Document:

Exhibit 10.1

Exhibit 10.1

SUBSCRIPTION AGREEMENT

SUBSCRIPTION AGREEMENT made as of this
 _____ 
day of
 ________________, 2009, between Genesis Fluid
Solutions Holdings, Inc., a Delaware corporation (the “Company”), and the undersigned (the
“Subscriber”).

WHEREAS, pursuant to a Confidential Private Placement Memorandum dated June
 _____, 2009 (the
“PPM”), the Company is offering in a private placement (the “Offering”) to accredited investors a
minimum of 64 Units (the “Minimum Offering”) and a maximum of 160 Units (the “Maximum Offering”) at
a purchase price of $25,000 per Unit, with each Unit (the “Units”) consisting of 25,000 shares of
the Company’s common stock, par value $0.001 per share (the “Common Stock”), and a two-year
detachable warrant (the “Warrant”) to purchase 12,500 shares of Common Stock with an exercise price
of $4.00 per share; and

WHEREAS, the Subscriber desires to subscribe for the number of Units set forth on the
signature page hereof, on the terms and conditions hereinafter set forth.

NOW, THEREFORE, for and in consideration of the premises and the mutual covenants hereinafter
set forth, the parties hereto do hereby agree as follows:

I. SUBSCRIPTION FOR AND REPRESENTATIONS AND COVENANTS OF SUBSCRIBER

1.1 Subject to the terms and conditions hereinafter set forth, the Subscriber hereby
subscribes for and agrees to purchase from the Company such number of Units set forth upon the
signature page hereof, at a price equal to $25,000 per Unit, and the Company agrees to sell such to
the Subscriber for said purchase price, subject to the Company’s right to sell to the Subscriber
such lesser number of (or no) Units as the Company may, in its sole discretion, deem necessary or
desirable. The purchase price is payable by wire transfer of immediately available funds, pursuant
to the wire instructions attached as Exhibit F to the PPM or by check payable to Sichenzia
Ross Friedman Ference LLP, as escrow agent for Genesis Fluid Solutions Holdings, Inc.

1.2 The Subscriber recognizes that the purchase of Units involves a high degree of risk in
that (i) an investment in the Company is highly speculative and only investors who can afford the
loss of their entire investment should consider investing in the Company and the Units; (ii) the
Units are not registered under the Securities Act of 1933, as amended (the “Act”), or any state
securities law; (iii) there is no trading market for the Units, none is likely ever to develop, and
the Subscriber may not be able to liquidate his, her or its investment; (iv) transferability of the
Units is extremely limited; and (v) an investor could suffer the loss of his, her or its entire
investment.

1.3 The Subscriber is an “accredited investor,” as such term in defined in Rule 501 of
Regulation D promulgated under the Act, and the Subscriber is able to bear the economic risk of an
investment in the Units.

 

 

 

1.4 The Subscriber has prior investment experience (including investment in non-listed and
non-registered securities), and has read and evaluated, or has employed the
services of an
investment advisor, attorney or accountant to read and evaluate, all of the documents furnished or
made available by the Company to the Subscriber and to all other prospective investors in the
Units, including the PPM, as well as the merits and risks of such an investment by the Subscriber.
The Subscriber’s overall commitment to investments which are not readily marketable is not
disproportionate to the Subscriber’s net worth, and the Subscriber’s investment in the Units will
not cause such overall commitment to become excessive. The Subscriber, if an individual, has
adequate means of providing for his or her current needs and personal and family contingencies and
has no need for liquidity in his or her investment in the Units. The Subscriber is financially
able to bear the economic risk of this investment, including the ability to afford holding the
Units for an indefinite period or a complete loss of this investment.

1.5 The Subscriber acknowledges receipt and careful review of the PPM, all supplements to the
PPM, and all other documents furnished in connection with this transaction by the Company,
including but not limited to the exhibits to the PPM (collectively, the “Offering Documents”), and
has been furnished by the Company during the course of this transaction with all information
regarding the Company which the Subscriber has requested or desires to know; and the Subscriber has
been afforded the opportunity to ask questions of and receive answers from duly authorized officers
or other representatives of the Company concerning the terms and conditions of the Offering, and
any additional information which the Subscriber has requested.

1.6 The Subscriber acknowledges that the purchase of the Units may involve tax consequences to
the Subscriber and that the contents of the Offering Documents do not contain tax advice. The
Subscriber acknowledges that the Subscriber must retain his, her or its own professional advisors
to evaluate the tax and other consequences to the Subscriber of an investment in the Units. The
Subscriber acknowledges that it is the responsibility of the Subscriber to determine the
appropriateness and the merits of a corporate entity to own the Subscriber’s Units and the
corporate structure of such entity.

