Document:

LOAN AND SECURITY AGREEMENT

 

This agreement is entered into by and between
InterCore, Inc., a Delaware corporation, and its wholly owned subsidiary SRG International, Inc., a Canadian corporation (InterCore,
Inc. together with SRG International, Inc., the "Companies") and RHINE PARTNERS, LP, a Texas Limited Partnership, (the
"Lender") as of May 5, 2014 (the "Agreement").

 

WHEREAS, the Companies require working
capital in order to implement their business plan which calls for the commercial sales of their proprietary alertness detection
products in several key markets; and

 

WHEREAS, the Lender is fully familiar with
their business strategy and desires to assist the Companies in achieving their business development by providing the working capital
they require; and

 

WHEREAS, the Companies and the Lender
have negotiated a Promissory Note, dated May 5, 2014 under which the Lender has agreed to provide a secured working capital
facility (the "Facility") in order to meet the working capital needs of the Companies; and

 

WHEREAS, this Agreement is the Definitive
Agreement to implement the loan, the Promissory Note and associated security interest.

 

NOW THEREFORE intending to be legally bound
the parties hereto do agree as follows:

 

1.Extension of Credit.
The Lender hereby agrees to extend credit to the Companies in the maximum amount of $4,000,000 at the Companies' request in
amounts from time to time. The Companies may make multiple draws to aggregate the maximum borrowing of $4,000,000. The
maximum draw that can be requested for the initial draw of this Agreement is $500,000. The maximum draw in any following draw
of this Agreement that may be requested is $1,000,000. Each draw shall be funded by the Lender within fifteen (15) days of
the date that written request for said draw is received. An additional draw may not be requested while a draw is pending. The
total of all draws made hereunder less repayments shall be called the "Outstanding Principal".

 

    	 

    	 

    

 

2.Term of the Facility: Unless
extended by the Lender the Facility must be retired fully on or before November 5, 2015.

 

3.Interest. The Companies further
agrees to pay to the Lender interest on the Outstanding Principal at the rate of 18% per annum calculated upon the actual number
of days such principal amounts are outstanding. Interest shall be paid within three business days after the end of each month.

 

The following example is provided for the
avoidance of doubt. Assume a 31 day month, Outstanding Principal at the beginning of the month is $1,000,000, and a $500,000 draw
occurs on the 15th day of the month. The interest due at the end of the month will be $19,479.45 ($1,000,000 X 18% X [14/365] plus
$1,500,000 X 18% X [17/365]).

 

4.Facility Fee. A one-time,
non-refundable fee of 4.5% of the Facility shall be earned when the Loan and Security Agreement for the Facility has been executed.
Half will be paid from the first draw and half will be paid from the second draw.

 

5.Origination Fee. A fee of
6% shall be deducted from each new advance made pursuant to the Facility.

 

6.Warrants. The Companies will
issue to the Lender a Warrant to purchase 2,000,000 shares of InterCore (ICOR) common stock. The Warrant will have a term of four
years and a strike price that will be equal to the closing price of the stock on the day the Term Sheet was extended (May 2, 2014).
The warrants will be fully vested as soon as the first draw is received by the Companies. The form of the Warrant will be consistent
with the warrants that have been issued in 2014 by InterCore.

 

    	 

    	 

    

 

7.Continuing Due Diligence.
The Company shall provide financial and marketing information to the Lender on a weekly basis. The content and list of required
information that the Borrower will supply will be in a format that is acceptable to the Lender. No additional draws will be supplied
as long as the Borrower is in default of this provision.

 

8.Conversion. Outstanding Principal
may be converted at the election of the Lender at any time into Series D Preferred Shares at the price of $10.00 per share; or
into restricted common stock at a price of a 60% discount to market based on the average closing price of the preceding five days.
The right to convert the Outstanding Principal can be exercised up to five days after the Borrower has tendered repayment of the
Principal.

 

9.Repayment. The principal will
begin to be repaid by the Companies as soon as the Companies becomes cash-flow positive. Becoming cash-flow positive is defined
as having revenue in any one month that is more than sufficient for the Companies to pay their monthly obligations, with the expectation
that the positive cash-flow will continue for the following month.

 

10.Prepayment. All or a portion
of Outstanding Principal and any accrued interest may be prepaid by the Companies to the Lender at any time without penalty. Prepayment
of Outstanding Principal does not preclude the Company from subsequently drawing upon this credit facility in equal or greater
amounts.

