Document:

Exhibit 4.2

 

THE SECURITIES REPRESENTED BY THIS
CERTIFICATE HAVE NOT BEEN REGISTERED UNDER EITHER THE SECURITIES ACT OF 1933, AS AMENDED (THE “1933 ACT”), OR APPLICABLE
STATE SECURITIES LAWS (THE “STATE ACTS”), AND SHALL NOT BE SOLD, ASSIGNED, PLEDGED, HYPOTHECATED, DONATED OR OTHERWISE
TRANSFERRED (WHETHER OR NOT FOR CONSIDERATION) BY THE HOLDER EXCEPT BY REGISTRATION OR PURSUANT TO AN EXEMPTION FROM REGISTRATION
UPON THE ISSUANCE TO THE COMPANY OF A FAVORABLE OPINION OF COUNSEL OR OTHER EVIDENCE REASONABLY SATISFACTORY TO THE COMPANY TO
THE EFFECT THAT ANY SUCH TRANSFER SHALL NOT BE IN VIOLATION OF THE 1933 ACT AND THE STATE ACTS.

 

CROSSROADS SYSTEMS, INC.

COMMON STOCK PURCHASE WARRANT

To Purchase ______ Shares of Common Stock

 

	 	Date of Issuance:  _______, 2015
	 	 	 
	 	Warrant No.: A-______

 

VOID
AFTER January 30, 2020

 

THIS CERTIFIES THAT,
for value received, __________________, or permitted registered assigns (the “Holder”), is entitled to
subscribe for and purchase at the Exercise Price (defined below) from Crossroads Systems, Inc., a Delaware corporation (the “Company”),
up to ______________ shares of the common stock of the Company, par value $0.001 per share (the “Common Stock”).
This Warrant is one of a series of warrants issued by the Company as of the date hereof (individually, a “Warrant”,
and collectively, “Company Warrants”).

 

This Warrant is granted
in connection with that certain Placement Agency Agreement between the Company, Roth Capital Partners, LLC and Northland Securities,
Inc., as placement agents, dated January 27, 2015 (the “Placement Agency Agreement”) and the offering
of 3,071,739 shares of the Common Stock and warrants to purchase 1,535,870 shares of Common Stock issued pursuant to a prospectus
filed with the Securities and Exchange Commission on January 27, 2015 (the “Offering”).

 

1.          Definitions.
Capitalized terms used herein but not otherwise defined herein shall have their respective meanings as set forth in the Placement
Agency Agreement. As used herein, the following terms shall have the following respective meanings:

 

(a)          “Exercise
Period” shall mean the period commencing with the date that is six months after the Closing Date and ending on the
fifth anniversary of the Closing Date, unless sooner terminated as provided below.

 

(b)          “Exercise
Price” shall initially mean $2.76 per share, subject to adjustment pursuant to Section 5 below.

 

    	 

    	 

    

 

(c)          “Person”
means an individual, corporation, partnership, limited liability company, trust, business trust, association, joint stock company,
joint venture, sole proprietorship, unincorporated organization, governmental authority or any other form of entity not specifically
listed herein. 

 

(d)          “Trading
Day” shall mean any day on which the principal Trading Market is open for business.

 

(e)          “Trading
Market” shall mean any of the following markets or exchanges on which the Common Stock is listed or quoted for trading
on the date in question: the NYSE MKT, the Nasdaq Capital Market, the Nasdaq Global Market, the Nasdaq Global Select Market, the
New York Stock Exchange or the OTC Bulletin Board (or any successors to any of the foregoing).

 

(f)          “Warrant
Shares” shall mean the shares of Common Stock issuable upon exercise of this Warrant.

 

2.          Exercise
of Warrant.

 

2.1           Exercise
Mechanics. The rights represented by this Warrant may, subject to Section 7 below, be exercised in whole or in
part at any time during the Exercise Period, by delivery of the following to the Company at its address set forth on the signature
page hereto (or at such other address as it may designate by notice in writing to the Holder):

 

(a)          A
complete and duly executed Notice of Exercise, by or for the benefit of the Holder, in the form attached hereto as Exhibit A;
and

 

(b)          Payment
of the Exercise Price either in cash or by check (subject to the limitations in Section 2.3 below), or pursuant to the “cashless
exercise” procedures set forth in Section 4 below.

 

Execution and delivery
of the Notice of Exercise shall have the same effect as cancellation of the portion of the original Warrant so exercised, and this
Warrant shall evidence the right to purchase the remaining number of Warrant Shares, if any. If requested by the Company, the Holder
agrees to provide this Warrant, or an affidavit of lost security, to the Company within a reasonable period after the delivery
of the Notice of Exercise.

 

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Certificates for shares
purchased hereunder shall be transmitted by the transfer agent of the Company to the Holder by crediting the account of the Holder’s
prime broker with the Depository Trust Company through its Deposits and Withdrawal at Custodian (DWAC) system if the Company is
a participant in such system, and otherwise by physical delivery to the address specified by the Holder in the Notice of Exercise
within three (3) business days from the delivery to the Company of the Notice of Exercise, surrender of this Warrant and payment
of the aggregate Exercise Price as set forth above. This Warrant shall be deemed to have been exercised on the date the Exercise
Price is received by the Company. The Warrant Shares shall be deemed to have been issued, and the Holder or any other person so
designated to be named therein shall be deemed to have become a holder of record of such shares for all purposes, as of the date
this Warrant has been exercised by payment to the Company of the Exercise Price. If by the close of the third full Trading Day
after delivery of a Notice of Exercise, the Company fails to deliver to the Holder a certificate representing the required number
of Warrant Shares in the manner required pursuant to this Section 2, and if after such third Trading Day and prior to the
receipt of such Warrant Shares, the Holder purchases (in an open market transaction or otherwise) shares of Common Stock to deliver
in satisfaction of a sale by the Holder of the Warrant Shares which the Holder anticipated receiving upon such exercise (a “Buy-In”),
then the Company shall, within three Trading Days after the Holder’s request and in the Holder’s sole discretion, either
(a) pay in cash to the Holder an amount equal to the Holder’s total purchase price (including brokerage commissions, if any)
for the shares of Common Stock so purchased (the “Buy-In Price”), at which point the Company’s
obligation to deliver such certificate (and to issue such Warrant Shares) shall terminate or (b) promptly honor its obligation
to deliver to the Holder a certificate or certificates representing such Warrant Shares and pay cash to the Holder in an amount
equal to the excess (if any) of the Buy-In Price over the product of (i) such number of Warrant Shares, times (ii) the closing
bid price on the date of the event giving rise to the Company’s obligation to deliver such certificate.

