Document:

Exhibit 10.5

 

	 	_________________, 2014

 

Committed Capital Acquisition Corporation II

712 Fifth Avenue, 22nd Floor

New York, NY 10019

Attn: Michael Rapoport

 

Broadband Capital Management LLC

712 Fifth Avenue, 22nd Floor

New York, NY 10019

Attn: George Cannon

 

	 	Re:	Initial Public Offering

 

Ladies and Gentlemen:

 

This letter (“Letter
Agreement”) is being delivered to you in accordance with the Underwriting Agreement (the “Underwriting Agreement”)
entered into, or proposed to be entered into, by and between Committed Capital Acquisition Corporation II, a Delaware corporation
(the “Company”), and Broadband Capital Management LLC, as representative of the several underwriters (the “Underwriters”),
relating to an underwritten initial public offering (the “Offering”) of 5,750,000 of the Company’s units (the
“Units”) (including up to 750,000 Units subject to an over-allotment option granted to the Underwriters), each comprised
of one share of the Company’s common stock, par value $0.00001 per share (the “Common Stock”), and one warrant
exercisable for one share of Common Stock (each, a “Warrant”). The Units sold in the Offering shall be quoted and
traded on the Over-the-Counter Bulletin Board pursuant to a registration statement on Form S-1 (the “Registration Statement”)
and prospectus (the “Prospectus”) filed by the Company with the Securities and Exchange Commission (the “Commission”).
Certain capitalized terms used herein are defined in Section 14 hereof.

 

In order to induce
the Company and the Underwriters to enter into the Underwriting Agreement and to proceed with the Offering and for other good
and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the undersigned hereby agrees with the
Company as follows:

 

1.          The
undersigned agrees that if the Company seeks stockholder approval of a proposed Business Transaction, then in connection with
such proposed Business Transaction, he, she or it shall vote all its Initial Shares and any shares acquired by him, her or it
in the Offering or the secondary public market in favor of such proposed Business Transaction.

 

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2. (a)      The
undersigned hereby agrees that in the event that the Company fails to consummate a Business Transaction within 24 months from
the Effective Date (such date, the “Termination Date”), he, she or it shall take all reasonable steps to cause the
Company to (i) cease all operations except for the purpose of winding up, (ii) as promptly as reasonably practicable, but not
more than five business days thereafter, redeem the Common Stock held by the Public Stockholders, at a per-share price, payable
in cash, equal to the aggregate amount including interest then on deposit in the Trust Account, but net of any taxes payable and
net interest withdrawn for working capital purposes, divided by the number of shares of Common Stock then outstanding, subject
to applicable law, and (iii) as promptly as reasonably practicable following such redemption, subject to the approval of the board
of directors of the Company, dissolve and liquidate the balance of the Company’s net assets to the holders of the Common
Stock, subject in each case to the Company’s obligations under Delaware law to provide for claims of creditors and other
requirements of applicable law.

 

(b)          The
undersigned acknowledges that the undersigned has no right, title, interest or claim of any kind in or to any monies held in the
Trust Account or any other asset of the Company as a result of any liquidation of the Trust Account with respect to the Initial
Shares or Placement Shares. To the extent that redemption rights are granted to the holders of Common Stock, the undersigned hereby
further waives, with respect to any shares of the Common Stock held by him or it, any redemption rights he or it may have in connection
with the consummation of a Business Transaction, including, without limitation, any such rights available in the context of a
stockholder vote to approve such Business Transaction or in the context of a tender offer made by the Company to purchase shares
of the Common Stock (although the undersigned shall be entitled to redemption and liquidation rights with respect to any shares
of the Common Stock (other than the Initial Shares and Placement Shares) the undersigned holds if the Company fails to consummate
a Business Transaction by the Termination Date).

 

(c)          The
undersigned hereby agrees not to take any action to amend or waive any provision of the Company’s amended and restated certificate
of incorporation relating to the Company’s obligation to redeem the shares of Common Stock held by Public Stockholders if
the Company fails to consummate a Business Transaction on or prior to the Termination Date in a manner that would limit the Company’s
obligations to redeem such shares.

 

(d)          If
the Company fails to consummate a Business Transaction on or prior to the Termination Date, and submits a plan of dissolution
to the Public Stockholders for approval because it is unable to redeem the shares of Common Stock held by Public Stockholders
in accordance with the Company’s amended and restated certificate of amendment, the undersigned hereby agrees to vote the
Initial Shares held by the undersigned in accordance with the majority of the Public Stockholders.

