company shall at any time combine the outstanding shares
      of Common Stock by recapitalization, reclassification or combination thereof,
      the number of shares of Common Stock or Other Securities subject to this warrant
      certificate immediately prior to such combination shall be proportionately
      decreased and the Exercise Price shall be proportionately increased. Any such
      adjustments pursuant to this Section 10.1 shall be effective at the close of
      business on the effective date of such subdivision or combination or if any
      adjustment is the result of a stock dividend or distribution then the effective
      date of such adjustment based thereon shall be the record date
      therefor.

    

    10.2
      ADJUSTMENT FOR REORGANIZATION, CONSOLIDATION, MERGER, ETC. In the case of a
      reorganization of the Company after the Base Date, the Holder, upon the exercise
      thereof as provided in Section 1, at any time after the consummation of such
      reorganization, shall be entitled to receive, in lieu of the securities and
      property receivable upon the exercise of this warrant certificate prior to
      such
      consummation, the securities or property to which such Holder would have been
      entitled upon such consummation if such Holder had exercised this warrant
      certificate immediately prior thereto; in each such case, the terms of this
      warrant certificate shall be applicable to the securities or property receivable
      upon the exercise of this warrant certificate after such
      consummation.

    

    10.3
      ISSUANCES BELOW EXERCISE PRICE. Except in the case of the issuance of Common
      Stock issued (i) pursuant to any employee benefit plan of the Company now
      existing or to be implemented in the future, (ii) for consideration other than
      cash pursuant to a merger, consolidation, acquisition or similar business
      combination, (iii) in connection with any transaction referred to in, or
      contemplated by, this Section 10 hereof, (iv) pursuant to any equipment leasing
      or loan arrangement, or debt financing from a bank or similar financial or
      lending institution, (v) issued by the Company pursuant

    

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

    to
      a
      registration statement filed under the Securities Act, or (v) issued in
      connection with strategic transactions involving the Company and other entities,
      including (a) joint ventures, manufacturing, marketing or distribution
      arrangements or (b) technology transfer or development arrangements, if the
      Company at any time while the Warrants are outstanding, shall issue shares
      of
      Common Stock at a price per share (an "Issuance Price") less than the Exercise
      Price (or in the case of an issuance of Common Stock in a private placement
      at
      less than 80% of the Exercise Price), then the Exercise Price shall be
      multiplied by a fraction, the numerator of which shall be the number of shares
      of Common Stock outstanding immediately prior to the issuance of such Common
      Stock plus the number of shares of Common Stock which the price paid for such
      shares of Common Stock would purchase at the Exercise Price, and the denominator
      of which shall be the sum of the number of shares of Common Stock outstanding
      immediately prior to such issuance plus the number of shares of Common Stock
      so
      issued or issuable. Upon each adjustment of the Exercise Price pursuant to
      the
      provisions of this Section 10.2, the number of Warrant Shares issuable upon
      the
      exercise of each Warrant shall be adjusted by multiplying a number equal to
      the
      Exercise Price in effect immediately prior to such adjustment by the number
      of
      Warrant Shares issuable upon exercise of the Warrant immediately prior to such
      adjustment and dividing the product so obtained by the adjusted Exercise
      Price.

    

    10.4
      NOTICES OF RECORD DATE, ETC. In case:

    

    (a)
      the
      Company shall take a record of the holders of its Common Stock (or Other
      Securities at the time receivable upon the exercise of the Warrants) for the
      purpose of entitling them to receive any dividend (other than a cash dividend
      at
      the same rate as the rate of the last cash dividend theretofore paid) or other
      distribution, or any right to subscribe for, purchase or otherwise acquire
      any
      shares of stock of any class or any other securities, or to receive any other
      right; or

    

    (b)
      of
      any capital reorganization of the Company, any reclassification of the capital
      stock of the Company, or any consolidation or merger of the Company with or
      into
      another corporation; then, and in each such case, the Company shall mail or
      cause to be mailed to the Holder at the time outstanding a notice specifying,
      as
      the case may be, (i) the date on which a record is to be taken for the purpose
      of such dividend, distribution or right, and stating the amount and character
      of
      such dividend, distribution or right, or (ii) the date on which such
      reorganization, reclassification, consolidation or merger is to take place,
      and
      the time, if any, is to be fixed, as to which the holders of record of Common
      Stock (or such Other Securities at the time receivable upon the exercise of
      the
      Warrants) shall be entitled to exchange their shares of Common Stock (or such
      Other Securities) for securities or other property deliverable upon such
      reorganization, reclassification, consolidation or merger. Such notice shall
      be
      mailed at least 20 days prior to the date therein specified and the Warrants
      may
      be exercised prior to said date during the term of the Warrants.

    

    10.5
      LIMITATION ON ANTI-DILUTION ADJUSTMENTS. Notwithstanding anything to the
      contrary contained herein, the Company shall not adjust the number of Warrant
      Shares as provided in this Section 10, if such adjustment would, either
      individually or together with one or more other adjustments or together with
      one
      or more issuances of Transaction Shares (as defined in the Unit Purchase
      Agreement dated as of ___________, 2003 (the "Unit Purchase Agreement") among
      the Company and the Purchasers named therein), cause the issuance of shares
      of
      Common Stock to exceed the number of shares that the Company could then issue
      under Section 4350(i) of the rules and regulations of Nasdaq (the "Nasdaq
      Rules") or any successor rule or regulation. Under Section 4350(i) of the Nasdaq
      Rules, a company may not issue shares, and may not issue securities convertible
      into shares, where the shares issued could in the aggregate equal 20% or more
      of
      the voting power of the shares outstanding, without obtaining shareholder
      approval. The foregoing limitation shall only apply until such time as the
      Company obtains the requisite approval of its shareholders for the issuance
      of
      the Transaction Shares, as required by Section 4350(i) of the Nasdaq Rules
      or
      any successor rule or regulation. The Company covenants and agrees that it
      shall
      include a proposal for the approval of the issuance of the Transaction Shares
      in
      the Company's proxy statement for its 2004 annual meeting of shareholders,
      which
      the Company currently anticipates shall take place in June 2004. If, due to
      the
      foregoing limitation, the Company cannot adjust the Warrant Shares as provided
      in Section 10.3 above, then, subject to NASD approval, the Company agrees that
      the Exercise

    

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

    Price
      hereof shall be reduced to equal the Issuance Price(s) of the shares of Common
      Stock that triggered the adjustment pursuant to Section 10.3.