 

The person in whose
name any Warrant Shares are to be issued upon exercise of this Warrant shall be deemed to have become the holder of record of such
shares on the date on which this Warrant was surrendered and payment of the Exercise Price was made, irrespective of the date of
delivery of such certificate or certificates, except that, if the date of such surrender and payment is a date when the stock transfer
books of the Company are closed, such person shall be deemed to have become the holder of such shares at the close of business
on the next succeeding date on which the stock transfer books are open.

 

To the extent permitted
by law, the Company’s obligations to issue and deliver Warrant Shares in accordance with the terms hereof are absolute and
unconditional, irrespective of any action or inaction by the Holder to enforce the same, any waiver or consent with respect to
any provision hereof, the recovery of any judgment against any person or entity or any action to enforce the same, or any setoff,
counterclaim, recoupment, limitation or termination, or any breach or alleged breach by the Holder or any other person or entity
of any obligation to the Company or any violation or alleged violation of law by the Holder or any other person or entity, and
irrespective of any other circumstance which might otherwise limit such obligation of the Company to the Holder in connection with
the issuance of Warrant Shares.

 

Nothing herein shall
limit a Holder’s right to pursue any other remedies available to it hereunder, at law or in equity including, without limitation,
a decree of specific performance and/or injunctive relief with respect to the Company’s failure to timely deliver certificates
representing the Warrant Shares upon exercise of this Warrant as required pursuant to the terms hereof.

 

2.2           Issuance
of New Warrants. Upon any partial exercise of this Warrant, the Company, at its expense, will forthwith and, in any event within
five (5) business days, issue and deliver to the Holder a new warrant or warrants of like tenor, registered in the name of the
Holder, exercisable, in the aggregate, for the balance of the number of the Warrant Shares remaining available for purchase under
this Warrant.

 

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2.3           Exercise
Limitations; Holder’s Restrictions.

 

(a)          The
number of Warrant Shares that may be acquired by the Holder upon any exercise of the Warrant (or otherwise in respect hereof) shall
be limited to the extent necessary to insure that, following such exercise (or other issuance), the total number of shares of Common
Stock then beneficially owned by such Holder and its affiliates (as defined under Rule 144, “Affiliates”)
and any other persons whose beneficial ownership of Common Stock would be aggregated with the Holder’s for purposes of Section
13(d) of the Exchange Act, does not exceed 19.999% (the “19.999% Ownership Limitation”) of the total
number of issued and outstanding shares of Common Stock (including for such purpose the shares of Common Stock issuable upon such
exercise but excluding any shares of Common Stock issuable upon (y) exercise of the remaining, unexercised portion of the
Warrant beneficially owned by such Holder and its Affiliates or (z) exercise or conversion of the unexercised or un-converted portion
of any other securities of the Company (including, without limitation any other shares of Common Stock or warrants) subject to
a limitation on exercise analogous to the limitation included in this Section 2.3(a) that are beneficially owned by such Holder
or any of its Affiliates). Except as described in the preceding sentence, for purposes of this Section 2.3(a), beneficial ownership
shall be determined in accordance with Section 13(d) of the Exchange Act and the rules and regulations promulgated thereunder.
This provision shall not restrict the number of shares of Common Stock which a Holder may receive or beneficially own in order
to determine the amount of securities or other consideration that such Holder may receive in the event of a Fundamental Transaction
as contemplated in Section 7 of this Warrant.

 

(b)          In
addition to the limitation contained in the preceding paragraph, (1) during any period of time in which a Holder’s beneficial
ownership of Common Stock is less than 10%, the number of Warrant Shares that may be acquired by such Holder upon any exercise
of the Warrant (or otherwise in respect hereof) shall be limited to the extent necessary to insure that, following such exercise
(or other issuance), the total number of shares of Common Stock then beneficially owned by such Holder and its affiliates does
not exceed 9.999% (the “9.999% Ownership Limitation”) (calculated as described in the first sentence
of the preceding paragraph), and (2) during any period of time in which a Holder’s beneficial ownership of Common Stock is
less than 5%, the number of Warrant Shares that may be acquired by such Holder upon any exercise of the Warrant (or otherwise in
respect hereof) shall be limited to the extent necessary to insure that, following such exercise (or other issuance), the total
number of shares of Common Stock then beneficially owned by such Holder and its affiliates does not exceed 4.999% (the “4.999%
Ownership Limitation”) (calculated as described in the first sentence of the preceding paragraph). The 4.999% limitation
may only be waived by the approval of the Board of Directors of the Company (but such waiver shall not affect any other Holder).
By written notice to the Company, the Holder may waive the 9.99% Ownership Limitation, but any such waiver will not be effective
until the 61st day after delivery of such notice, nor will any such waiver effect any other Holder. The 19.999% Ownership Limitation
may not be waived.

 

(c)          For
purposes of Section 2.3(a) and (b), it understood that (1) that the Company is not representing to any Holder that
any calculations required hereby are in compliance with Section 13(d) of the Exchange Act and each Holder is solely responsible
for any schedules required to be filed in accordance therewith and (2) to the extent that the limitation contained in this Section
2.3 applies, the determination of whether this Warrant is exercisable (in relation to other securities owned by such Holder) and
of which portion of this Warrant is exercisable shall be in the sole discretion of a Holder, and the submission of an Exercise
Notice shall be deemed to be each Holder’s determination of whether a Warrant is exercisable (in relation to other securities
owned by such Holder) and of which portion of a Warrant is exercisable, in each case subject to such aggregate percentage limitation,
and the Company shall have no obligation to verify or confirm the accuracy of such determination.

 

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3.          Covenants
of the Company.

 

3.1           Due
Authorization. The Company covenants and agrees that all Warrant Shares that may be issued upon the exercise of the rights
represented by this Warrant will, upon issuance, be validly issued and outstanding, fully paid and nonassessable, and free from
all taxes, liens and charges with respect to the issuance thereof.

 

3.2           Available
Shares. The Company covenants and agrees that the Company will, at all times during the Exercise Period, have authorized and
reserved, free from preemptive rights, a sufficient number of shares of Common Stock to provide for the exercise of the rights
represented by this Warrant. During the Exercise Period, if the number of authorized but unissued shares of Common Stock shall
not be sufficient to permit exercise of this Warrant into the applicable Warrant Shares, the Company will take such corporate action
as may, in the opinion of its counsel, be necessary to increase its authorized but unissued shares of Common Stock to such number
of shares as shall be sufficient for such purposes.