 

3. (a)      The
undersigned agrees that the Initial Shares held by the undersigned are subject to forfeiture as described in this Section 3. As
a result of such forfeiture, after giving effect to (I) the Offering, (II) any exercise of the over-allotment option by the Underwriters,
(III) the completion of a Private Placement (as defined in Section 5) in the amount of at least $10,000,000, and (IV) any exercises
of the Warrants, the Initial Shares collectively held by all Initial Stockholders, after all forfeitures, will collectively be
equal to 20.0% of the Company’s issued and outstanding shares of Common Stock. The forfeiture of Initial Shares shall be
calculated as follows:

 

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(i)          First,
to the extent that the Underwriters do not exercise their over-allotment option to purchase an additional 750,000 Units in full,
the undersigned, together with the other Initial Stockholders, shall return to the Company for cancellation, at no cost, up to
3,130,556 of the Initial Shares. The board of directors of the Company shall determine the number of Initial Shares to be forfeited
by the undersigned, which determination shall be made on a pro rata basis based on (A) the Pro Rata Share of the undersigned and
(B) the quotient calculated by dividing (X) 750,000 minus the number of Units purchased by the Underwriters upon the exercise
of their over-allotment option, by (Y) 750,000. All adjustments under this Section 3(a)(i) shall be calculated prior to calculating
the adjustments pursuant to Sections 3(a)(ii) and 3(a)(iii). The Initial Shares to be forfeited by the undersigned pursuant to
this Section 3(a)(i) is referred to herein as the “Over-allotment Forfeiture Shares”.

 

(ii)         Second,
to the extent that the Warrants are not exercised in full by the Warrant Expiration Time, the undersigned, together with the other
Initial Stockholders, shall return to the Company for cancellation, at no cost, up to 12,000,463 Initial Shares. The board of
directors of the Company shall determine the number of Initial Shares to be forfeited by the undersigned, which determination
shall be made on a pro rata basis based on (A) the Pro Rata Share of the undersigned and (B) the quotient calculated by dividing
(X) the number of Warrants issued in the Offering minus the number of Warrants exercised on or prior to the Warrant Expiration
Time, by (Y) the number of Warrants issued in the Offering. All adjustments under this Section 3(a)(ii) shall be calculated after
calculating the adjustments pursuant to Section 3(a)(i). The Initial Shares to be forfeited by the undersigned pursuant to this
Section 3(a)(ii) is referred to herein as the “Warrant Exercise Forfeiture Shares”.

 

(iii)        Third,
up to 24,800,000 Initial Shares held by the undersigned and the other Initial Stockholders shall be subject to forfeiture based
on (A) the decision of the board of directors of the Company to cause the forfeiture and cancellation of such Initial Shares at
its sole discretion, and (B) the number of Over-allotment Forfeiture Shares and Warrant Exercise Forfeiture Shares. All forfeitures
under this Section 3(a)(iii) may be for any reason or no reason and shall be at the sole discretion of the board of directors
of the Company. Such forfeitures shall be effective upon the resolution by the board of directors to cancel such Initial Shares
held by the undersigned. If all of the Initial Shares held by the undersigned are forfeited and cancelled, the Company shall send
a check to the undersigned for the original subscription amount, provided that the Company has the funds legally available therefor
under Delaware law. In the event that fewer than all of such Initial Shares are forfeited, there will be no return of capital
to the undersigned. The undersigned shall return to the Company for cancellation, at no cost (unless all of the Initial Shares
are forfeited), the number of Initial Shares determined by the board of directors of the Company to be forfeited by the undersigned
pursuant to this Section 3(a)(iii) in accordance with the determination of the board of directors of the Company. All adjustments
under this Section 3(a)(iii) shall be calculated after calculating the adjustments pursuant to Section 3(a)(i).

 

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(b)          The
undersigned further agrees that to the extent that the size of the Offering is increased or decreased, the number of Initial Shares
to be forfeited pursuant to this Section 3 shall be adjusted proportionately such that the Initial Shares after all such forfeitures
shall equal 20.0% of the number of issued and outstanding shares of Common Stock.

 

(c)           In
all instances, the aggregate number of Initial Shares collectively held by all Initial Stockholders, after all forfeitures, will
collectively be equal to 20.0% of the Company’s issued and outstanding shares of Common Stock. To the extent that any deviations
occur in the ownership percentage represented by the Initial Shares after giving effect to the forfeitures set forth above, the
undersigned agrees that the board of directors of the Company may, at its sole discretion, require the undersigned to forfeit
any portion of the Initial Shares of the undersigned in order to maintain the necessary ownership percentage as described in this
Letter Agreement and in the Registration Statement and the Prospectus.

 

(d)           All
Initial Shares subject to forfeiture (A) as described in Section 3(a)(iii) will be forfeited by the undersigned on or prior to
the date of the completion of the Business Transaction and (B) as described in Section 3(a)(ii) will be forfeited by the undersigned
as promptly as practicable after the Warrant Expiration Time.

