Document:

<PAGE>
                                                                   EXHIBIT 10.64

NOTICE OF GRANT OF STOCK OPTIONS                   ESS TECHNOLOGY, INC
AND OPTION AGREEMENT ID:                           48401 Fremont Boulevard
                                                   Fremont, CA 94538
                                                   (510) 492-1088

[NAME OF OPTIONEE]                                  OPTION NUMBER:
[ADDRESS OF OPTIONEE]                               PLAN:  95D
                                                    ID:

Effective [Grant Date], you have been granted a(n) Non-Qualified Stock Option to
buy [Number] shares of ESS TECHNOLOGY, INC. (the "Company") stock at $[Option
Price] per share.

The total option price of the shares granted is $[Total Grant Price].

Shares in each period will become fully vested on the date shown.

<TABLE>
<CAPTION>
         SHARES           VEST TYPE        FULL VEST           EXPIRATION
         ------           ---------        ---------           ----------
<S>     <C>               <C>              <C>                 <C>

</TABLE>

------------------------------------------------------------------------------
By your signature and the Company's signature below, you and the Company agree
that these options are granted under and governed by the terms and conditions of
the Company's Stock Option Plan as amended and the Option Agreement, all of
which are attached and made a part of this document.
------------------------------------------------------------------------------

--------------------------------         ---------------------------
ESS TECHNOLOGY, INC.                     Date

--------------------------------         ---------------------------
[Name of Optionee]                       Date

                                         Date:
                                         Time:
<PAGE>
                              ESS TECHNOLOGY, INC.
                        1995 DIRECTORS STOCK OPTION PLAN

                             DIRECTORS NONQUALIFIED
                     SUCCEEDING STOCK OPTION GRANT AGREEMENT

     This Succeeding Stock Option Grant Agreement (this "GRANT") is made and
entered into pursuant to the Company's 1995 Directors Stock Option Plan (the
"PLAN") as of the date of grant (the "GRANT DATE") set forth in the Notice of
Grant of Stock Options and Option Agreement attached hereto (the "NOTICE") by
and between ESS Technology, Inc., a California corporation (the "COMPANY"), and
the Optionee named in the Notice ("OPTIONEE").

     1.   GRANT OF OPTION. The Company hereby grants to Optionee an option (this
"OPTION") to purchase up to the total number of shares of Common Stock of the
Company set forth in the Notice (collectively, the "SHARES") at the exercise
price per share set forth in the Notice (the "EXERCISE PRICE"), subject to all
of the terms and conditions of this Grant, the Notice, and the Plan. Unless
otherwise defined herein, capitalized terms used herein shall have the meanings
ascribed to them in the Plan.

     2.   EXERCISE AND VESTING OF OPTION. Subject to the terms and conditions of
the Plan, the Notice, and this Grant, this Option shall become exercisable as it
vests. Subject to the terms and conditions of the Plan, the Notice, and this
Grant, this Option shall vest as to 1/48th of the Shares monthly on the same day
each month as the Grant Date beginning with the first month following the Grant
Date, so long as the Optionee continuously remains a member of the Board of
Directors of the Company (a "BOARD MEMBER").

     3.   RESTRICTION ON EXERCISE. This Option may not be exercised unless such
exercise is in compliance with the Securities Act, and all applicable state
securities laws, as they are in effect on the date of exercise, and the
requirements of any stock exchange or national market system on which the
Company's Common Stock may be listed at the time of exercise. Optionee
understands that the Company is under no obligation to register, qualify or list
the Shares with the SEC, any state securities commission or any stock exchange
or national market system to effect such compliance.

     4.   TERMINATION OF OPTION. Except as provided below in this Section, this
Option shall terminate and may not be exercised on the earlier of the expiration
date set forth in the Notice or the date Optionee ceases to be a Board Member.
The date on which Optionee ceases to be a Board Member shall be referred to as
the "TERMINATION DATE." If Optionee ceases to be a Board Member for any reason,
then this Option, to the extent (and only to the extent) that it would have been
exercisable by Optionee on the Termination Date, may be exercised by Optionee
(or Optionee's legal representative) within three (3) years after the
Termination Date, but in no event later than the expiration date set forth in
the Notice.