1.7 The Subscriber acknowledges that this Offering has not been reviewed by the Securities and
Exchange Commission (the “SEC”) or any state securities commission, and that no federal or state
agency has made any finding or determination regarding the fairness or merits of the Offering. The
Subscriber represents that the Units are being purchased for his, her or its own account, for
investment only, and not with a view toward distribution or resale to others. The Subscriber
agrees that he, she or it will not sell or otherwise transfer the Units unless they are registered
under the Act or unless an exemption from such registration is available.

1.8 The Subscriber understands that the provisions of Rule 144 under the Act are not available
for at least one (1) year to permit resales of the Units or the Common Stock and Warrants
comprising the Units and there can be no assurance that the conditions necessary to
permit such sales under Rule 144 will ever be satisfied. The Subscriber understands that the
Company is under no obligation to comply with the conditions of Rule 144 or take any other action
necessary in order to make available any exemption from registration for the sale of the Units or
the Common Stock and Warrants comprising the Units.

 

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1.9 The Subscriber understands that the Units have not been registered under the Act by reason
of a claimed exemption under the provisions of the Act which depends, in part, upon his, her or its
investment intention. In this connection, the Subscriber understands that it is the position of
the SEC that the statutory basis for such exemption would not be present if his, her or its
representation merely meant that his, her or its present intention was to hold such securities for
a short period, such as the capital gains period of tax statutes, for a deferred sale, for a market
rise, assuming that a market develops, or for any other fixed period. The Subscriber realizes
that, in the view of the SEC, a purchase now with an intent to resell would represent a purchase
with an intent inconsistent with his, her or its representation to the Company and the SEC might
regard such a sale or disposition as a deferred sale, for which such exemption is not available.

1.10 The Subscriber agrees to indemnify and hold the Company, its directors, officers and
controlling persons and their respective heirs, representatives, successors and assigns harmless
against all liabilities, costs and expenses incurred by them as a result of any misrepresentation
made by the Subscriber contained herein or any sale or distribution by the Subscriber in violation
of the Act (including, without limitation, the rules promulgated thereunder), any state securities
laws, or the Company’s Certificate of Incorporation or By-laws, as amended from time to time.

1.11 The Subscriber consents to the placement of a legend on any certificate or other document
evidencing the Common Stock or the Warrants stating that such securities have not been registered
under the Act and setting forth or referring to the restrictions on transferability and sale
thereof.

1.12 The Subscriber understands that the Company will review and rely on this Subscription
Agreement without making any independent investigation; and it is agreed that the Company reserves
the unrestricted right to reject or limit any subscription and to withdraw the Offering at any
time.

1.13 The Subscriber hereby represents that the address of the Subscriber furnished at the end
of this Subscription Agreement is the undersigned’s principal residence, if the Subscriber is an
individual, or its principal business address if it is a corporation or other entity.

1.14 The Subscriber acknowledges that if the Subscriber is a Registered Representative of a
Financial Industry Regulatory Authority, Inc. (“FINRA”) member firm, the Subscriber must give such
firm the notice required by the FINRA’s Conduct Rules, receipt of which must be acknowledged by
such firm on the signature page hereof.

1.15 The Subscriber hereby acknowledges that neither the Company nor any persons associated
with the Company who may provide assistance or advice in connection with the Offering (other than
the placement agent, if one is engaged by the Company) are or are
expected to be members or associated persons of members of the FINRA or registered
broker-dealers under any federal or state securities laws.

 

A-3

 

1.16 The Subscriber understands that, pursuant to the terms of the Offering as set forth in
the PPM, the Company must receive subscriptions for 64 Units for an aggregate
purchase price of
$1,600,000 in order to close on the sale of any Units and that persons affiliated with the Company
or its consultants, advisors, or placement agents may subscribe for Units, in which case the
Company may accept subscriptions from such affiliated parties in order to reach the Minimum
Offering; and that, accordingly, no investor should conclude that achieving the Minimum Offering is
the result of any independent assessment of the merits or advantages of the Offering or the Company
made by Subscribers in the Minimum Offering.

1.17 The Subscriber hereby represents that, except as expressly set forth in the Offering
Documents, no representations or warranties have been made to the Subscriber by the Company or any
agent, employee or affiliate of the Company and, in entering into this transaction, the Subscriber
is not relying on any information other than that contained in the Offering Documents and the
results of independent investigation by the Subscriber.