 

4. (a)       In
the case of any of the Initial Shares owned by the undersigned and the other Initial Stockholders that, as of the date of determination,
are not subject to forfeiture pursuant to Section 3 above, until the earlier of (i) the date that is (A) one year after the completion
of the Business Transaction or (B) earlier if, subsequent to the Business Transaction, the last sales price of the Common Stock
equals or exceeds $7.50 per share (as adjusted for stock splits, stock dividends, reorganizations, recapitalizations and the like)
for any 20 trading days within any 30-trading day period after the completion of the Business Transaction and all Warrants have
been exercised or have expired, and (ii) the date on which the Company consummates a liquidation, merger, stock exchange or other
similar transaction subsequent to the consummation of the Business Combination that results in all of the Company’s stockholders
having the right to exchange their shares of Common Stock for cash, securities or other property (such period, the “Lock-Up
Period”), the undersigned shall not, except as described in the Prospectus, (x) sell, offer to sell, contract or agree to
sell, hypothecate, pledge, grant any option to purchase or otherwise dispose of or agree to dispose of, directly or indirectly,
or establish or increase a put equivalent position or liquidate or decrease a call equivalent position within the meaning of Section
16 of the Securities Exchange Act of 1934, as amended, and the rules and regulations of the Commission promulgated thereunder
(the “Exchange Act”), with respect to the Initial Shares, (y) enter into any swap or other arrangement that transfers
to another, in whole or in part, any of the economic consequences of ownership of any of the Initial Shares, whether any such
transaction is to be settled by delivery of the Common Stock or such other securities, in cash or otherwise, or (z) publicly announce
any intention to effect any transaction specified in clause (x) or (y); provided, however, that the Initial Stockholders
and the Private Placement Investors may require the Company to file a registration statement under the Securities Act of 1933,
as amended (the “Securities Act”), during the Lock-Up Period, so long as such registration statement does not become
effective prior to the end of the Lock-Up Period.

 

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(b)          In
the case of any of the Initial Shares owned by the undersigned and the other Initial Stockholders that, as of the date of determination,
are subject to forfeiture pursuant to Section 3 above, the undersigned shall not, except as described in the Prospectus, (i) sell,
offer to sell, contract or agree to sell, hypothecate, pledge, grant any option to purchase or otherwise dispose of or agree to
dispose of, directly or indirectly, or establish or increase a put equivalent position or liquidate or decrease a call equivalent
position within the meaning of Section 16 of the Exchange Act with respect to the Initial Shares, (ii) enter into any swap or
other arrangement that transfers to another, in whole or in part, any of the economic consequences of ownership of any of the
Initial Shares, whether any such transaction is to be settled by delivery of the Common Stock or such other securities, in cash
or otherwise, or (iii) publicly announce any intention to effect any transaction specified in clause (i) or (ii); provided,
however, that the Initial Stockholders and the Private Placement Investors may require the Company to file a registration
statement under the Securities Act during the Lock-Up Period, so long as such registration statement does not become effective
prior to the end of the Lock-Up Period.

 

(c)          Notwithstanding
the provisions contained in Sections 4(a) and (b) above, the undersigned may transfer the Initial Shares owned by the undersigned
or any Units, shares of Common Stock, Warrants or any securities convertible into, or exercisable, or exchangeable for, shares
of Common Stock owned by the undersigned, as the case may be: (i) to the Company’s officers or directors, the Initial Stockholders
or the Private Placement Investors, to any affiliate of the Company’s officers or directors, the Initial Stockholders or
the Private Placement Investors, or to any immediate family member of the Company’s officers or directors, the Initial Stockholders
or the Private Placement Investors or their respective affiliates; (ii) by gift to a member of the immediate family of the undersigned
or, if the undersigned is an entity, a member of the immediate family of a member, partner or stockholder of the undersigned (a
“Member”), or a trust, the beneficiary of which is an immediate family member of the undersigned or an immediate family
member of a Member of the undersigned, or to an affiliate of the undersigned or a Member of the undersigned, or to a charitable
organization; (iii) by virtue of the laws of descent and distribution upon death of the undersigned or a Member of the undersigned;
(iv) pursuant to a qualified domestic relations order; (v) if the undersigned is an entity, by virtue of the laws of the state
of formation of the undersigned or the organizational documents of the undersigned upon dissolution of the undersigned; (vi) in
the event of the Company’s liquidation prior to the completion of the Business Transaction; or (vii) in the event that the
Company consummates a liquidation, merger, stock exchange or other similar transaction that results in all of its stockholders
having the right to exchange their shares of the Common Stock for cash, securities or other property subsequent to the consummation
of the Company’s initial Business Transaction; provided, however, that, in the case of clauses (i) through
(v), these permitted transferees enter into a written agreement with the Company agreeing to be bound by the transfer restrictions
in Sections 4(a) and (b).

 

(d)          Further,
the undersigned agrees that after the Lock-Up Period has elapsed, the Initial Shares owned by the undersigned shall only be transferable
or saleable pursuant to a sale registered under the Securities Act or pursuant to an available exemption from registration under
the Securities Act. The undersigned agrees that after the Placement Shares Effectiveness Date, the Placement Shares owned by the
undersigned shall only be transferable or salable pursuant to a sale registered under the Securities Act or pursuant to an available
exemption from registration under the Securities Act. The Company and the undersigned each acknowledge that pursuant to that certain
registration rights agreement (the “Registration Rights Agreement”) to be entered into among the Company and the other
Initial Stockholders, the Initial Stockholders may request that a registration statement relating to the Initial Shares and/or
the Placement Shares be filed with the Commission prior to the end of the Lock-Up Period or prior to the Placement Shares Effectiveness
Date, as the case may be; provided, however, that such registration statement does not become effective prior to
the end of the Lock-Up Period or prior to the Placement Shares Effectiveness Date, as applicable.