     5.   MANNER OF EXERCISE.

          5.1  Exercise Agreement. This Option shall be exercisable by delivery
to the Company of an executed written Directors Stock Option Exercise Agreement
in the form attached hereto as Exhibit A, or in such other form as may be
approved by the Committee, which shall set forth Optionee's election to exercise
some or all of this Option,

<PAGE>

the number of Shares being purchased, any restrictions imposed on the Shares and
such other representations and agreements as may be required by the Company to
comply with applicable securities laws.

          5.2  Payment. Payment for the Shares purchased upon exercise of this
Option may be made (a) in cash or by check; (b) by surrender of shares of Common
Stock of the Company that have been owned by Optionee for more than six (6)
months (and which have been paid for within the meaning of SEC Rule 144 and, if
such shares were purchased from the Company by use of a promissory note, such
note has been fully paid with respect to such shares) or were obtained by the
Optionee in the open public market, having a Fair Market Value equal to the
Exercise Price of the Option; (c) by waiver of compensation due or accrued to
Optionee for services rendered; (d) provided that a public market for the
Company's stock exists, through a "same day sale" commitment from the Optionee
and a broker-dealer that is a member of the National Association of Securities
Dealers (an "NASD Dealer") whereby the Optionee irrevocably elects to exercise
the Option and to sell a portion of the Shares so purchased to pay for the
Exercise Price and whereby the NASD Dealer irrevocably commits upon receipt of
such Shares to forward the Exercise Price directly to the Company; or (e) by any
combination of the foregoing.

          5.3  Withholding Taxes. Prior to the issuance of the Shares upon
exercise of this Option, Optionee shall pay or make adequate provision for any
applicable federal or state withholding obligations of the Company.

          5.4  Issuance of Shares. Provided that such notice and payment are in
form and substance satisfactory to counsel for the Company, the Company shall
cause the Shares to be issued in the name of Optionee or Optionee's legal
representative. To enforce any restrictions on Optionee's Shares, the Committee
may require Optionee to deposit all certificates, together with stock powers or
other instruments of transfer approved by the Committee appropriately endorsed
in blank, with the Company or an agent designated by the Company to hold in
escrow until such restrictions have lapsed or terminated, and the Committee may
cause a legend or legends referencing such restrictions to be placed on the
certificates.

     6.   NONTRANSFERABILITY OF OPTION. During the lifetime of the Optionee,
this Option shall be exercisable only by Optionee or by Optionee's guardian or
legal representative, unless otherwise permitted by the Committee. This Option
may not be sold, pledged, assigned, hypothecated, transferred or disposed of in
any manner other than by will or by the laws of descent and distribution.

     7.   INTERPRETATION. Any dispute regarding the interpretation of this Grant
shall be submitted by Optionee or the Company to the Committee that administers
the Plan, which shall review such dispute at its next regular meeting. The
resolution of such a dispute by the Committee shall be final and binding on the
Company and on Optionee. Nothing in the Plan or this Grant shall confer on
Optionee any right to continue as a Board Member.

     8.   ENTIRE AGREEMENT. The Plan, the Grant, and the Directors Stock Option
Exercise Agreement in the form attached hereto as Exhibit A, and the terms and
conditions thereof, are incorporated herein by this reference. The Notice, this
Grant, the Plan and the Directors Stock Option Exercise Agreement constitute the
entire agreement and understanding of the parties hereto with respect to the
subject matter hereof and supersede all prior understandings and agreements with
respect to such subject matter.

                                       2
<PAGE>

                                    EXHIBIT A
                              ESS TECHNOLOGY, INC.
                        1995 DIRECTORS STOCK OPTION PLAN
                    DIRECTORS STOCK OPTION EXERCISE AGREEMENT

I hereby elect to purchase the number of shares of common stock of ESS
TECHNOLOGY, INC. (the "COMPANY") as set forth below:

<TABLE>
<CAPTION>
<S>                                               <C>
Optionee:______________________________________   Number of Shares Purchased: ___________________________________
Address:_______________________________________   Purchase Price per Share: _____________________________________
_______________________________________________   Aggregate Purchase Price: _____________________________________
Type of Stock Option: Nonqualified Stock Option   Date of Stock Option Grant: ___________________________________
                                                  Exact Name of Title to Shares: ________________________________
</TABLE>

1.   DELIVERY OF PURCHASE PRICE. Optionee hereby delivers to the Company the
     Aggregate Purchase Price, to the extent permitted in the Directors
     Nonqualified Stock Option Grant referred to above (the "GRANT"), as follows
     (check as applicable and complete):