 

11.Promissory Notes. The Companies
shall execute a promissory notes in the form attached hereto as “Exhibit A" to document each draw.

 

    	 

    	 

    

 

12.Security Interest. The underlying
collateral for the Outstanding Principal under the terms of this Agreement shall be a first lien on all assets of the Companies
including all cash, existing and future accounts receivable, inventory, purchase orders, and all intellectual property and patents
and copyrights owned or licensed for use by the Companies, including all rights to the ADS software, including all marketing,
royalty, and distributions rights to the ADS software and product lines, both current and future, and the Lender is hereby granted
a security interest in said assets excluding all property, plant and equipment. The Companies agree to execute and file a UCC-1
Financing Statement in favor of the Lender. To the extent that any UCC-1 Financing Statement is now active, the Companies agrees
to obtain subordination or cancellation of said UCC-1 Financing Statement. In the event that the Companies have repaid all the
outstanding advances and declared its intention not to make further use of the Facility, the Lender shall forthwith release its
first security lien on the above described assets of the Companies and the Facility shall be terminated.

 

13.Lender Representations.
Lender hereby represents that it is an “accredited” investor and Lender (as defined in 17 CFR 230.501 (a) subsection
8. Lender further represents that Lender has not been formed for the purpose of making this investment, that Lender is acquiring
the promissory note(s), warrants and securities therein for its own account and for investment purposes only and has no present
intention, agreement or arrangement for the distribution, transfer, assignment, resale or subdivision thereof. Lender further
agrees that it will not distribute, transfer, assign, sell, or by any other means transfer ownership of, or any rights to, the
promissory note(s) without prior approval of the Companies.

 

14.Entire Agreement. This is
the entire Agreement of the parties relating to this subject matter. It is to be governed by the laws of the State of Delaware
and shall be enforced in the state or federal courts of the State of Delaware if the parties cannot amicably resolve any disputes
by voluntary submission to an agreed upon mediator or arbitration mechanism. The Agreement may be modified only in writing that
is signed by the parties.

 

[Signature page follows]

 

    	 

    	 

    

 

WITNESS THE HAND AND SEAL OF THE PARTIES
AS OF THE DATE FIRST ABOVE WRITTEN:

 

InterCore, Inc.

 

	/s/  James F. Groelinger	 
	By: James F. Groelinger, Chief Executive Officer	 
	 	 
	SRG International, Inc.	 
	 	 
	/s/ Raphael Huppe	 
	By: Raphael Huppe, Chief Technology Officer	 
	 	 
	SRG International, Inc.	 
	 	 
	/s/ Claude Brun	 
	By: Claude Brun, Director	 
	 	 
	Rhine Partners, LP	 
	 	 
	/s/ Jennifer Hammond	 
	By Jennifer Hammond, Funding Manager	 
	Richson Investments, LLC, its General Partner	 

 

    	 

    	 

    

 

Exhibit A

 

Form Of

 

SECURED PROMISSORY NOTE

 

1.      FOR VALUE RECEIVED,
the undersigned, InterCore Inc., a Delaware corporation, and its wholly owned subsidiary SRG International, Inc., a Canadian Corporation,
(collectively the "Borrower"), promises to pay to Rhine Partners, LP, a Texas Limited Partnership, (“Lender"),
the principal sum of $______________ (_____________dollars) (the "Principal Amount").

 

2.      This Note shall
mature and the Principal Amount become due and payable on November 5, 2015. Payment of the Principal Amount and any accrued and
unpaid interest shall be made by wire transfer to an account to be designated by the Lender.

 

3.      This Note is issued
pursuant to that certain Loan and Security Agreement dated May 5, 2014 and the terms therein are incorporated herein by reference
and made a part hereof as if fully stated herein.

 

4.      Borrower, for
itself and its legal representatives, successors, and assigns, expressly waives presentment, demand, protest, notice of dishonor,
notice of non-payment, notice of maturity, notice of protest, presentment for the purposes of accelerating maturity, diligence
in collection, and any other condition precedent to action against Borrower for the payment hereof.