 

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(e)          The
undersigned shall retain all of its rights as a stockholder during the Lock-Up Period including, without limitation, the right
to vote such shares.

 

(f)           During
the Lock-Up Period, all dividends payable in cash with respect to the Initial Shares shall be paid to the undersigned, but all
dividends in respect of the Initial Shares payable in Common Stock or other non-cash property shall become subject to the Lock-Up
Period as described herein and shall be released from such lock-up only in accordance with the provisions of this Section 4.

 

5.            In
connection with a Business Transaction, the undersigned understands that the Company will enter into a private placement agreement,
pursuant to which Michael Rapoport (a/k/a Michael Rapp) and Philip Wagenheim or their respective designees, together with the
other Private Placement Investors, will purchase at least 2,000,000 shares of Common Stock at a per share price of $5.00 a share,
in a transaction exempt from the registration requirements of the Securities Act (the “Private Placement”). The Private
Placement will be completed concurrently with the completion of the Business Transaction.

 

6.            [RESERVED]

 

7.            The
undersigned’s biographical and other information furnished to the Company and included in the Registration Statement, the
Preliminary Prospectus and the Prospectus is true and accurate in all material respects and does not omit any material information
with respect to the undersigned’s background. The questionnaires furnished to the Company by the undersigned are true and
accurate in all material respects. The undersigned represents and warrants that:

 

(a)           the
undersigned is not subject to or a respondent in any legal action for, any injunction, cease-and-desist order or order or stipulation
to desist or refrain from any act or practice relating to the offering of securities in any jurisdiction;

 

(b)           the
undersigned has never been convicted of, or pleaded guilty to, any crime (i) involving fraud, (ii) relating to any financial transaction
or handling of funds of another person, or (iii) pertaining to any dealings in any securities and the undersigned is not currently
a defendant in any such criminal proceeding; and

 

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(c)          the
undersigned has never been suspended or expelled from membership in any securities or commodities exchange or association or had
a securities or commodities license or registration denied, suspended or revoked.

 

8.            Except
as disclosed in the Preliminary Prospectus and the Prospectus, prior to the completion of the Business Transaction, neither the
undersigned nor any affiliate of the undersigned shall receive any finder’s fee, reimbursement, consulting fee, monies in
respect of any repayment of a loan or other compensation in connection with any services rendered in order to effectuate the consummation
of the Offering or the Company’s initial Business Transaction (regardless of the type of transaction that it is). Except
as disclosed in the Preliminary Prospectus and the Prospectus, on or after the completion of the Business Transaction, neither
the undersigned nor any affiliate of the undersigned shall receive any finder’s fee, reimbursement, consulting fee, monies
in respect of any repayment of a loan or other compensation prior to, or in connection with any services rendered in order to
effectuate, the consummation of the Offering or the Company’s initial Business Transaction (regardless of the type of transaction
that it is).

 

9.            The
undersigned acknowledges and understands that the Underwriters and the Company will rely upon the agreements, representations,
and warranties set forth herein in proceeding with the Offering.

 

10.         The
undersigned authorizes any employer, financial institution, or consumer credit reporting agency to release to the Underwriters
and their legal representatives or agents (including any investigative search firm retained by the Underwriters) any information
they may have about the undersigned’s background and finances (“Information”), purely for the purposes of the
Offering (and shall thereafter hold such information confidential). Neither the Underwriters nor its agents shall be violating
the undersigned’s right of privacy in any manner in requesting and obtaining the Information and the undersigned hereby
releases them from liability for any damage whatsoever in that connection.

 

11.         The
undersigned acknowledges and agrees that the Company will not consummate any Business Transaction with any company with which
the undersigned has had any discussions, formal or otherwise, prior to the consummation of the Offering, with respect to a merger,
capital stock exchange, asset acquisition, stock purchase, reorganization or similar business transaction with the Company.

 

12.         The
undersigned acknowledges and agrees that the Company will not consummate any Business Transaction that involves a company which
is affiliated with any of the undersigned unless the Company obtains an opinion from an independent investment banking firm that
the Business Transaction is fair to the Company’s stockholders from a financial perspective.

 

13.         The
undersigned has full right and power, without violating any agreement to which he, she or it is bound (including, without limitation,
any non-competition or non-solicitation agreement with any employer or former employer), to enter into this Letter Agreement,
and hereby consents to being named in the Preliminary Prospectus, the Prospectus and the Registration Statement.