 

3.3           No
Impairment. Except and to the extent as waived or consented to by the Holder, the Company will not, by amendment of its Certificate
of Incorporation or through any reorganization, transfer of assets, consolidation, merger, dissolution, issue or sale of securities
or any other voluntary action, avoid or seek to avoid the observance or performance of any of the terms to be observed or performed
hereunder by the Company, but will at all times in good faith assist in the carrying out of all the provisions of this Warrant
and in the taking of all such action as may be necessary or appropriate in order to protect the exercise rights of the Holder against
impairment.

 

4.          Cashless
Exercise. If this Warrant is exercisable for Warrant Shares, then this Warrant may be exercised at such time by means of a
“cashless exercise” in which the Holder shall be entitled to receive a certificate for the number of Warrant Shares
equal to the quotient obtained by dividing [(A-B) (X)] by (A), where:

 

(A) =the VWAP on
the Trading Day immediately preceding the date of such election;

 

(B) =the Exercise
Price of this Warrant, as adjusted; and

 

(X) =the number
of Warrant Shares issuable upon exercise of this Warrant in accordance with the terms of this Warrant by means of a cash exercise
rather than a cashless exercise.

 

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“VWAP” means,
for any date, the price determined by the first of the following clauses that applies: (a) if the Common Stock is then listed
or quoted on the principal Trading Market, the daily volume weighted average price of the Common Stock for such date (or the nearest
preceding date) on the principal Trading Market on which the Common Stock is then listed or quoted for trading as reported by Bloomberg
(as defined below) (based on a Trading Day from 9:30 a.m. (New York City time) to 4:02 p.m. (New York City time); (b) if the
Common Stock is not then quoted for trading on a Trading Market and if prices for the Common Stock are then reported in the “Pink
Sheets” published by OTC Markets Group Inc. (or a similar organization or agency succeeding to its functions of reporting
prices), the most recent bid price per share of the Common Stock so reported; or (c) in all other cases, the fair market value
of a share of Common Stock as determined by an independent appraiser selected in good faith by the Holders of Company Warrants
representing at least a majority of the Warrant Shares then subject to outstanding Company Warrants and reasonably acceptable to
the Company, the fees and expenses of which shall be paid by the Company.

 

5.          Adjustment
of Exercise Price and Shares.

 

5.1           Stock
Dividends, Split-Ups, Recapitalizations, Etc. In the event of changes in the outstanding Common Stock of the Company by reason
of stock dividends, split-ups, recapitalizations, reclassifications, combinations or exchanges of shares, separations, reorganizations,
liquidations, consolidation, acquisition of the Company (whether through merger or acquisition of substantially all the assets
or stock of the Company), or the like, the number, class and type of shares available under this Warrant in the aggregate and the
Exercise Price shall be correspondingly adjusted to give the Holder of this Warrant, on exercise for the same aggregate Exercise
Price, the total number, class, and type of shares or other property as the Holder would have owned had this Warrant been exercised
prior to the event and had the Holder continued to hold such shares until the event requiring adjustment. The form of this Warrant
need not be changed because of any adjustment in the number of Warrant Shares subject to this Warrant.

 

5.2           Certificate
of Adjustment. Upon the occurrence of each adjustment pursuant to this Section 5, the Company at its expense will, at
the written request of the Holder, promptly compute such adjustment in accordance with the terms of this Warrant and prepare a
certificate setting forth such adjustment, including a statement of the adjusted Exercise Price and adjusted number or type of
Warrant Shares or other securities issuable upon exercise of this Warrant (as applicable), describing the transactions giving rise
to such adjustments and showing in detail the facts upon which such adjustment is based. Upon written request, the Company will
promptly deliver a copy of each such certificate to the Holder and to the Company’s transfer agent.

 

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6.          Fractional
Shares. No fractional shares shall be issued upon the exercise of this Warrant as a consequence of any adjustment pursuant
hereto. All Warrant Shares (including fractions) issuable upon exercise of this Warrant may be aggregated for purposes of determining
whether the exercise would result in the issuance of any fractional share. If, after aggregation, the exercise would result in
the issuance of a fractional share, the Company shall, in lieu of issuance of any fractional share, pay the Holder otherwise entitled
to such fraction a sum in cash equal to the product resulting from multiplying the then current Fair Market Value of a share of
Common stock by the fractional share not to be issued. “Fair Market Value” of one share of Common Stock
shall mean (a) the average of the closing sales prices for the shares of Common Stock on the principal Trading Market as reported
by Bloomberg Financial Markets (or a comparable reporting service of national reputation selected by the Company and reasonably
acceptable to the Holder if Bloomberg Financial Markets is not then reporting sales prices of such security) (collectively, “Bloomberg”)
for the ten (10) consecutive trading days immediately preceding such date, or (b) if the foregoing does not apply, the last sales
price of such security in the over-the-counter market on the pink sheets or bulletin board for such security as reported by Bloomberg,
or if no sales price is so reported for such security, the last bid price of such security as reported by Bloomberg, or (c) if
Fair Market Value cannot be calculated as of such date on either of the forgoing bases, the Fair Market Value shall be as determined
by the Board of Directors of the Company (or a duly constituted committee thereof) in the exercise of its good faith judgment.

 