[ ]  in cash (by check) in the amount of $__________, receipt of which is
     acknowledged by the Company;

[ ]  by delivery of _________ fully-paid, nonassessable and vested shares of
     the common stock of the Company owned by Optionee for at least six (6)
     months prior to the date hereof (and which have been paid for within the
     meaning of SEC Rule 144), or obtained by Optionee in the open public
     market, and owned free and clear of all liens, claims, encumbrances or
     security interests, valued at the current Fair Market Value of $________
     per share;

[ ]  by the waiver hereby of compensation due or accrued to Optionee for
     services rendered in the amount of $_________; or

[ ]  through a "same-day-sale" commitment, delivered herewith, from Optionee
     and the NASD Dealer named therein, in the amount of $__________.

2.   MARKET STANDOFF AGREEMENT. Optionee, if requested by the Company and an
     underwriter of Common Stock (or other securities) of the Company, agrees
     not to sell or otherwise transfer or dispose of any Common Stock (or other
     securities) of the Company held by Optionee during the period requested by
     the managing underwriter following the effective date of a registration
     statement of the Company filed under the Securities Act, provided that all
     officers and directors of the Company are required to enter into similar
     agreements. Such agreement shall be in writing in a form satisfactory to
     the Company and such underwriter. The Company may impose stop-transfer
     instructions with respect to the shares (or other securities) subject to
     the foregoing restriction until the end of such period.

3.   TAX CONSEQUENCES. OPTIONEE UNDERSTANDS THAT OPTIONEE MAY SUFFER ADVERSE TAX
     CONSEQUENCES AS A RESULT OF OPTIONEE'S PURCHASE OR DISPOSITION OF THE
     SHARES. OPTIONEE REPRESENTS THAT OPTIONEE HAS CONSULTED WITH ANY TAX
     CONSULTANT(S) OPTIONEE DEEMS ADVISABLE IN CONNECTION WITH THE PURCHASE OR
     DISPOSITION OF THE SHARES AND THAT OPTIONEE IS NOT RELYING ON THE COMPANY
     FOR ANY TAX ADVICE.

4.   ENTIRE AGREEMENT. The Plan, the Notice, and the Grant are incorporated
     herein by reference. This Agreement, the Plan, the Notice, and the Grant
     constitute the entire agreement of the parties and supersede in their
     entirety all prior understandings and agreements of the Company and
     Optionee with respect to the subject matter hereof, and are governed by
     California law except for that body of law pertaining to conflict of laws.

Date:________________________________         _________________________________
                                              Signature of Optionee
<PAGE>

                              ESS TECHNOLOGY, INC.
                        1995 DIRECTORS STOCK OPTION PLAN
                                SPOUSE'S CONSENT

     I acknowledge that I have read the foregoing Directors Stock Option
Exercise Agreement (the "AGREEMENT") and that I know its contents. I hereby
consent to and approve all the provisions of the Agreement and agree that the
shares of the Common Stock of ESS Technology, Inc. purchased thereunder (the
"SHARES") and any interest I may have in such Shares are subject to all the
provisions of the Agreement. I will take no action at any time to hinder
operation of the Agreement on these Shares or any interest I may have on them.

Spouse of Optionee
_______________________________________        Date: __________________________

_______________________________________        Date: __________________________
Optionee's Name<PAGE>
                                                                   EXHIBIT 10.65

NOTICE OF GRANT OF STOCK OPTIONS                   ESS TECHNOLOGY, INC
AND OPTION AGREEMENT ID:                           48401 Fremont Boulevard
                                                   Fremont, CA 94538
                                                   (510) 492-1088

[NAME OF OPTIONEE]                                  OPTION NUMBER:
[ADDRESS OF OPTIONEE]                               PLAN:
                                                    ID:

Effective [Grant Date], you have been granted a(n) Non-Qualified Stock Option to
buy [Number] shares of ESS TECHNOLOGY, INC. (the "Company") stock at $[Option
Price] per share.

The total option price of the shares granted is $[Total Grant Price].

Shares in each period will become fully vested on the date shown.