 

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14.         As
used in this Letter Agreement, (i) “Business Transaction” shall mean a merger, capital stock exchange, asset acquisition,
stock purchase, reorganization or similar business transaction, involving the Company and one or more businesses; (ii) “Effective
Date” shall mean the date on which the Registration Statement for the Offering becomes effective; (iii) “Initial Shares”
shall mean the shares of the Common Stock (as may be adjusted for stock splits, stock dividends, reverse stock splits, contributions
back to capital or otherwise) of the Company held by the Initial Stockholders which were issued and outstanding prior to the consummation
of the Offering; (iv) the “Initial Stockholders” shall mean the holders of the Initial Shares prior to the consummation
of the Offering and any permitted transferees of the Initial Shares in accordance with Section 4 hereof; (v) “Preliminary
Prospectus” shall mean each prospectus included in such registration statement (and any amendments thereto) before effectiveness,
any prospectus filed with the Commission pursuant to Rule 424(a) under the Securities Act and the prospectus included in the Registration
Statement at the time of its effectiveness that omits information under Rule 430 of the Securities Act; (vi) “Placement
Shares” shall mean the shares of Common Stock sold in the Private Placement; (vii) “Placement Shares Effectiveness
Date” shall mean, with respect to the Placement Shares, the period ending 30 days after the completion of the Business Transaction;
(viii) “Private Placement Investors” shall mean Michael Rapp and Philip Wagenheim or their respective designees, and
any other Initial Stockholders or their designees, who purchase the Placement Shares in the Private Placement , if any; (ix) “Pro
Rata Share” shall mean the quotient calculated by dividing the number of Initial Shares held by the undersigned by the total
number of Initial Shares then outstanding; (x) “Public Stockholders” shall mean the holders of securities issued in
the Offering; (xi) “Trust Account” shall mean the trust account into which a portion of the net proceeds of the Offering
will be deposited; and (xii) “Warrant Expiration Time” shall mean the time at which the Warrants cease to be exercisable,
which will occur at 5:00 p.m., New York City time, on the date that is the earlier of (i) two years after the effective date of
the registration statement registering the shares of common stock issuable upon the exercise of the Warrants or (ii) the forty-fifth
(45th) day following the date that the Company’s Common Stock closes at or above $6.25 per share for 20 out of 30 trading
days commencing on such effective date.

 

15.         (a)          This
Letter Agreement constitutes the entire agreement and understanding of the parties hereto in respect of the subject matter hereof
and supersede all prior understandings, agreements, or representations by or among the parties hereto, written or oral, to the
extent they relate in any way to the subject matter hereof or the transactions contemplated hereby.

 

(b)          The
undersigned acknowledges and agrees that the terms of Section 3 of this Letter Agreement may be amended unilaterally by Broadband
Capital Management LLC and the Company to change (including change to the numbers and percentages) any term or provision as the
terms of the Offering and any proposed Business Transaction may require. In addition, the undersigned acknowledges and agrees
that any provision of this Letter Agreement may be amended unilaterally by Broadband Capital Management LLC and the Company as
a result of comments, if any, received from the Securities and Exchange Commission relating to the Registration Statement. In
each case, the Company shall provide written notice of such change to the undersigned.

 

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(c)          Subject
to subsection 15(b) above, this Letter Agreement may not be changed, amended, modified or waived (other than to correct a typographical
error or to cure any ambiguity, omission, mistake, defect or inconsistency) as to any particular provision, except by a written
instrument executed by the parties hereto.

 

16.         No
party may assign either this Letter Agreement or any of his, her or its rights, interests, or obligations hereunder without the
prior written consent of the other party. Any purported assignment in violation of this paragraph shall be void and ineffectual
and shall not operate to transfer or assign any interest or title to the purported assignee. This Letter Agreement shall be binding
on the undersigned and each of his or its heirs, personal representatives, successors and assigns.

 

17.         This
Letter Agreement shall be governed by and construed and enforced in accordance with the laws of the State of New York, without
giving effect to conflicts of law principles that would result in the application of the substantive laws of another jurisdiction.
The parties hereto (i) agree that any action, proceeding, claim or dispute arising out of, or relating in any way to, this Letter
Agreement shall be brought and enforced in the courts of New York, in the State of New York, and irrevocably submits to such jurisdiction
and venue, which jurisdiction and venue shall be exclusive and (ii) waives any objection to such exclusive jurisdiction and venue
or that such courts represent an inconvenient forum.

 

18.         Any
notice, consent or request to be given in connection with any of the terms or provisions of this Letter Agreement shall be in
writing and shall be sent by express mail or similar private courier service, by certified mail (return receipt requested), by
hand delivery, electronic or facsimile transmission.

 

19.         This
Letter Agreement shall terminate on the earlier of (i) the expiration of the Lock-Up Period, or (ii) the liquidation of the Trust
Account; provided, however, that this Letter Agreement shall earlier terminate in the event that the Offering is
not consummated and closed by June 30, 2014.

 

[Signature page follows]

 

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	 	Sincerely,
	 	 
	 	[NAME OF INITIAL STOCKHOLDER]

 

	 	By:	 	 
	 	Name:
	 	Title:]

 

Acknowledged and Agreed:

 

COMMITTED CAPITAL ACQUISITION
CORPORATION II

 

	By:	 	 
	Name:
	Title:

 

BROADBAND CAPITAL MANAGEMENT
LLC

 

	By:	 	 
	Name:
	Title:

 

[Letter Agreement]SUBSCRIPTION AGREEMENT

 

This
SUBSCRIPTION Agreement (this “Agreement”) is made as of October __, 2013 by and between CNS Response,
Inc., a Delaware corporation (the “Company”), and the investor listed on Schedule A hereto (each, an
“Investor” and together, the “Investors”).