7.          Fundamental
Transactions. If, at any time while this Warrant is outstanding, (a) the Company, directly or indirectly, in one or more related
transactions effects any merger or consolidation of the Company with or into another Person, (b) the Company, directly or indirectly,
effects any sale, lease, license, assignment, transfer, conveyance or other disposition of all or substantially all of its assets
in one or a series of related transactions, (c) any direct or indirect purchase offer, tender offer or exchange offer (whether
by the Company or another Person) is completed pursuant to which holders of Common Stock are permitted to sell, tender or exchange
their shares for other securities, cash or property and has been accepted by the holders of more than 50% of the outstanding shares
of Common Stock, (d) the Company, directly or indirectly, in one or more related transactions effects any reclassification, reorganization
or recapitalization of the Common Stock or any compulsory share exchange pursuant to which the Common Stock is effectively converted
into or exchanged for other securities, cash or property, or (e) the Company, directly or indirectly, in one or more related transactions
consummates a stock or share purchase agreement or other business combination (including, without limitation, a reorganization,
recapitalization, spin-off or scheme of arrangement) with another Person whereby such other Person acquires more than 50% of the
outstanding shares of Common Stock (not including any shares of Common Stock held by the other Person or other Persons making or
party to, or associated or affiliated with the Persons making or party to, such stock or share purchase agreement or other business
combination) (each, a “Fundamental Transaction”), then, subject to the last sentence of this Section,
the Holder shall have the right thereafter to receive, upon exercise of the Warrant, the same amount and kind of securities, cash
or property as it would have been entitled to receive upon the occurrence of such Fundamental Transaction if it had been, immediately
prior to such Fundamental Transaction, the holder of the number of Warrant Shares then issuable upon exercise in full of the Warrant
(the “Alternate Consideration”). For purposes of any such exercise, the determination of the Exercise
Price shall be appropriately adjusted to apply to such Alternate Consideration based on the amount of Alternate Consideration issuable
in respect of one share of Common Stock in such Fundamental Transaction, and the Company shall apportion the Exercise Price among
the Alternate Consideration in a reasonable manner reflecting the relative value of any different components of the Alternate Consideration.
If holders of Common Stock are given any choice as to the securities, cash or property to be received in a Fundamental Transaction,
then the Holder shall be given the same choice as to the Alternate Consideration it receives upon any exercise of the Warrant following
such Fundamental Transaction. At the Holder’s option and request and upon surrender of the Holder’s Warrant, any successor
to the Company or surviving entity in such Fundamental Transaction shall issue to the Holder a new warrant substantially in the
form of the Warrant and consistent with the foregoing provisions and evidencing the Holder’s right to purchase the Alternate
Consideration for the aggregate Exercise Price upon exercise thereof. The terms of any agreement pursuant to which a Fundamental
Transaction is effected shall include terms requiring any such successor or surviving entity to comply with the provisions of this
Section 7 and insuring that the Warrant (or any such replacement security) will be similarly adjusted upon any subsequent transaction
analogous to a Fundamental Transaction. In the event of a Fundamental Transaction other than one in which the consideration consists
of only cash and/or stock quoted or listed for trading on a Trading Market (“Public Stock”), the Company
or the successor entity shall, at the Holder’s option and request and upon surrender of the Holder’s Warrant, purchase
the Warrant from the Holder for a purchase price, payable in cash within five Trading Days after such request (or, if later, on
the effective date of the Fundamental Transaction), equal to the Black Scholes value of the remaining unexercised portion of the
Warrant on the date of such request. Notwithstanding anything in this Section 7 to the contrary, if at any time while this Warrant
is outstanding, the Company engages in any Fundamental Transaction in which the holders of Common Stock receive in exchange for
their shares of Common Stock only cash and/or Public Stock, then the Holder of this Warrant shall only be entitled to receive only
an amount of cash or Public Stock (as applicable) equal to (or in the case of Public Stock, having a fair market value equal to)
(i) (A) the amount of cash (or fair market value of the number of shares of Public Stock) payable in such Fundamental Transaction
to the holders of Common Stock for each share of Common Stock held; less (B) the Exercise Price of this Warrant, as adjusted; multiplied
by (ii) the number of Warrant Shares issuable upon exercise of this Warrant, at the same time and on the same terms as the holders
of Common Stock, and immediately upon the receipt of such payment by the Holder this Warrant shall terminate.

 

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8.          No
Stockholder Rights. Other than as provided herein, this Warrant in and of itself shall not entitle the Holder to any voting
rights or other rights as a stockholder of the Company.

 

9.          Charges,
Taxes and Expenses. Issuance and delivery of Warrant Shares upon exercise of the Warrant
shall be made without charge to the Holder for any issue or transfer tax, withholding tax, transfer agent fee or other incidental
tax or expense in respect of the issuance of such certificates, all of which taxes and expenses shall be paid by the Company; provided,
however, that the Company shall not be required to pay any tax which may be payable in respect of any transfer involved in the
registration of any certificates for Warrant Shares or Warrants in a name other than that of the Holder. The Holder shall be responsible
for all other tax liability that may arise as a result of holding or transferring the Warrant or receiving Warrant Shares upon
exercise hereof. The Company shall pay all fees required for same-day processing of any Notice of Exercise.

 

10.         Transfer
of Warrant. Subject to compliance with any applicable laws, this Warrant and all rights hereunder are transferable, by the
Holder in person or by duly authorized attorney, only upon delivery of this Warrant and the form of assignment attached hereto
as Exhibit B to any transferee designated by the Holder. The transferee shall sign an investment letter in form and substance
reasonably satisfactory to the Company and its counsel.

 

11.         Lost,
Stolen, Mutilated or Destroyed Warrant. If this Warrant is lost, stolen, mutilated or destroyed, the Company may, on such terms
as to indemnity or otherwise as it may reasonably impose (which shall, in the case of a mutilated Warrant, include the surrender
thereof for cancellation at the office of the Company), issue a new Warrant of like denomination and tenor as this Warrant so lost,
stolen, mutilated or destroyed. Any such new Warrant shall constitute an original contractual obligation of the Company, whether
or not the allegedly lost, stolen, mutilated or destroyed Warrant shall be at any time enforceable by anyone.

 

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12.         Lock-Up.
Notwithstanding any other provision of this Warrant, in accordance with FINRA Rule 5110(g), this Warrant shall not be sold during
the Offering, or sold, transferred, assigned, pledged, or hypothecated, or be the subject of any hedging, short sale, derivative,
put, or call transaction that would result in the effective economic disposition of this Warrant or the Warrant Shares, by any
person for a period of 180 days immediately following the date of effectiveness or commencement of sales of the Offering, except
as provided in paragraph (g)(2) of FINRA Rule 5110.

 

13.         Notices,
Etc. All notices required or permitted hereunder shall be in writing and shall be deemed effectively given: (a) upon personal
delivery to the party to be notified, (b) when sent by electronic transmission or facsimile if sent during normal business hours
of the recipient, if not, then on the next business day, (c) five (5) days after having been sent by registered or certified mail,
return receipt requested, postage prepaid, or (d) one (1) day after deposit with a nationally recognized overnight courier, specifying
next day delivery, with written verification of receipt. All communications shall be sent to the Company at the address listed
on the signature page hereto to the attention of the Chief Financial Officer (with a copy to Andrews Kurth LLP, Attn: J. Matthew
Lyons, Fax: (512) 320-9292, Email: mlyons@andrewskurth.com) and to the Holder at the applicable address set forth in Section 11
of the Placement Agency Agreement or at such other address as the Company or the Holder may designate by ten (10) days advance
written notice to the other parties hereto.