<TABLE>
<CAPTION>
         SHARES           VEST TYPE        FULL VEST           EXPIRATION
         ------           ---------        ---------           ----------
<S>     <C>               <C>              <C>                 <C>

</TABLE>

------------------------------------------------------------------------------
By your signature and the Company's signature below, you and the Company agree
that these options are granted under and governed by the terms and conditions of
the Company's Stock Option Plan as amended and the Option Agreement, all of
which are attached and made a part of this document.
------------------------------------------------------------------------------

--------------------------------         ---------------------------
ESS TECHNOLOGY, INC.                     Date

--------------------------------         ---------------------------
[Name of Optionee]                       Date

                                         Date:
                                         Time:

<PAGE>
                              ESS TECHNOLOGY, INC.

                             STOCK OPTION AGREEMENT

     1. GRANT OF OPTION. ESS Technology, Inc., a California corporation (the
"Company"), hereby grants to the optionee (the "Optionee") named in the Notice
of Grant of Stock Options and Option Agreement (the "Notice") an option (the
"Option") to purchase the total number of shares of common stock set forth in
the Notice (the "Shares") at the exercise price per Share set forth in the
Notice (the "Exercise Price") subject to the terms and conditions of the Notice,
this Agreement and the plan identified in the Notice (the ESS Technology, Inc.
1997 Equity Incentive Plan, the ESS Technology, Inc. 1995 Equity Incentive Plan,
or the 2002 Non-Executive Stock Option Plan, the "Plan"), which Plan is
incorporated in this Agreement by reference. Unless otherwise defined in this
Agreement, the terms used in this Agreement shall have the meanings defined in
the Plan. This Agreement shall be deemed executed by the Company and Optionee
upon execution by such parties of the Notice.

     2. DESIGNATION OF OPTION. This Option is intended to be an incentive stock
option as defined in Section 422 of the Code (an "Incentive Stock Option") only
to the extent so designated in the Notice, and to the extent it is not so
designated or to the extent the Option does not qualify as an Incentive Stock
Option, it is intended to be a nonstatutory stock option.

     Notwithstanding the above, if designated as an Incentive Stock Option, in
the event that the Shares subject to this Option (and all other Incentive Stock
Options granted to Optionee by the Company or any Parent or Subsidiary,
including under other plans of the Company) that first become exercisable in any
calendar year have an aggregate fair market value (determined for each Share as
of the date of grant of the option covering such Share) in excess of $100,000,
the Shares in excess of $100,000 shall be treated as subject to a nonstatutory
stock option.

     3.   EXERCISE OF OPTION. This Option shall be exercisable during its term
in accordance with the vesting schedule set out in the Notice and with the
applicable provisions of the Plan as follows:

          (a)  RIGHT TO EXERCISE.

               (i)  This Option may not be exercised for a fraction of a share.

               (ii) In the event of Optionee's death, disability or other
termination of service, the exercisability of the Option is governed by Section
5 below, subject to the limitations contained in this Section 3.

               (iii) In no event may this Option be exercised after the
Expiration Date of the Option as set forth in the Notice.
<PAGE>

          (b)  METHOD OF EXERCISE.

               (i) This Option shall be exercisable by delivering to the Company
a written notice of exercise (in the form attached as Exhibit A or in any other
form of notice approved by the Committee) which shall state Optionee's election
to exercise the Option, the number of Shares in respect of which the Option is
being exercised, and such other representations and agreements as to the
holder's investment intent with respect to such Shares as may be required by the
Company pursuant to the provisions of the Plan. Such written notice shall be
signed by Optionee and shall be delivered to the Company by such means as are
determined by the Committee in its discretion to constitute adequate delivery.
The written notice shall be accompanied by payment of the Exercise Price. This
Option shall be deemed to be exercised upon receipt by the Company of such
written notice accompanied by the Exercise Price.

               (ii) As a condition to the exercise of this Option, Optionee
agrees to make adequate provision for federal, state or other tax withholding
obligations, if any, which arise upon the vesting or exercise of the Option, or
disposition of Shares, whether by withholding, direct payment to the Company, or
otherwise.

               (iii) The Company is not obligated, and will have no liability
for failure, to issue or deliver any Shares upon exercise of the Option unless
such issuance or delivery would comply with the Applicable Laws, with such
compliance determined by the Company in consultation with its legal counsel.
This Option may not be exercised until such time as the Plan has been approved
by the stockholders of the Company, or if the issuance of such Shares upon such
exercise or the method of payment of consideration for such shares would
constitute a violation of any applicable federal or state securities or other
law or regulation, including any rule under Part 221 of Title 12 of the Code of
Federal Regulations as promulgated by the Federal Reserve Board. As a condition
to the exercise of this Option, the Company may require Optionee to make any
representation and warranty to the Company as may be required by the Applicable
Laws. Assuming such compliance, for income tax purposes the Shares shall be
considered transferred to Optionee on the date on which the Option is exercised
with respect to such Shares.