 

Agreement

 

In consideration for
the mutual promises and covenants herein, the parties agree as follows:

 

WHEREAS, the Company
is offering in a private placement up to $1.0 million of its common stock, par value $0.001 per share (“Shares”
or “Common Stock”) for $0.25 per share in a private placement to accredited investors pursuant to a Confidential
Offering Memorandum dated September 25, 2013; and

 

WHEREAS, the undersigned
desires to subscribe for and purchase the number of Shares set forth on Schedule A hereto.

 

Section
1 – Purchase and Sale of SHARES

 

1.1Purchase
and Sale of Shares. The Company has authorized the issuance and sale, in accordance with the terms hereof, of shares of Common
Stock, in the aggregate amount of up to $1,000,000 (the “Shares Cap Amount”).
On the terms and subject to the conditions set forth in this Agreement, at the Closings (as defined below), the Company agrees
to issue to each Investor, and the Investor agrees to purchase from the Company, in the amount set forth on Schedule A.
The Company will sell Shares to more than one Investor, each of whom will enter into Subscription Agreement substantially identical
to this one. The financing pursuant to which the Company is issuing the Shares is hereinafter referred to as the “Financing”.

 

1.2Closings.

 

(a)Initial
Closing. The initial purchase and sale of the Shares shall take place at a closing (the “Initial Closing”)
which shall take place remotely via exchange of documents and signatures at 10:00 a.m. Eastern Time on the business day immediately
following execution and delivery of this Agreement, or at such other place and time as may be agreed to among the Company and the
Investors. At the Initial Closing, the Company shall deliver to each of the Investors purchasing Securities for cash at such closing
a certificate or certification representing such number of Shares as is set forth opposite such Investor’s name on Schedule
A under the column entitled “Purchase Price (Initial Closing)” against receipt of a check subject to collection
or a wire transfer in immediately available funds of the purchase price, to an account designated by the Company. 

 

    	 

    	 

    

 

(b)Additional
Closings. The Company shall have the right, on one or more occasions, to hold additional closings (each, an “Additional
Closing”, and collectively with the Initial Closing, the “Closings”,
and individually, a “Closing”), pursuant to which it shall have the right
to issue and sell additional Shares to additional Investors or existing Investors (provided that no Additional Closings shall take
place later than November 25, 2013). At each Additional Closing, the Company shall deliver to each Investor purchasing Shares at
such closing a certificate or certification representing such number of Shares as is in set forth opposite such Investor’s
name on Schedule A under the column entitled “Purchase Price” against
receipt of a check subject to collection or a wire transfer in immediately available funds of the purchase price, to an account
designated by the Company. By receiving Shares at an Additional Closing, each Investor so receiving Shares thereby represents that
its representations and warranties contained in Section 3 are true and correct as of the date of such Additional Closing. The aggregate
principal amount of Shares that may be issued at Closings hereunder shall, in no event exceed the Share Cap Amount.

 

The obligation of each
Investor to purchase and pay cash for the Shares to be delivered at a Closing is, unless waived by such Investor, subject to the
condition that the Company’s representations and warranties contained in Section 2 are true, complete and correct on and
as of such Closing date. The obligation of the Company to sell and issue Shares to be delivered at a Closing is, unless waived
by the Company, subject to the condition that the relevant Investor’s representations and warranties contained in Section
3 are true, complete and correct on and as of the Closing Date.

 

 

Section
2 - Representations and Warranties

of
the Company

 

The Company represents
and warrants to each Investor as follows:

 

2.1Existence
of Company. The Company is a duly organized Delaware corporation. The Company is validly existing in all jurisdictions where
it conducts its business.

 

2.2Authority to Execute.
The execution, delivery and performance by the Company of this Agreement and the issuance of the Shares are within the Company’s
corporate powers, have been duly authorized by all necessary corporate action, do not and will not conflict with any provision
of law or organizational document of the Company (including its Certificate of Incorporation or Bylaws) or of any agreement or
contractual restrictions binding upon or affecting the Company or any of its property and need no further stockholder or creditor
consent.

 

2.3No Stockholder
Approval Required. No approval of the Company’s stockholders is required for (i) the entry by the Company into this Agreement,
or (ii) the issuance of the Shares contemplated by this Agreement.

 

2.4Valid Issuance.
The Shares will be, validly issued, fully paid and nonassessable and free of restrictions on transfer other than restrictions on
transfer under, applicable state and federal securities laws and liens or encumbrances created by or imposed by the Investor. Assuming
the accuracy of the representations of the Investor in Section 3 of this Agreement, and the Shares will be issued in compliance
with all applicable federal and state securities laws.

 

    	2

    	 

    

 

2.5Binding
Obligation. This Agreement is, a valid and binding obligation of the Company enforceable against the Company in accordance
with its terms, subject, as to enforcement of remedies, to applicable bankruptcy, insolvency, moratorium, reorganization and similar
laws affecting creditors’ rights generally and to general equitable principles.