1.18 The Subscriber hereby represents that all information provided by the Subscriber in the
Investor Questionnaire attached as Exhibit B to the PPM is true and accurate in all
respects, and the Subscriber acknowledges that the Company will be relying on such information to
its possible detriment in deciding whether the Company can sell these securities to the Subscriber
without giving rise to the loss of the exemption from registration under applicable securities
laws.

1.19 The Subscriber hereby acknowledges and agrees that, except for Subscriber signing the
Reconfirmation of Subscription attached as Exhibit E to the PPM, once the Minimum Offering
amount is received by the Company, no further approval will be required for the Company to
consummate the Initial Closing.

1.20 The Subscriber agrees, pursuant to the terms of the Escrow Agreement, jointly and
severally with the other subscribers in the Offering and the Company, to indemnify and hold
harmless the escrow agent and its partners, employees, agents and representatives from any and all
claims, liabilities, costs or expenses in any way arising from or relating to the duties or
performance of the escrow agent under the Escrow Agreement or the transactions contemplated thereby
or hereby other than any such claim, liability, cost or expense to the extent the same shall have
been determined by final, unappealable judgment of a court of competent jurisdiction to have
resulted from the gross negligence, fraud or willful misconduct of the escrow agent.

II. REPRESENTATIONS BY THE COMPANY

(a) The Company is a corporation duly incorporated, validly existing and in good standing
under the laws of the State of Delaware and has the corporate power to conduct the business which
it conducts and proposes to conduct.

(b) The execution, delivery and performance of this Subscription Agreement by the Company have
been duly authorized by the Company and all other corporate
action required to authorize and consummate the offer and sale of the Units has been duly
taken and approved.

 

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(c) The Units and the underlying Common Stock have been duly and validly authorized and will
be duly and validly issued at closing of the Offering.

(d) The Company has obtained, or is in the process of obtaining, all licenses, permits and
other governmental authorizations necessary for the conduct of its business, except where the
failure to so obtain such licenses, permits and authorizations would not have a material adverse
effect on the Company. Such licenses, permits and other governmental authorizations which have been
obtained are in full force and effect, except where the failure to be so would not have a material
adverse effect on the Company, and the Company is in all material respects complying therewith.

(e) The Company knows of no pending or threatened legal or governmental proceedings to which
the Company is a party which would materially adversely affect the business, financial condition or
operations of the Company.

(f) The Company is not in violation of or default under, nor will the execution and delivery
of this Subscription Agreement or the issuance of the Common Stock, or the consummation of the
transactions herein contemplated, result in a violation of, or constitute a default under, the
Company’s Certificate of Incorporation or By-laws, any material obligations, agreements, covenants
or conditions contained in any bond, debenture, note or other evidence of indebtedness or in any
material contract, indenture, mortgage, loan agreement, lease, joint venture or other agreement or
instrument to which the Company is a party or by which it or any of its properties may be bound or
any material order, rule, regulation, writ, injunction, or decree of any government, governmental
instrumentality or court, domestic or foreign.

III. COVENANTS BY THE COMPANY

3.1 Until the earlier of (i) twelve (12) months following the Initial Closing Date (as defined
in the PPM) or (ii) such date that there is an effective registration statement on file with the
SEC covering the resale of all of the shares of Common Stock issued in the Offering and all shares
of Common Stock issuable upon exercise of the Warrants issued in the Offering, in the event that
the Company issues or sells any shares of Common Stock or any Common Stock Equivalents (as defined
below) pursuant to which shares of Common Stock may be acquired at a price less than $1.00 per
share, then the Company shall promptly issue additional shares of Common Stock to the Subscriber in
an amount sufficient that the subscription price paid hereunder, when divided by the total number
of shares issued will result in an actual price paid per share of Common Stock hereunder equal to
such lower price (this is intended to be a “full ratchet” adjustment). Such adjustment shall be
made successively whenever such an issuance is made. Notwithstanding the foregoing, this Section
3.1 shall not apply in respect of an Exempt Issuance (as defined below).

 

A-5

 

3.2 For purposes of this Agreement, (i) “Common Stock Equivalents” means any securities of the
Company or any of its subsidiaries which would entitle the holder thereof to acquire at any time
Common Stock, including, without limitation, any debt, preferred stock,
rights, options, warrants or other instrument that is at any time convertible into or
exercisable or exchangeable for, or otherwise entitles the holder thereof to receive, Common Stock
and (ii) “Exempt Issuance” means the issuance of (a) shares of Common Stock or options to
employees,
officers, directors, or consultants of the Company pursuant to any stock or option plan
duly adopted for such purpose by a majority of the non-employee members of the Board of Directors
of the Company or a majority of the members of a committee of non-employee directors established,
(b) securities upon the exercise or exchange of or conversion of any securities issued hereunder
and/or other securities exercisable or exchangeable for or convertible into shares of Common Stock
issued and outstanding on the date of this Agreement, provided that such securities have not been
amended since the date of this Agreement to increase the number of such securities or to decrease
the exercise, exchange or conversion price of such securities; and (c) securities issued pursuant
to acquisitions or strategic transactions approved by a majority of the disinterested directors of
the Company, provided that any such issuance shall only be to a person which is either an owner of,
or an entity that is, itself or through its subsidiaries, an operating company in a business
synergistic with the business of the Company and in which the Company receives benefits in addition
to the investment of funds, but shall not include a transaction in which the Company is issuing
securities primarily for the purpose of raising capital or to an entity whose primary business is
investing in securities.