     4.   METHOD OF PAYMENT. Payment of the Exercise Price shall be by any of
the following, or a combination of the following, at the election of Optionee:

          (a)  cash or check; or

          (b) delivery of a properly executed exercise notice together with
irrevocable instructions to a broker approved by the Company to deliver promptly
to the Company the amount of sale or loan proceeds required to pay the exercise
price; or

          (c)  surrender of other shares of common stock of the Company that:

               (i) either have been owned by Optionee for more than six (6)
     months on the date of surrender or were not acquired, directly or
     indirectly, from the Company, and

                                        2
<PAGE>

               (ii) have a Fair Market Value on the date of surrender equal to
     the aggregate exercise price of the Shares as to which said Option shall be
     exercised.

     5. TERMINATION OF RELATIONSHIP. Following the date of termination of
Optionee's Continuous Service Status for any reason (the "Termination Date"),
Optionee may exercise the Option only as set forth in the Notice and this
Section 5. To the extent that Optionee is not entitled to exercise this Option
as of the Termination Date, or if Optionee does not exercise this Option within
the termination periods set forth below, the Option shall terminate in its
entirety. In no event, may the Option be exercised after the Expiration Date of
the Option as set forth in the Notice.

          (a) TERMINATION. In the event of the termination of Optionee's
Continuous Service Status other than for Cause or as a result of Optionee's
disability or death, Optionee may, but only within 90 days of the Termination
Date, exercise this Option to the extent Optionee was entitled to exercise it as
of the Termination Date.

          (b)  OTHER TERMINATIONS. In connection with any termination other than
a termination covered by Section 5(a), Optionee may exercise the Option only as
described below:

               (i) TERMINATION UPON DISABILITY OF OPTIONEE. In the event of the
termination of Optionee's Continuous Service Status as a result of Optionee's
total and permanent disability (as defined in Section 22(e)(3) of the Code),
Optionee may, but only within twelve months from the Termination Date, exercise
this Option to the extent Optionee was entitled to exercise it as of such
Termination Date.

               (ii) DEATH OF OPTIONEE. In the event of the death of Optionee (a)
during the period of Continuous Service Status since the date of grant of the
Option, or (b) within three months after Optionee's Termination Date, the Option
may be exercised at any time within twelve months following the date of death by
Optionee's estate or by a person who acquired the right to exercise the Option
by bequest or inheritance, but only to the extent Optionee was entitled to
exercise the Option as of the Termination Date.

               (iii) CAUSE. In the event of the termination of Optionee's
Continuous Service Status for Cause, the Option (including any exercisable
portion thereof) shall immediately terminate in its entirety upon first
notification to the Optionee of the termination of his or her Continuous Service
Status. If Optionee's employment or consulting relationship is suspended pending
an investigation of whether the Optionee shall be terminated for Cause, all of
the Optionee's rights under the Option shall be suspended during the
investigation period and the Optionee shall have no right to exercise the Option
during such period.

     6. NON-TRANSFERABILITY OF OPTION. This Option may not be transferred in any
manner otherwise than by will or by the laws of descent or distribution and may
be exercised during the lifetime of Optionee only by him or her. The terms of
this Option shall be binding upon the executors, administrators, heirs,
successors and assigns of Optionee.

                                        3
<PAGE>

     7. EFFECT OF AGREEMENT. Optionee acknowledges receipt of a copy of the
Plan, the Notice and this Agreement and represents that he or she is familiar
with the terms and provisions thereof (and has had an opportunity to consult
counsel regarding the Option terms), and hereby accepts this Option and agrees
to be bound by its contractual terms as set forth herein and in the Notice and
the Plan. Optionee hereby agrees to accept as binding, conclusive and final all
decisions and interpretations of the Committee regarding any questions relating
to the Option. In the event of a conflict between the terms and provisions of
the Plan and the terms and provisions of the Notice and this Agreement, the Plan
terms and provisions shall prevail. The Option, including the Plan and the
Notice, constitutes the entire agreement between Optionee and the Company on the
subject matter hereof and supersedes all proposals, written or oral, and all
other communications between the parties relating to such subject matter.