 

2.6Litigation.
Other than the litigation disclosed in the Company’s most recent SEC Reports (as defined below), no litigation or governmental
proceeding is pending or threatened against the Company which may have a materially adverse effect on the financial condition,
operations or prospects of the Company, and to the knowledge of the Company, no basis therefore exists.

 

2.7Intellectual
Property. To the best of the Company’s knowledge, the Company owns or possesses sufficient legal rights to all patents,
trademarks, service marks, trade names, copyrights, trade secrets, licenses, information and other proprietary rights and processes
necessary for its business as now conducted and as presently proposed to be conducted, without any known infringement of the rights
of others. There are no outstanding options, licenses or agreements of any kind relating to the foregoing proprietary rights, nor
is the Company bound by or a party to any options, licenses or agreements of any kind with respect to the patents, trademarks,
service marks, trade names, copyrights, trade secrets, licenses, information and other proprietary rights and processes of any
other person or entity other than such licenses or agreements arising from the purchase of “off the shelf” or standard
products.

 

2.8SEC Reports.The
Company has filed all forms, reports, schedules, proxy statements, registration statements and other documents (including all exhibits
thereto) required to be filed by it with the Securities and Exchange Commission (the “SEC”) pursuant to the
federal securities laws and the SEC rules and regulations thereunder, together with all certifications required pursuant to the
Sarbanes-Oxley Act of 2002 (the “Sarbanes-Oxley Act”) (as they have been amended since the time of their filing,
including all exhibits thereto, the “SEC Reports”). Each of the SEC Reports complied in all material respects
with the applicable requirements of the Securities Act of 1933, as amended (the “Securities Act”) and the Securities
Exchange Act of 1934, as amended (the “Exchange Act”), the Sarbanes-Oxley Act and the rules and regulations
of the SEC under all of the foregoing. None of the SEC Reports contained any untrue statement of a material fact or omitted to
state a material fact required to be stated therein or necessary in order to make the statements therein, in light of the circumstances
under which they were made, not misleading.

 

Section
3 - Representations and Warranties

of
the Investors

 

Each Investor represents
and warrants to the Company as follows:

 

3.1Authorization;
Binding Obligations. The Investor has full power and authority to enter into this Agreement and this Agreement constitutes
a valid and legally binding obligation of the Investor, enforceable against the Investor in accordance with its terms, subject,
as to enforcement of remedies, to applicable bankruptcy, insolvency, moratorium, reorganization and similar laws affecting creditors’
rights generally and to general equitable principles.

 

    	3

    	 

    

 

3.2Accredited
Investor. The Investor is an “accredited investor” within the meaning of SEC Rule 501 of Regulation D promulgated
under the Securities Act.

 

3.3Investment
for Own Account. The Shares are being acquired for his, her or its own account, for investment and not with a view to, or for
resale in connection with, any distribution or public offering thereof within the meaning of the Securities Act.

 

3.4Knowledge
and Experience. The Investor has such knowledge and experience in financial and business matters that (s)he is capable of evaluating
the merits and risks of an investment in the Shares and of making an informed investment decision with respect thereto, has the
ability and capacity to protect his/her interests and can bear the economic risk of the acceptance of the Shares, including a total
loss of his/her investment.

 

3.5 Opportunity
to Ask Questions. The Investor has had the opportunity to ask questions and receive answers from the Company or any authorized
person acting on its behalf concerning the Company and its business and to obtain any additional information, to the extent possessed
by the Company (or to the extent it could have been acquired by the Company without unreasonable effort or expense) necessary to
verify the accuracy of the information received by the Investor. In connection therewith, the Investor acknowledges that (s)he
has had the opportunity to discuss the Company’s business, management and financial affairs with the Company’s management
or any authorized person acting on its behalf.

 

3.6.Receipt
of Information. The Investor has received and reviewed all the information concerning the Company, the Securities and the Shares,
both written and oral, that the Investor desires. Without limiting the generality of the foregoing, the Investor has been furnished
with or has had the opportunity to acquire, and to review: all information, both written and oral, that the Investor desires with
respect to the Company’s business, management, financial affairs and prospects. In determining whether to make this investment,
the Investor has relied solely on his/her own knowledge and understanding of the Company and its business and prospects based upon
the Investor’s own due diligence investigations and the Company’s filings with the SEC.

 

Section
4 - Miscellaneous

 

4.1No Waiver;
Cumulative Remedies. No failure or delay on the part of any party to this Agreement in exercising any right or remedy under,
or pursuant to, this Agreement shall operate as a waiver thereof, nor shall any single or partial exercise of any such right, remedy
or power preclude other or further exercise thereof, or the exercise of any other right, remedy or power. The remedies in this
Agreement are cumulative and are not exclusive of any remedies provided by law.

 

4.2Amendments
and Waivers. Except as otherwise expressly set forth in this Agreement, any term of this Agreement may be amended (either retroactively
or prospectively) with the written consent of the Company and the Investor. Any amendment effected in accordance with this Section
4.2 shall be binding upon each Investor, each future holder of Securities and the Company.