3.3 Absent a prior determination by the non-employee directors of the Company that it is in
the Company’s best interest, for a period of 12 months following the closing of the Merger (as
defined in the PPM), the Company shall not (i) issue or grant more than an aggregate of 2,500,000
options, warrants or shares of common stock (subject to appropriate adjustments for any stock
dividend, stock split, stock combination, reclassification or similar transaction) to any
employees, officers, directors, or consultants of the Company or (ii) issue any options having an
exercise price that is less than $1.00 per share (subject to appropriate adjustments for any stock
dividend, stock split, stock combination, reclassification or similar transaction).

IV. TERMS OF SUBSCRIPTION

4.1 Subject to Section 4.2 hereof, the subscription period will begin as of the date of the
PPM and will terminate at 11:59 PM Eastern Time, on the earlier of the date on which the Maximum
Offering is sold or the Offering is terminated by the Company (the “Termination Date”). The minimum
subscription amount is $25,000, although the Company may, in its discretion, accept subscriptions
for less than $25,000.

4.2 The Subscriber shall effect a wire transfer in the full amount of the purchase price for
the Units to the Company’s escrow account in accordance with the wire instructions attached as
Exhibit F to the PPM or shall deliver a check in payment of the purchase price for the
Units.

4.3 Pending the sale of the Units, all funds paid hereunder shall be deposited by the Company
in escrow with the Company’s escrow agent, which funds shall be held and distributed pursuant to an
Escrow Agreement, the form of which is attached as Exhibit H to the PPM. If the Company
shall not have obtained subscriptions (including this subscription) for the Minimum Offering on or
before the Termination Date (as such date may be extended by the
Company), then this subscription shall be void and all funds paid hereunder by the Subscriber
shall be promptly returned without interest to the Subscriber, to the same account from which the
funds were drawn. If subscriptions are received, reconfirmed and accepted and payment
tendered for
the Minimum Offering on or prior to the Termination Date, then all subscription proceeds (less fees
and expenses) shall be paid over to the Company within ten (10) days thereafter or such earlier
date that is one business day after the amount of good funds in escrow equals or exceeds
$1,600,000. In such event, sales of the Units may continue thereafter until the earlier of the
date on which the Maximum Offering is sold and the Termination Date, with subsequent releases of
funds from time to time at the discretion of the Company.

 

A-6

 

4.4 The Subscriber hereby authorizes and directs the Company and its escrow agent to deliver
any certificates or other written instruments representing the Units, and/or its underlying
securities to be issued to such Subscriber pursuant to this Subscription Agreement to the address
indicated on the signature page hereof.

4.5 The Subscriber hereby authorizes and directs the Company and its escrow agent to return
any funds, without interest, for unaccepted subscriptions to the same account from which the funds
were drawn.

4.6 If the Subscriber is not a United States person, such Subscriber shall immediately notify
the Company and the Subscriber hereby represents that the Subscriber is satisfied as to the full
observance of the laws of its jurisdiction in connection with any invitation to subscribe for the
Units or any use of this Subscription Agreement, including (i) the legal requirements within its
jurisdiction for the purchase of the Units, (ii) any foreign exchange restrictions applicable to
such purchase, (iii) any governmental or other consents that may need to be obtained, and (iv) the
income tax and other tax consequences, if any, that may be relevant to the purchase, holding,
redemption, sale or transfer of the Units. Such Subscriber’s subscription and payment for, and
continued beneficial ownership of, the Units will not violate any applicable securities or other
laws of the Subscriber’s jurisdiction.

V. MISCELLANEOUS

5.1 Any notice or other communication given hereunder shall be deemed sufficient if in writing
and sent by reputable overnight courier, facsimile (with receipt of confirmation) or registered or
certified mail, return receipt requested, addressed to the Company, at Genesis Fluid Solutions,
6660 Delmonico Drive, Suite 242-D, Colorado Springs, CO 80919, Attention: Michael Whaley,
facsimile: ___________________, and to the Subscriber at the address or facsimile number indicated
on the signature page hereof. Notices shall be deemed to have been given on the date when mailed
or sent by facsimile transmission or overnight courier, except notices of change of address, which
shall be deemed to have been given when received.