     8. NO ADDITIONAL EMPLOYMENT RIGHTS. Optionee understands and agrees that
the vesting of Shares pursuant to the vesting schedule is earned only by
continuing as an employee or consultant at the will of the Company or, to the
extent applicable, its Parent, Subsidiary or Affiliate (not through the act of
being hired, being granted this Option or acquiring Shares under this
Agreement). Optionee further acknowledges and agrees that nothing in this
Agreement, nor in the Plan which is incorporated in this Agreement by reference,
shall confer upon Optionee any right with respect to continuation as an employee
or consultant with the Company, its Parent, Subsidiaries or Affiliates, nor
shall it interfere in any way with his or her right or the Company's (or the
Parents, Subsidiaries, or Affiliates) right to terminate his or her employment
or consulting relationship at any time, with or without cause.

     9.   DEFINITIONS.

          (a) "Applicable Laws" means all applicable laws, rules and
     regulations, including, but not limited to, U.S. state corporate laws, U.S.
     federal and applicable state securities laws, the Internal Revenue Code of
     1986, as amended, any Stock Exchange rules or regulations and the
     applicable laws of any other country or jurisdiction where awards are
     granted under the Plan or where Plan participants reside or provide
     services to the Company or any Parent, Subsidiary or Affiliate, as such
     laws, rules, regulations and requirements shall be in place from time to
     time.

          (b) "Cause" for termination of Optionee's Continuous Service Status
     will exist (unless otherwise defined in an applicable employment agreement)
     if Optionee is terminated for any of the following reasons: (i) Optionee's
     willful failure substantially to perform his or her duties and
     responsibilities to the Company or deliberate violation of a Company
     policy; (ii) Optionee's commission of any act of fraud, embezzlement,
     dishonesty or any other willful misconduct that has caused or is reasonably
     expected to result in material injury to the Company; (iii) unauthorized
     use or disclosure by Optionee of any proprietary information or trade
     secrets of the Company or any other party to whom the Optionee owes an
     obligation of nondisclosure as a result of his or her relationship with the
     Company; or (iv) Optionee's willful breach of any of his or her obligations
     under any written agreement or covenant with the Company. The determination
     as to whether Optionee is being terminated for Cause shall be made in good
     faith by the Company and shall be final and binding on the Optionee. The
     foregoing

                                        4
<PAGE>

     definition does not in any way limit the Company's ability to terminate
     Optionee's employment or consulting relationship at any time, and the term
     "Company" will be interpreted to include any Subsidiary, Parent, Affiliate
     or successor thereto, if appropriate.

          (c) "Continuous Service Status" means the absence of any interruption
     or termination of service as an employee or consultant. Continuous Service
     Status as an employee or consultant shall not be considered interrupted in
     the case of: (i) sick leave; (ii) military leave; (iii) any other leave of
     absence approved by the Committee, provided that such leave is for a period
     of not more than ninety days, unless reemployment upon the expiration of
     such leave is guaranteed by contract or statute, or unless provided
     otherwise pursuant to Company policy adopted from time to time; or (iv) in
     the case of transfers between locations of the Company or between the
     Company, its Parents, Subsidiaries, Affiliates or their respective
     successors. A change in status from an employee to a consultant or from a
     consultant to an employee will not constitute an interruption of Continuous
     Service Status.

                                        5
<PAGE>

                                    EXHIBIT A

                               NOTICE OF EXERCISE

To:       ESS Technology, Inc.
Attn:     Stock Option Administrator
Subject:  Notice of Intention to Exercise Stock Option

     This is official notice that the undersigned ("Optionee") intends to
exercise Optionee's option (Option Number _________) to purchase
___________________ shares of ESS Technology, Inc. common stock, under and
pursuant to the Notice of Grant of Stock Options and Option Agreement ("Notice")
dated ______________________, the plan identified in the Notice, and the Stock
Option Agreement, as follows:

           Grant Number:
                              -------------------------------------------------

           Date of Purchase:
                              -------------------------------------------------

           Number of Shares:
                              -------------------------------------------------

           Purchase Price:
                              -------------------------------------------------

           Method of Payment
           of Purchase Price:
                              -------------------------------------------------

     The shares should be issued as follows:

           Name:
                    -------------------------------------------------

           Address:
                    -------------------------------------------------

                    -------------------------------------------------

           Signed:
                    -------------------------------------------------
           Date:
                    -------------------------------------------------

                                        6

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