 

    	4

    	 

    

 

4.3Notices,
Etc. All notices, requests, consents and other communications hereunder to any party shall be deemed to be sufficient if contained
in a written instrument delivered in person; sent by facsimile transmission; sent by electronic mail; duly sent by first class
registered or certified mail, return receipt requested, postage prepaid; or duly sent by overnight delivery service (e.g.,
Federal Express) addressed to such party (i) if to the Company, at the address, fax number or electronic mail address, as applicable,
set forth on the signature page hereof or (ii) if to an Investor, at the address, fax number or electronic mail address, as applicable,
set forth on Schedule A hereto, or at such other address, fax number or electronic mail address as may hereafter be designated
in writing by the addressee to the sender. All such notices, advises and communications shall be deemed to have been received:
(a) in the case of personal delivery, on the date of such delivery; (b) in the case of facsimile or electronic mail transmission,
on the date of transmission; and (c) in the case of mailing or delivery by service, on the date of delivery as shown on the return
receipt or delivery service statement.

 

4.4Governing
Law. This Agreement shall be governed by and construed in accordance with the laws of the State of California, without regard
to the conflicts of law provisions of the State of California or of any other state. The Company and each Investor consent to personal
jurisdiction in Orange County, California.

 

4.5Severability.
If any term in this Agreement is held to be illegal or unenforceable, the remaining portions of this Agreement shall not be affected,
and this Agreement shall be construed and enforced as if this Agreement did not contain the term held to be illegal or unenforceable.

 

4.6Binding Effect.
This Agreement shall be binding upon and inure to the benefit of the Company and each Investor and their respective successors
and assigns.

 

4.7Transfer
of Shares. Notwithstanding the legend required to be placed on the Shares by applicable law, no registration statement or opinion
of counsel shall be necessary: (a) for a transfer of Shares to the respective estate of each Investor or for a transfer of Shares
by gift, will or intestate succession of each Investor to his or her spouse or to the siblings, lineal descendants or ancestors
each Investor or his or her spouse, if the transferee agrees in writing to be subject to the terms hereof to the same extent as
if he or she were the original Investor hereunder; or (b) for a transfer of Shares pursuant to SEC Rule 144 or any successor rule,
or for a transfer of Shares pursuant to a registration statement declared effective by the SEC under the Securities Act relating
to the Securities.

 

4.8Survival
of Representations, Warranties and Covenants. The representations and warranties of the parties contained in or made pursuant
to this Agreement shall survive the execution and delivery of this Agreement indefinitely, and shall in no way be affected by any
investigation of the subject matter thereof made by or on behalf of the other parties. The covenants of the parties contained in
or made pursuant to this Agreement shall survive the execution and delivery of this Agreement until such time as the Notes have
been paid in full.

 

    	5

    	 

    

 

4.9California
Commissioner of Corporations. THE SALE OF THE SECURITIES WHICH ARE THE SUBJECT OF THIS AGREEMENT HAS NOT BEEN QUALIFIED WITH
THE COMMISSIONER OF CORPORATIONS OF THE STATE OF CALIFORNIA AND THE ISSUANCE OF THE SECURITIES OR PAYMENT OR RECEIPT OF ANY PART
OF THE CONSIDERATION FOR SUCH SECURITIES PRIOR TO THE QUALIFICATION IS UNLAWFUL, UNLESS THE SALE OF SECURITIES IS EXEMPT FROM QUALIFICATIONS
BY SECTION 25100, 25102 OR 25105 OF THE CALIFORNIA CORPORATIONS CODE. THE RIGHTS OF ALL PARTIES TO THIS AGREEMENT ARE EXPRESSLY
CONDITIONED UPON SUCH QUALIFICATION BEING OBTAINED, UNLESS THE SALE IS SO EXEMPT.

 

 

 

 

[Remainder of Page Intentionally Left
Blank]

 

    	6

    	 

    

 

IN WITNESS WHEREOF,
the parties hereto have caused this Agreement to be duly executed and delivered by their proper and duly authorized officers as
of the date first written above.

 

 

	 	CNS RESPONSE, INC.
	 	 	 
	 	 	 
	 	By:	 
	 	 	Name: Paul Buck
	 	 	Title:   Chief Financial Officer

 

Address/Fax Number/E-mail Address for Notice:

 

85 Enterprise, Suite 410

Aliso Viejo, CA 92656

Fax: (866) 867 4446

pbuck@cnsresponse.com

 

 

	 	INVESTOR:
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	 	 
	 	By:	 
	 	 	Name:
	 	 	 
	 	 	 
	 	 	Title:

 

 

 

 

[SIGNATURE PAGE TO SUBSCRIPTION AGREEMENT]

 

    	 

    	 

    

 

SCHEDULE A

 

	Name, Address, Fax Number, E-Mail Address and Tax ID Number of Investor 	
        Aggregate Purchase Price 

         

	
         

         

        Name:_________________________________

         

        Address:_______________________________

         

        ______________________________________

         

        Fax:__________________________________

         

        Email:_________________________________

         

        Tax ID:________________________________

         
	
         

         

         

        $______________________

	TOTAL:

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00226-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00226-of-00352.parquet"}]]