 

14.         Acceptance.
Receipt of this Warrant by the Holder shall constitute acceptance of and agreement to all of the terms and conditions contained
herein.

 

15.         Governing
Law; Venue; Waiver of Jury Trial. This Warrant shall be governed by, and construed in accordance with, the laws of the State
of Delaware. The Holder hereby submits to the non-exclusive jurisdiction of the federal and state courts in the City of Wilmington,
Delaware in any suit or proceeding arising out of or relating to this Warrant or the transactions contemplated thereby. The Holder
irrevocably and unconditionally waives any objection to the laying of venue of any suit or proceeding arising out of or relating
to this Warrant in federal and state courts in the City of Wilmington, Delaware and irrevocably and unconditionally waives and
agrees not to plead or claim in any such court that any such suit or proceeding in any such court has been brought in an inconvenient
forum. The Holder hereby irrevocably waives any right it may have, and agrees not to request, a jury trial for the adjudication
of any dispute hereunder or in connection with or arising out of this Warrant.

 

16.         Interpretation.
All parties have participated jointly in the negotiation and drafting of this Warrant and, in the event an ambiguity or question
of intent or interpretation arises, this Warrant shall be construed as jointly drafted by all of the parties and no presumption
or burden of proof shall arise favoring or disfavoring any party by virtue of the authorship of any provision of this Warrant.

 

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17.         Amendment
or Waiver. Any term of this Warrant may be amended or waived (either generally or in a particular instance and either retroactively
or prospectively) only by an instrument in writing signed by (i) the Company and (ii) the holders of a majority of the outstanding
warrants issued pursuant to the Placement Agency Agreement. No waivers of any term, condition or provision of this Warrant, in
any one or more instances, shall be deemed to be, or construed as, a further or continuing waiver of any such term, condition or
provision.

 

[Remainder of Page Intentionally Left
Blank]

 

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IN WITNESS WHEREOF,
the Company has caused this Warrant to be executed by its duly authorized officer as of the date first indicated above.

 

	 	CROSSROADS SYSTEMS, INC.
	 	 	 
	 	 	By:	 
	 	 	 	 
	 	 	Name:	 
	 	 	 	 
	 	 	Title:	 

 

[Signature Page to Agent Warrant]

 

    	 

    	 

    

 

EXHIBIT
A

 

NOTICE OF EXERCISE

 

TO: CROSSROADS SYSTEMS, INC.

 

(1)         The
undersigned hereby elects to purchase __________shares of the common stock, par value $0.001 (the “Common
Stock”), of Crossroads Systems, Inc. (the “Company”)
pursuant to the terms of the attached Warrant, and tenders herewith payment of the applicable exercise price in full, subject to
the limitations set forth in Section 2.3 of the Warrant.

 

(2)         Please
issue the certificate for shares of Common Stock in the name of, and pay any cash for any fractional share to:

 

	 
	(Print or type name)
	 
	 
	(Social Security or other Identifying Number)
	 
	 
	(Street Address)
	 
	 
	(City, State, Zip Code)

 

(3)         If
such number of shares shall not be all the shares purchasable upon the exercise of the Warrants evidenced by this Warrant, a new
warrant certificate for the balance of such Warrants remaining unexercised shall be registered in the name of and delivered to:

 

Please insert Social
Security or other identifying number: ____________________

 

(Please print name and address)

 

	Dated:	 	 	 
	 	(Date)	 	(Signature)
	 	 	 
	 	 	 
	 	 	(Print Name)

 

Exhibit
A

 

    	 

    	 

    

 

EXHIBIT
B

 

ASSIGNMENT FORM

 

(To assign the foregoing
Warrant, execute this form and supply required information. Do not use this form to purchase shares.)

 

FOR VALUE RECEIVED,
the foregoing Warrant and all rights evidenced thereby are hereby assigned to

	Name:	 
	 	(Please Print)
	 	 
	Address:	 
	 	 
	 	(Please Print)
	 	 
	Dated:	_____________________, 20__
	 	 
	Holder’s Signature:	 
	 	 
	Holder’s Address:	 
	 	 

 

NOTE: The signature to this Assignment
Form must correspond with the name as it appears on the face of the Warrant, without alteration or enlargement or any change whatever.
Officers of corporations and those acting in a fiduciary or other representative capacity should file proper evidence of authority
to assign the foregoing Warrant.

 

Exhibit
BExhibit 10.1

 

Final Form

 

UNIT SUBSCRIPTION AGREEMENT

 

_________, 2015

 

Crossroads Systems, Inc.

 

Ladies and Gentlemen:

 

The undersigned (the “Investor”)
hereby confirms and agrees with you as follows:

 

1.          This
Unit Subscription Agreement (the “Agreement”) is made as of the date hereof between Crossroads Systems, Inc.,
a Delaware corporation (“Crossroads” or the “Company”), and the Investor that is a signatory
to this Agreement.

 

2.          The
Company has authorized the sale and issuance (the “Offering”) of up to 3,071,739 shares of the Company’s
common stock, par value $0.001 (the “Common Stock”) and warrants (“Warrants”) exercisable for 1,535,870
shares of Common Stock , with such Common Stock and Warrants to be sold as units (“Units”) composed of one share
of Common Stock and one Warrant exercisable for one-half shares of Common Stock (such Units also referred to as the “Offered
Securities”).  The Offering is being made pursuant to an effective shelf registration statement on Form S-3 (SEC
File No. 333-196379).

 

3.          The
Company and the Investor agree that the Offering is being made subject to the execution by the Company and the Placement Agents
(as defined in Annex I attached hereto) of the Placement Agency Agreement (as defined in Annex I attached hereto),
delivery of the preliminary prospectus relating to the Offered Securities and delivery of additional offering information, including
pricing information.  A final prospectus supplement will be delivered to the Investor as required by law. The Company
and the Investor agree that the Investor will purchase from the Company and the Company will issue and sell to the Investor the
number of Offered Securities set forth below the Investor’s name on Schedule I hereto, at a purchase price of $2.30 per Unit,
pursuant to the Terms and Conditions for Purchase of Offered Securities attached hereto as Annex I and incorporated herein
by reference as if fully set forth herein.  The Investor acknowledges that the Offering is not being underwritten by
the Placement Agents and that there is no minimum offering amount.  Shares of Common Stock will be credited to the Investor
using customary book-entry procedures and Warrants will be delivered in paper form.
The investor also acknowledges that the following individuals or entities may purchase Units in this offering: (i) affiliates
of the Placement Agents; (ii) Lone Star Value Investors, LP, an affiliate of Jeffrey Eberwein (Chairman of the Company's board
of directors), or its affiliates; and (iii) entities owned by certain directors, officers, management and other employees of the
Company.