 

    	 

    	 

    

 

5.      This Note shall
become immediately due and payable without notice or demand upon the happening to Borrower of any one of the following specified
events: (a) assignment for the benefit of creditors; (b) application for, or appointment of a receiver for, it or its property;
(c) filing a voluntary petition under any of the provision of the Bankruptcy Code or having an involuntary petition filed against
it under the Bankruptcy Code which is not dismissed within 60 days; (d) any other proceeding under bankruptcy, insolvency, reorganization,
relief of debtors, or similar laws is commenced by Borrower, or is commenced against Borrower and not dismissed within sixty (60)
days; (e) if any payment of Principal Amount or interest due hereunder is not made within thirty (30) days after the date such
payment was due; (f) if Borrower fails to perform any covenant or agreement hereunder in any material respect; (g) if any representation
or warranty made by Borrower herein was not true and correct in all material respects when made. All such events shall constitute
an Event of Default hereunder. If any of the Events of Default specified in clauses (a) through (d) above occurs, the balance of
the Principal Amount, together with all accrued but unpaid interest, shall immediately become due and payable. If any other Event
of Default occurs, Lender may declare the balance of the Principal Amount, together with all accrued but unpaid interest, to be
immediately due and payable by written notice thereof to Borrower.

 

6.      This obligation
is secured by a first lien on all of the Companies' assets including cash, inventory, accounts receivable and all intellectual
property and patents owned or licensed for use by the Companies. All Property, Plant and Equipment is excluded from the Lender
filing a UCC-1 Financing Statement to perfect this security interest. This first lien shall not be subordinate to security interests
granted to other parties as reflected in UCC-1 Financing Statements filed prior to the date hereof.

 

7.      This Note is to
be construed and enforced according to and governed by the laws of the State of Delaware.

 

    	 

    	 

    

 

8.      Borrower agrees
to pay all costs and expenses (including, without limitation, reasonable attorney fees) incurred or payable by Lender in enforcing
each provision of this Note including, without limitation, respecting the collection of any and all amounts payable under this
Note.

 

9.      Borrower acknowledges
that its obligations to make payments hereunder are absolute and unconditional, and agrees that such payments shall not be requested
to be, and shall not be, subject to any defense, setoff, or counterclaim of any kind or nature, or any other action similar to
the foregoing, provided that nothing contained herein shall preclude any separate proceeding by Borrower against Lender so long
as such proceeding does not in any manner relate to or otherwise impair the payment or the collection of the amounts due hereunder
in accordance with the terms of this Note.

 

10.      No amendment,
modification, rescission, waiver, consent, forbearance, or release of any provision of this Note shall be valid or binding unless
made in writing and executed by a duly authorized representative of Borrower and Lender. No consent or waiver, express or implied,
by Lender to the breach by Borrower in the performance by it of any of its obligations hereunder shall be deemed or construed to
be a consent to or waiver of the further breach in the performance of the same or any other obligation of Borrower hereunder. Failure
on the part of Lender to complain of the act or failure to act by Borrower or to declare Borrower in breach, irrespective of how
long such failure continues, shall not constitute a waiver by Lender of any of its rights hereunder.

 

[Signature page follows]

 

    	 

    	 

    

 

IN WITNESS WHEREOF, Borrower has executed
and delivered this Note as of__________, 2014.

  

InterCore, Inc.

 

	 	 
	By: James Groelinger, Chief Executive Officer	 
	 	 
	SRG International, Inc.	 
	 	 
	 	 
	By: Raphael Huppe, Chief Technology Officer	 
	 	 
	SRG International, Inc.	 
	 	 
	 	 
	By: Claude Brun, DirectorExhibit 10.2 

 

INTERCORE, INC.

 

THE SECURITIES REPRESENTED BY THIS CERTIFICATE
HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (“THE ACT”), OR THE SECURITIES LAWS OF ANY STATE,
AND MAY NOT BE OFFERED, SOLD, TRANSFERRED, PLEDGED, HYPOTHECATED, OR OTHERWISE DISPOSED OF EXCEPT PURSUANT TO (i) AN EFFECTIVE
REGISTRATION STATEMENT UNDER THE ACT AND ANY APPLICABLE STATE LAWS, (ii) TO THE EXTENT APPLICABLE, RULE 144 UNDER THE ACT (OR ANY
SIMILAR RULE UNDER THE ACT RELATING TO THE DISPOSITION OF SECURITIES), OR (iii) AN OPINION OF COUNSEL, IF SUCH OPINION SHALL BE
REASONABLY SATISFACTORY TO COUNSEL TO THE ISSUER, THAT AN EXEMPTION FROM REGISTRATION UNDER THE ACT AND APPLICABLE STATE LAW IS
AVAILABLE.