    

    11.
      TRANSFER TO COMPLY WITH THE SECURITIES ACT. The Warrants and any Warrant Shares
      or Other Securities may not be sold, transferred, pledged, hypothecated or
      otherwise disposed of unless registered under the Securities Act and any
      applicable state securities laws or pursuant to available exemptions from such
      registration, provided that the transferor delivers to the Company an opinion
      of
      counsel satisfactory to the Company confirming the availability of such
      exemption.

    

    12.
      REGISTRATION RIGHTS. The Warrants and the Warrant Shares issuable upon exercise
      of the Warrants shall be subject to certain registration rights as provided
      in
      the registration rights agreement (the "Registration Rights Agreement") among
      the Company and the initial holders of the Warrants. If the Company fails to
      comply with the terms of the Registration Rights Agreement, the Exercise Price
      shall be reduced by 10% for each full period of 30 consecutive days of such
      non-compliance (and there shall be no pro rata reduction of the Exercise Price
      if a period of non-compliance is not a full 30-day period).

    

    13.
      LEGEND. Unless the Warrant Shares or Other Securities have been registered
      under
      the Securities Act, upon exercise of any of the Warrants and the issuance of
      any
      of the Warrant Shares or Other Securities, all certificates representing such
      securities shall bear on the face thereof substantially the following
      legend:

    

    

    "The
      securities represented by this certificate have not been

    registered
      under the Securities Act of 1933, as amended (the

    "Act"),
      or under applicable state securities laws and may not

    be
      sold,
      offered for sale, assigned, transferred or otherwise

    disposed
      of, unless registered pursuant to the provisions of

    the
      Act
      and any applicable state securities laws or unless an

    opinion
      of counsel to the Company is obtained stating that

    such
      disposition is in compliance with an available exemption

    from
      such
      registration."

    

    14.
      NOTICES. All notices required hereunder shall be in writing and shall be deemed
      given when sent by facsimile, delivered personally or within two days after
      mailing when mailed by certified or registered mail, return receipt requested,
      to the Company at its principal office, or to the Holder at the address set
      forth on the record books of the Company, or at such other address of which
      the
      Company or the Holder has been advised by notice hereunder.

    

    15.
      APPLICABLE LAW. The Warrants are issued under and shall for all purposes be
      governed by and construed in accordance with the laws of the State of Florida,
      without giving effect to the choice of law rules thereof.

    

    IN
      WITNESS WHEREOF, the Company has caused this warrant certificate to be signed
      on
      its behalf, in its corporate name, by its duly authorized officer, all as of
      the
      day and year first above written.

     

     

    
      	 	 	 
	 	
              21ST
                CENTURY HOLDING COMPANY,

              a
                Florida corporation

            
	 
 	 
 	 
 
	 	By:  	 
	 	
              
Name:_________________________________________________
	 	Title:__________________________________________________

    

     

     

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

    EXHIBIT
      A

    

    WARRANT
      EXERCISE FORM

    

    (To
      be
      executed by the Holder to exercise the right to purchase shares of Common Stock
      under the foregoing Warrant)

    

    To
      21st
      Century Holding Company:

    

    In
      accordance with the warrant certificate enclosed with this Warrant Exercise
      Form, the undersigned hereby irrevocably elects to purchase________ shares
      of
      Common Stock, $0.01 par value per share ("Common Stock"), of 21st
      Century
      Holding Company and, encloses herewith $__________ in cash, certified or
      official bank check or checks, which sum represents the aggregate Exercise
      Price

    (as
      defined in the Warrant) for the number of shares of Common Stock to which this
      Warrant Exercise Form relates, together with any applicable taxes payable by
      the
      undersigned pursuant to the warrant certificate.

    

    The
      undersigned requests that certificates for the shares of Common Stock issuable
      upon this exercise be issued in the name of:

    

     

    
      
        	 	
                PLEASE INSERT SOCIAL SECURITY OR

                TAX IDENTIFICATION
                  NUMBER

              

      

    

     

    ________________________________________________________________________________________________________

    (Please
      print name and address)

    

    If
      the
      number of shares of Common Stock issuable upon this exercise shall not be all
      of
      the shares of Common Stock that the undersigned is entitled to purchase in
      accordance with the enclosed warrant certificate, the undersigned requests
      that
      a new warrant certificate evidencing the right to purchase the shares of Common
      Stock not issuable pursuant to the exercise evidenced hereby be

    issued
      in
      the name of and delivered to:

    

    

    ________________________________________________________________________________________________________

    (Please
      print name and address)

    

    ________________________________________________________________________________________________________

    

    ________________________________________________________________________________________________________

    

     

    
      	 	 	 
	 	 
	Date: __________________________________	 
 	____________________________________
 (Print
              name of holder
	 	 	By: ________________________________
	 	Title 
              _______________________________
	 	Title: _______________________________
	 	
              (Signature
                must conform in all respects to

              name
                of Holder as specified on the face of

              the
                Warrant)

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00102-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00102-of-00352.parquet"}]]