 

4.          The
Investor represents that, except as set forth below, (a) it has had no position, office or other material relationship within the
past three years with the Company or persons known to it to be affiliates of the Company, (b) neither it, nor any group of which
it is a member or to which it is related, beneficially owns (including the right to acquire or vote) more than 19.9% of any class
of securities of the Company and (c) it is not a FINRA member as of the date hereof.

 

5.          The
Investor confirms that it has had full access to all filings made by the Company with the Securities and Exchange Commission, including
the registration statement and preliminary prospectus relating to the Offered Securities, and the documents incorporated by reference
therein, and that it was able to read, review, download and print each such filing.  In subscribing to the Units, Investor
agrees that Investor has conducted substantive due diligence with respect to Crossroads and the Units including, without limitation,
reviewing in detail the Registration Statement (including exhibits thereto) and discussing the proposed business and activities
of Crossroads with management.  In addition, Investor understands that there is a high degree of risk in subscribing to the
Units and that Investor may lose the entire investment in the Units.

 

6.          This
Agreement may be executed in any number of counterparts, all of which taken together shall constitute one and the same instrument
and shall become effective when counterparts have been signed by each party and delivered to the other parties hereto, it being
understood that all parties need not sign the same counterpart.  Execution may be made by delivery by facsimile or via electronic
format.

 

[Signature Page to Follow]

 

    	 

    	 

    

 

Final Form

 

Please confirm that the foregoing
correctly sets forth the agreement between us by signing in the space provided below for that purpose.

 

	 	Name of Investor:	 	 	 
	 	 	 	 	 
	 	 	 	By:	 
	 	 	 	 	 
	 	 	 	Name:	 
	 	 	 	 	 
	 	 	 	Title:	 

 

AGREED AND ACCEPTED:

 

CROSSROADS SYSTEMS, INC.

 

	By:	 	 	 
	 	 	 	 
	Name:	 	 	 
	 	 	 	 
	Title:	 	 	 

 

    	 

    	 

    

 

Final Form

 

SCHEDULE I

 

SCHEDULE OF INVESTORS

 

	Name of Investor:
	 
	 
	
        Name of Individual Representing Investor:

	 
	 
	
        Title of Individual Representing Investor:

	 

 

	Address:	 	 
	Telephone:	 	 
	Telecopier:	 	 

  

	Number of Units to 
Be Purchased	 	Price Per Unit In
 Dollars	 	 	Aggregate 

Purchase Price	 
		 	$	2.30	 	 	$	 	 

 

    	 

    	 

    

 

Final Form

ANNEX I

 

TERMS AND CONDITIONS FOR PURCHASE OF OFFERED SECURITIES

 

1.              Agreement
to Sell and Purchase the Offered Securities; Placement Agents.

 

1.1           Upon
the terms and subject to the conditions hereinafter set forth, at the Closing (as defined in Section 2 below), the Company will
sell to the Investor, and the Investor will purchase from the Company, the number of Units set forth on Schedule I of this Agreement
below such Investor’s name at the purchase price set forth therein.

 

1.2           The
Company may enter into agreements similar to this Agreement with certain other investors (the “Other Investors”)
and expects to complete sales of Offered Securities to them. (The Investor and the Other Investors hereinafter collectively are
referred to as the “Investors,” and this Agreement and the agreements executed by the Other Investors are hereinafter
collectively referred to as the “Agreements”). The Company may accept or reject any one or more Agreements in
its sole discretion.

 

1.3           The
Company has entered into a Placement Agency Agreement (the “Placement Agency Agreement”) dated the date hereof
with Roth Capital Partners, LLC (“Roth”) and Northland Securities, Inc. in their capacities as Placement Agents
for the Offering (together, the “Placement Agents”), and the Company has agreed to pay the Placement Agents
a fee in respect of the sale of the Units.

 

2.             Delivery
of the Units at Closing.  The completion of the purchase and sale of the Offered Securities (the “Closing”)
shall take place at a place and time (the “Closing Date”) to be specified by the Company and the Placement Agents,
in accordance with Rule 15c6-1 promulgated under the Securities Exchange Act of 1934, as amended (the “Exchange Act”).

 

The Company’s obligation to issue and sell the Offered
Securities at Closing to the Investor shall be subject to the accuracy of the representations and warranties made by the Investor
and the fulfillment of those undertakings of the Investor to be fulfilled prior to the Closing.

 

The Investor’s obligation to purchase the Offered Securities
shall be subject to the accuracy of the representations and warranties made by the Company and the fulfillment of those undertakings
of the Company to be fulfilled prior to the Closing and to the condition that the Placement Agents shall not have (a) terminated
the Placement Agency Agreement pursuant to the terms thereof or (b) determined that the conditions to closing in the Placement
Agency Agreement have not been satisfied.

 

Warrants purchased by the Investor shall be delivered in paper
form to the address set forth for such Investor on Schedule I hereto, or at such other address or addresses as may have
been furnished to the Company in writing by such Investor.

 

The manner of settlement of the Common Stock purchased by the
Investor shall be determined by such Investor as follows (check one):

 

		[____]	A.           Delivery
by crediting the account of the Investor’s prime broker (as specified by such Investor on Exhibit A annexed hereto) with
the Depository Trust Company (“DTC”) through its Deposit/Withdrawal At Custodian (“DWAC”)
system, whereby Investor’s prime broker shall initiate a DWAC transaction on the Closing Date using its DTC participant
identification number, and released by American Stock Transfer & Trust Company, the Company’s transfer agent (the “Transfer
Agent”), at the Company’s direction. NO LATER THAN ONE (1) BUSINESS DAY AFTER THE EXECUTION OF THIS AGREEMENT
BY THE INVESTOR AND THE COMPANY, THE INVESTOR SHALL:

 

		(I)	DIRECT THE BROKER-DEALER AT WHICH THE ACCOUNT OR ACCOUNTS
TO BE CREDITED WITH THE SHARES ARE MAINTAINED TO SET UP A DWAC INSTRUCTING THE TRANSFER AGENT TO CREDIT SUCH ACCOUNT OR ACCOUNTS
WITH THE SHARES, AND