 

ICOR No. 2014-05-01

 

STOCK PURCHASE WARRANT

 

THIS IS TO CERTIFY
that, for value received, Rhine Partners, LP, or its assigns (the “Holder”) is entitled, subject to the terms and conditions
set forth herein, to purchase from InterCore Energy, Inc., a Delaware corporation (the “Company”) up to Two Million
(2,000,000) fully paid and nonassessable shares of common stock of the Company (the “Warrant Securities”) at $1.00
per share, as adjusted under Section 3 (the “Exercise Price”), upon payment by cashier’s check or wire transfer
of the Exercise Price for such shares of the Common Stock to the Company at the Company’s offices.

 

1.             Exercisability.
This Warrant may be exercised in whole or in part at any time, or from time to time, between the date hereof and 5:00 p.m. EST
on May 2, 2018, by presentation and surrender hereof to the Company of a notice of election to purchase duly executed and accompanied
by payment by check or wire transfer of the Exercise Price. Notwithstanding any other provision governing the Warrants, the Holder
may not exercise these Warrants to the extent that immediately following such exercise the Holder would beneficially own more
than 9.99% of the outstanding Common Stock of the Company. For this purpose, a representation of the Holder that following such
exercise it would not beneficially own more than 9.99% of the outstanding Common Stock of the Company shall be conclusive and
binding upon the Company.

 

2.             Manner of Exercise.
In case of the purchase of less than all of the Warrant Securities, the Company shall cancel this Warrant upon the surrender hereof
and shall execute and deliver a new warrant of like tenor for the balance of the Warrant Securities. Upon the exercise of this
Warrant, the issuance of certificates for securities, properties, or rights underlying this Warrant shall be made forthwith (and
in any event within three (3) business days thereafter) without charge to the Holder including, without limitation, any tax that
may be payable in respect of the issuance thereof: provided, however, that the Company shall not be required to pay any tax in
respect of income or capital gain of the Holder.

 

    	 

    	 

    

 

If and to the extent this Warrant is exercised,
in whole or in part, the Holder shall be entitled to receive a certificate or certificates representing the Warrant Securities
so purchased, upon presentation and surrender to the Company of the form of election to purchase attached hereto duly executed,
and accompanied by payment of the purchase price.

 

3.             Adjustment in Number of Shares.

 

(A)              Adjustment for Reclassifications
. In case at any time or from time to time after the issue date the holders of the Common Stock of the Company (or any shares
of stock or other securities at the time receivable upon the exercise of this Warrant) shall have received, or, on or after the
record date fixed for the determination of eligible stockholders, shall have become entitled to receive, without payment therefore,
additional stock or other securities or property (including cash) by way of stock split, spin-off, reclassification, combination
of shares or similar corporate rearrangement (exclusive of any stock dividend of its or any subsidiary’s capital stock),
then and in each such case the Holder of this Warrant, upon the exercise hereof as provided in Section 1, shall be entitled to
receive the amount of stock and other securities and property which such Holder would hold on the date of such exercise if on the
issue date he had been the holder of record of the number of shares of Common Stock of the Company called for on the face of this
Warrant and had thereafter, during the period from the issue date, to and including the date of such exercise, retained such shares
and/or all other or additional stock and other securities and property receivable by him as aforesaid during such period, giving
effect to all adjustments called for during such period. In the event of any such adjustment, the Exercise Price shall be adjusted
proportionally.

 

(B)              Adjustment for Reorganization,
Consolidation, Merger. In case of any reorganization of the Company (or any other corporation the stock or other securities
of which are at the time receivable on the exercise of this Warrant) after the issue date, or in case, after such date, the Company
(or any such other corporation) shall consolidate with or merge into another corporation or convey all or substantially all of
its assets to another corporation, then and in each such case the Holder of this Warrant, upon the exercise hereof as provided
in Section 1 at any time after the consummation of such reorganization, consolidation, merger or conveyance, shall be entitled
to receive, in lieu of the stock or other securities or property to which such Holder would be entitled had the Holder exercised
this Warrant immediately prior thereto, all subject to further adjustment as provided herein; in each such case, the terms of this
Warrant shall be applicable to the shares of stock or other securities or property receivable upon the exercise of this Warrant
after such consummation.

 

    	 

    	 

    

 

4.            No Requirement to Exercise.
Nothing contained in this Warrant shall be construed as requiring the Holder to exercise this Warrant prior to or in connection
with the effectiveness of a registration statement.

 

5.            Cashless Exercise.
Notwithstanding any provisions herein to the contrary, if the fair market value of one share of the Company’s common
stock is greater than the Exercise Price, in lieu of exercising this Warrant by payment of cash, the holder hereof may elect to
receive shares equal to the value (as determined below) of this Warrant (or the portion thereof being canceled) by surrender of
this Warrant at the principal office of the Company together with the properly endorsed Exercise Agreement in which event the Company
shall issue to the holder hereof a number of shares of the Company’s common stock computed using the following formula:

 

X = Y (A-B)           Where X = the number
of shares of the Company’s common stock to

             A                be issued to the
holder hereof

 

Y =          the number
of shares of the Company’s common stock purchasable under the Warrant or, if only a portion of the Warrant is being exercised,
the portion of the Warrant being canceled (at the date of such calculation)

 

A = the fair market
value of one share of the Company’s common stock (at the date of such calculation)

 

B = the Exercise Price

 

All references herein
to an “exercise” of the Warrant shall include an exchange pursuant to this Section 5. For the purposes of the above
calculation, the Fair Market Value of one share of the Company’s common stock as of a particular date shall mean:

 

             (a)              If traded on a securities exchange
or the NASDAQ National Market, the Fair Market Value shall be deemed to be the average of the closing prices of the common stock
of the Company on such exchange or market over the five (5) business days ending immediately prior to the applicable date of valuation;

 

             (b)              If actively traded over-the-counter,
the Fair Market Value shall be deemed to be the closing price of the common stock of the Company on the day immediately prior to
the applicable date of valuation; and

 

             (c)              If there is no active public
market, the “Fair Market Value” shall be the value thereof, as determined in good faith by the Company’s
Board of Directors

 

A stock certificate
representing the appropriate number of shares of the common stock shall be delivered to the holder hereof within five (5) days
following the date of exercise.

 

    	 

    	 

    

 

6.             No Stockholder Rights.
Unless and until this Warrant is exercised, this Warrant shall not entitle the Holder hereof to any voting rights or other rights
as a stockholder of the Company, or to any other rights whatsoever except the rights herein expressed, and, no dividends shall
be payable or accrue in respect of this Warrant.

 

Upon receipt by the
Company of evidence reasonably satisfactory to it of the loss, theft, destruction, or mutilation of this Warrant, and, in case
of loss, theft, or destruction, of indemnity or security reasonably satisfactory to it and reimbursement to the company of all
reasonable expenses incidental thereto, and upon surrender and cancellation hereof, if mutilated, the Company will make and deliver
a new warrant of like tenor and amount, in lieu hereof.

 

7.             Exchange. This Warrant
is exchangeable upon the surrender hereof by the Holder to the Company for new warrants of like tenor representing in the aggregate
the right to purchase the number of Warrant Securities purchasable hereunder, each of such new warrants to represent the right
to purchase such number of Warrant Securities as shall be designated by the Holder at the time of surrender.

 

8.              Elimination of Fractional
Interests. The Company shall not be required to issue certificates representing fractions of securities upon the exercise
of this Warrant, nor shall it be required to issue scrip or pay cash in lieu of fractional interests. All fractional interests
shall be eliminated by rounding any fraction up to the nearest whole number of securities, properties, or rights receivable upon
exercise of this Warrant.

 

9.              Reservation of Securities.
The Company shall at all times reserve and keep available out of its authorized shares of Common Stock or other securities, solely
for the purpose of issuance upon the exercise of this Warrant, such number of shares of Common Stock or other securities, properties,
or rights as shall be issuable upon the exercise hereof. The Company covenants and agrees that, upon exercise of this Warrant and
payment of the Principal Value, all shares of Common Stock and other securities issuable upon such exercise shall be duly and validly
issued, fully paid, non-assessable and not subject to the preemptive rights of any stockholder.

 

10.           Notices to Holder.
If at any time prior to the expiration of this Warrant or its exercise, any of the following events shall occur:

 

             (a)             
the Company shall take a record of the holders of any class of its securities for the purpose of entitling them to receive a
dividend or distribution payable otherwise than in cash, or a cash dividend or distribution payable otherwise than out of
current or retained earnings, as indicated by the accounting treatment of such dividend or distribution on the books of the
Company; or

 

             (b)              the Company shall offer to
all the holders of a class of its securities any additional shares of capital stock of the Company or securities convertible into
or exchangeable for shares of capital stock of the Company, or any option or warrant to subscribe therefor; or

 

    	 

    	 

    

 

             (c)              a dissolution, liquidation,
or winding up of the Company (other than in connection with a consolidation or merger) or a sale of all or substantially all of
its property, assets and business as an entirety shall be proposed.