 

    	 

    	 

    

 

Final
Form

 

		(II)	REMIT BY WIRE TRANSFER THE AMOUNT OF FUNDS EQUAL TO
THE AGGREGATE PURCHASE PRICE FOR THE OFFERED SECURITIES BEING PURCHASED BY THE INVESTOR TO THE FOLLOWING ACCOUNT:

 

Silicon Valley Bank

9020 Capital of Texas Highway, North

Building One, Suite 350

Austin, Texas 78759

Phone (512) 372-6750

Fax (512) 346-9207

 

Account Name: [***]

ABA: [***]

Swift Code: [***]

Account Number: [***]

 

—OR—

 

		[____]	B.           Delivery
Versus Payment (“DVP”) through DTC (i.e., on the Closing Date, the Company shall issue the Offered Securities
registered in the Investor’s name and address as set forth below and released by the Transfer Agent directly to the account(s)
at Roth identified by the Investor; upon receipt of such Offered Securities, Roth shall promptly electronically deliver such Offered
Securities to the Investor, and simultaneously therewith payment shall be made by Roth by wire transfer to the Company). NO
LATER THAN ONE (1) BUSINESS DAY AFTER THE EXECUTION OF THIS AGREEMENT BY THE INVESTOR AND THE COMPANY, THE INVESTOR SHALL:

 

		(I)	NOTIFY ROTH OF THE ACCOUNT OR ACCOUNTS AT ROTH TO
BE CREDITED WITH THE SHARES BEING PURCHASED BY SUCH INVESTOR, AND

 

		(II)	CONFIRM THAT THE ACCOUNT OR ACCOUNTS AT ROTH TO BE
CREDITED WITH THE SHARES BEING PURCHASED BY THE INVESTOR HAVE A MINIMUM BALANCE EQUAL TO THE AGGREGATE PURCHASE PRICE FOR THE
UNITS BEING PURCHASED BY THE INVESTOR.

 

IT IS THE INVESTOR’S RESPONSIBILITY TO (A) MAKE
THE NECESSARY WIRE TRANSFER OR CONFIRM THE PROPER ACCOUNT BALANCE IN A TIMELY MANNER AND (B) ARRANGE FOR SETTLEMENT BY WAY OF DWAC
OR DVP IN A TIMELY MANNER. IF THE INVESTOR DOES NOT DELIVER THE AGGREGATE PURCHASE PRICE FOR THE OFFERED SECURITIES OR DOES NOT
MAKE PROPER ARRANGEMENTS FOR SETTLEMENT IN A TIMELY MANNER, THE OFFERED SECURITIES MAY NOT BE DELIVERED AT CLOSING TO THE
INVESTOR OR THE INVESTOR MAY BE EXCLUDED FROM THE CLOSING ALTOGETHER.

 

3.             
Representations, Warranties and Covenants of the Company.  The Company hereby represents and warrants to, and covenants
with, the Investor, as follows:

 

3.1           The
issuance and sale of each of the Offered Securities have been duly authorized by the Company, and the Offered Securities, when
issued and paid for in accordance with this Agreement, will be duly and validly issued, fully paid and nonassessable and will not
be subject to preemptive or similar rights.

 

3.2           This
Agreement constitutes a valid and binding obligation of the Company enforceable against the Company in accordance with its terms,
subject to the effect of applicable bankruptcy, insolvency or similar laws affecting creditors’ rights generally and equitable
principles of general applicability.

 

3.3           The
Company shall not effect any offer or sale of any equity or equity-related securities that would result in the transactions contemplated
hereby becoming subject to stockholder approval under the rules and regulations of FINRA or the NASDAQ Global Market.

 

    	 

    	 

    

 

Final Form

 

3.4           It
is understood and acknowledged by the Company that: (i) except pursuant to the terms of this Agreement and any confidentiality
agreement entered into by the Investor with respect to the transactions contemplated hereby, the Investor has not been asked by
the Company to agree, nor has the Investor agreed, to desist from purchasing or selling, long and/or short, securities of the Company,
or “derivative” securities based on securities issued by the Company or to hold the Offered Securities for any specified
term; (ii) past or future open market or other transactions by the Investor, specifically including, without limitation, Short
Sales or “derivative” transactions, before or after the closing of this or future private placement transactions, may
negatively impact the market price of the Company’s publicly-traded securities; (iii) the Investor, and counter-parties in
“derivative” transactions to which the Investor is a party, directly or indirectly, presently may have a “short”
position in the Common Stock, and (iv) the Investor shall not be deemed to have any affiliation with or control over any arm’s
length counter-party in any “derivative” transaction merely by reason of such “derivative” transaction.
The Company further understands and acknowledges that (y) subject to the terms of this Agreement and any confidentiality agreement
entered into by the Investor with respect to the transactions contemplated hereby, the Investor may engage in hedging activities
at various times during the period that the Offered Securities are outstanding, and (z) such hedging activities (if any) could
reduce the value of the existing stockholders’ equity interests in the Company at and after the time that the hedging activities
are being conducted.

 

3.5           The
Company will use its commercially reasonable efforts to maintain the effectiveness of the registration statement through the Closing
in accordance with the rules and regulations promulgated by the Securities and Exchange Commission.

 

3.6           Prior
to 9:30 a.m., New York City time, on January 27, 2015, the Company will issue a press release (the “Press Release”)
via BusinessWire (or other national wire service) announcing the transaction contemplated by this Agreement. In connection with
the transactions contemplated by this Agreement, the Company has not disclosed, or caused to be disclosed, to the Investor any
material non-public information regarding the Company that will not at the time of the issuance of the Press Release be in the
public domain.

 

4.             Representations,
Warranties and Covenants of the Investor.  The Investor represents and warrants to the Company as follows:

 

4.1           The
Investor has received the Company’s preliminary prospectus relating to the Offered Securities describing the terms of the
proposed Offering.  The Investor acknowledges that the Investor has received certain additional information regarding
the Offering, including pricing information (the “Offering Information”). Such Offering Information may be provided
to the Investor by any means permitted under the Securities Act of 1933, as amended, including through a prospectus supplement,
a free writing prospectus and oral communications.

 

4.2           The
Investor has full right, power, authority and capacity to enter into this Agreement and to consummate the transactions contemplated
hereby and has taken all necessary action to authorize the execution, delivery and performance of this Agreement, and this Agreement
constitutes a valid and binding obligation of the Investor enforceable against the Investor in accordance with its terms, subject
to the effect of applicable bankruptcy, insolvency or similar laws affecting creditors’ rights generally and equitable principles
of general applicability.

 

4.3           The
Investor is knowledgeable, sophisticated and experienced in making, and is qualified to make, decisions with respect to investments
in shares representing an investment decision like that involved in the purchase of the Offered Securities and has, in connection
with its decision to purchase the number of Offered Securities set forth on Schedule I to the Agreement, relied solely upon the
registration statement, the preliminary prospectus, the preliminary term sheet, the Offering Information and any amendments or
supplements thereto and has not relied upon any information provided by the Placement Agents.

 

4.4           The
Investor understands that nothing in the registration statement, the preliminary prospectus, the preliminary term sheet, the Offering
Information and any amendments or supplements thereto, this Agreement or any other materials presented to such Investor in connection
with the purchase and sale of the Offered Securities constitutes legal, tax or investment advice.  The Investor has consulted
such legal, tax and investment advisors as it, in its sole discretion, has deemed necessary or appropriate in connection with its
purchase of Offered Securities.

 

4.5           The
Investor will not, upon the Closing of the transactions contemplated by this Agreement, beneficially own (individually or together
with other person with whom the Investor has identified, or will have identified, itself as part of a “group” in a
public filing made with the Securities and Exchange Commission involving the Company’s securities), as calculated in accordance
with Section 13(d) of the Securities Exchange Act of 1934, as amended (the “Exchange Act”), in excess of, 19.99% of
the shares of Common Stock outstanding. The Investor acknowledges that it, and not the Company, is responsible for complying with
the Investors’ obligations, if any, under Sections 13 or 16 of the Exchange Act.

 

    	 

    	 

    

 

Final Form

 

4.6           From
and after obtaining knowledge of the sale of the Offered Securities contemplated hereby, the Investor has not engaged in any purchases
or sales of the securities of the Company (including, without limitation, any Short Sales (as defined herein) involving the Company’s
securities), and has not violated its obligations of confidentiality.  The Investor covenants that it will not engage in any
purchases or sales of the securities of the Company (including Short Sales) or disclose any information about the contemplated
offering (other than to its advisors that are under a legal obligation of confidentiality) prior to the time that the transactions
contemplated by this Agreement are publicly disclosed.  The Investor agrees that it will not use any of the Units acquired
pursuant to this Agreement to cover any short position in the Common Stock if doing so would be in violation of applicable securities
laws.  For purposes hereof, “Short Sales” include, without limitation, all “short sales” as defined
in Rule 200 promulgated under Regulation SHO under the Exchange Act, whether or not against the box, and all types of direct and
indirect stock pledges, forward sales contracts, options, puts, calls, short sales, swaps, “put equivalent positions”
(as defined in Rule 16a-1(h) under the Exchange Act) and similar arrangements (including on a total return basis), and sales and
other transactions through non-US broker dealers or foreign regulated brokers.

 

 

5.          Survival
of Representations, Warranties and Agreements.  Notwithstanding any investigation made by any party to this Agreement,
all covenants, agreements, representations and warranties made by the Company and the Investor herein shall survive the execution
of this Agreement, the delivery to such Investor of the Offered Securities being purchased and the payment therefor.

 

6.          
Notices.  All notices, requests, consents and other communications hereunder shall be in writing, shall be mailed
(A) if within domestic United States, by first-class registered or certified airmail, or nationally recognized overnight express
courier, postage prepaid, or by facsimile, or (B) if delivered from outside the United States, by International Federal Express
or facsimile, and shall be deemed given (i) if delivered by first-class registered or certified mail domestic, three business days
after so mailed, (ii) if delivered by a nationally recognized overnight carrier, one business day after so mailed, (iii) if delivered
by International Federal Express, two business days after so mailed, (iv) if delivered by facsimile, upon electronic confirmation
of receipt and shall be delivered as addressed as follows: (a) if to the Company, to Crossroads Systems, Inc., 11000 North Mopac
Expressway, Suite 150, Austin, TX, with copies (which shall not constitute notice) to: Andrews Kurth LLP, 111 Congress Avenue,
Suite 1700, Austin, Texas 78701, Attn: J. Matthew Lyons; and (b) if to an Investor, at its address on Schedule I hereto,
or at such other address or addresses as may have been furnished to the Company in writing by such Investor.

 

7.          Changes.  This
Agreement may not be modified or amended except pursuant to an instrument in writing signed by the Company and the Investor.

 

8.          Headings.  The
headings of the various sections of this Agreement have been inserted for convenience or reference only and shall not be deemed
to be part of this Agreement.

 

9.          Severability.  In
case any provision contained in this Agreement should be invalid, illegal or unenforceable in any respect, the validity, legality
and enforceability of the remaining provisions contained herein shall not in any way be affected or impaired thereby.

 

10.         Governing
Law.  This Agreement shall be governed by, and construed in accordance with, the internal laws of the State of New
York, without giving effect to the principles of conflicts of law.

 

11.         Counterparts;
Facsimile.  This Agreement may be executed in two or more counterparts, each of which shall constitute an original,
but all of which, when taken together, shall constitute one instrument, and shall become effective when one or more counterparts
have been signed by each party hereto and delivered to the other parties.  Facsimile signatures shall be as effective
as original signatures.

  

    	 

    	 

    

 

Final Form

Annex II

 

CROSSROADS SYSTEMS, INC.

 

INVESTOR QUESTIONNAIRE

 

Pursuant to Annex I to the Agreement, please provide
us with the following information:

 

	1. The exact name that your Offered Securities are to be registered in. You may use a nominee name if appropriate:	 	 
	 	 	 
	 2. The relationship between the Investor and the registered holder listed in response to item 1 above:	 	 
	 	 	 
	 3. The mailing address of the registered holder listed in response to item 1 above:	 	 
	 	 	 
	 4. The Social Security Number or Tax Identification Number of the registered holder listed in the response to item 1 above:	 	 
	 	 	 
	 5. Name of DTC Participant (broker-dealer at which the account or accounts to be credited with the Shares are maintained):	 	 
	 	 	 
	 6. DTC Participant Number:	 	 
	 	 	 
	 7. Name of Account at DTC Participant being credited with the Offered Securities:	 	 
	 	 	 
	 8. Account Number at DTC Participant being credited with the Offered Securities:	 	 

 

 

	9. Current ownership of Company Securities	Type of Security		Number of
	(other than Offered Securities):	 		Securities

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