 

Then, in any one or more of said events,
the Company shall give written notice of such event to the Holder at least fifteen (15) days prior to the date fixed as a record
date or the date of closing the transfer books for the determination of the stockholder entitled to such dividend, distribution,
convertible or exchangeable securities or subscription rights, or entitled to vote on such proposed dissolution, liquidation, winding
up, or sale. Such notice shall specify such record date or the date of closing the transfer books, as the case may be.

 

11.           Transferability. This
Warrant may be transferred or assigned by the Holder only upon written consent by the Company.

 

12.           Informational Requirements.
The Company will transmit to the Holder such information, documents, and reports as are generally distributed to stockholders of
the Company concurrently with the distribution thereof to such stockholders.

 

13.           Investor Questionnaire.
The Purchaser has accurately completed the Investor Questionnaire attached hereto as Exhibit A and incorporated by reference
herein.

 

14.           Notice. Notices to
be given to the Company or the Holder shall be deemed to have been sufficiently given if delivered personally or sent by overnight
courier or messenger, or by facsimile transmission. Notices shall be deemed to have been received on the date of personal delivery
or facsimile transmission. The address of the Company and of the Holder shall be as set forth in the Company’s books and
records.

 

15.          Consent to Jurisdiction and
Service. The Company consents to the jurisdiction of any court of the State of Delaware, and of any federal court located
in Delaware, in any action or proceeding arising out of or in connection with this Warrant. The Company waives personal service
of any summons, complaint, or other process in connection with any such action or proceeding and agrees that service thereof may
be made at the location provided in Section 12 hereof, or, in the alternative, in any other form or manner permitted by law. The
Holder and Company agree that Delaware shall be deemed proper venue.

 

16.           Successors. All the
covenants and provisions of this Warrant shall be binding upon and inure to the benefit of the Company, the Holder, and their respective
legal representatives, successors, and assigns.

 

17.           Attorneys’ Fees.
In the event the Holder hereof shall refer this Warrant to an attorney to enforce the terms hereof, the Company agrees to pay all
the costs and expenses incurred in attempting or effecting collection hereunder, including reasonable attorney's fees, whether
or not suit is instituted.

 

    	 

    	 

    

 

18.           Governing Law. THIS
WARRANT SHALL BE GOVERNED, CONSTRUED AND INTERPRETED UNDER THE LAWS OF THE STATE OF DELAWARE, WITHOUT GIVING EFFECT TO THE RULES
GOVERNING CONFLICTS OF LAW.

 

IN WITNESS WHEREOF, the Company has
caused this Warrant to be executed by the signature of its President, CEO and to be delivered in New Jersey.

 

Dated:        May 2, 2014 except for paragraph #1 which

was amended effective February 10, 2015

 

	 	INTERCORE, INC.  
	 	A Delaware Corporation
	 	 
	 	By: 
	 	 
	 	/s/ James F. Groelinger
	 	 
	 	Its:  President, CEO

 

    	 

    	 

    

 

[FORM OF ELECTION TO PURCHASE]

 

The undersigned, the holder of the attached
Warrant, hereby irrevocably elects to exercise the purchase right represented by this Warrant Certificate to purchase securities
of InterCore, Inc. and herewith, using the cashless exercise provision of this warrant, requests that (that using the value of
______ of the warrant shares) a certificate for _______ free trading common shares be issued in the name of, and delivered to ___________________,
whose address is ______________________________.

 

Dated: ________________ 20___

 

	 	By:______________________________
	 	 
	 	Its:___Manager_______________________
	 	 
	 	(Signature must conform in
	 	respects to name of holder
	 	as specified on the face of the
	 	Warrant Certificate)
	 	 
	 	__________________________________
	 	 
	 	(Insert Social Security or
	 	Other Identifying Number of
	 	Holder)

 

    	 

    	 

    

 

Exhibit A

 

Investor Questionnaire

 

(to be completed by each Purchaser)

 

	Name:	FEIN:
	 	 
	Cell Phone:	Email:
	 	 
	Work Phone:	 

 

	1.	a.  State of Residence: ___________________________________________________________________
	 	 
	 	b.  For how long? _______________________________________________________________________
	 	 
	 	c.  Do you maintain a residence in any other state? ______________________________________________
	 	 
	2.	In which state(s) do you
	 	 
	 	a.  File state income tax returns: ____________________________________________________________
	 	 
	 	b.  Hold current driver’s license: ____________________________________________________________
	 	 
	 	c.  Maintain a house or apartment: __________________________________________________________

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