5.2 This Subscription Agreement shall not be changed, modified or amended except by a writing
signed by both (a) the Company and (b) subscribers in the Offering holding a majority of the Units
issued in the Offering.

5.3 This Subscription Agreement shall be binding upon and inure to the benefit of the parties
hereto and to their respective heirs, legal representatives, successors and
assigns. This Subscription Agreement sets forth the entire agreement and understanding
between the parties as to the subject matter hereof and merges and supersedes all prior
discussions, agreements and understandings of any and every nature among them.

 

A-7

 

5.4 Notwithstanding the place where this Subscription Agreement may be executed by any of the
parties hereto, the parties expressly agree that all the terms and provisions hereof shall be
construed in accordance with and governed by the laws of the State of New York. The parties hereby
agree that any dispute which may arise between them arising out of or in connection with this
Subscription Agreement shall be adjudicated only before a Federal court located in New York, New
York and they hereby submit to the exclusive jurisdiction of the federal courts located in New
York, New York with respect to any action or legal proceeding commenced by any party, and
irrevocably waive any objection they now or hereafter may have respecting the venue of any such
action or proceeding brought in such a court or respecting the fact that such court is an
inconvenient forum, relating to or arising out of this Subscription Agreement or any acts or
omissions relating to the sale of the securities hereunder, and consent to the service of process
in any such action or legal proceeding by means of registered or certified mail, return receipt
requested, in care of the address set forth below or such other address as the undersigned shall
furnish in writing to the other. The parties further agree that in the event of any dispute,
action, suit or other proceeding arising out of or in connection with this Subscription Agreement,
the PPM or other matters related to this subscription brought by a Subscriber (or transferee), the
Company (and each other defendant) shall recover all of such party’s attorneys’ fees and costs
incurred in each and every action, suit or other proceeding, including any and all appeals or
petitions therefrom. As used herein, attorney’s fees shall be deemed to mean the full and actual
costs of any investigation and of legal services actually performed in connection with the matters
involved, calculated on the basis of the usual fee charged by the attorneys performing such
services.

5.5 This Subscription Agreement may be executed in counterparts. Upon the execution and
delivery of this Subscription Agreement by the Subscriber, this Subscription Agreement shall become
a binding obligation of the Subscriber with respect to the purchase of Units as herein provided;
subject, however, to the right hereby reserved by the Company to (i) enter into the same agreements
with other subscribers, (ii) add and/or delete other persons as subscribers and (iii) reduce the
amount of or reject any subscription.

5.6 The holding of any provision of this Subscription Agreement to be invalid or unenforceable
by a court of competent jurisdiction shall not affect any other provision of this Subscription
Agreement, which shall remain in full force and effect.

5.7 It is agreed that a waiver by either party of a breach of any provision of this
Subscription Agreement shall not operate or be construed as a waiver of any subsequent breach by
that same party.

5.8 The parties agree to execute and deliver all such further documents, agreements and
instruments and take such other and further actions as may be necessary or appropriate to carry out
the purposes and intent of this Subscription Agreement.

[Signature Pages Follow]

 

A-8

 

IN WITNESS WHEREOF, the parties have executed this Subscription Agreement as of the day and
year first written above.

	 	 	 	 	 
	
 __________________________ 

	 	X $25,000 for each Unit
	 	= $ __________________________;
..
	Number of Units subscribed for

	 	 	 	Aggregate Purchase Price

Manner in which Title is to be held (Please Check One):

	 	 	 	 	 	 	 	 	 	 	 	 	 
	1.

	 	o
	 	Individual
	 	 	7.	 	 	o
	 	Trust/Estate/Pension or
Profit Sharing Plan
Date Opened:
 _________________ 

	 
	 	 	 	 	 	 	 	 	 	 	 	 
	2.

	 	o
	 	Joint Tenants with Right
of Survivorship
	 	 	8.	 	 	o
	 	As a Custodian for

 _______________________________ 

Under the Uniform Gift to
Minors Act of the State of

 ________________________________ 

	 
	 	 	 	 	 	 	 	 	 	 	 	 
	3.

	 	o
	 	Community Property
	 	 	9.	 	 	o
	 	Married with Separate Property
	 
	 	 	 	 	 	 	 	 	 	 	 	 
	4.

	 	o
	 	Tenants in Common
	 	 	10.	 	 	o
	 	Keogh
	 
	 	 	 	 	 	 	 	 	 	 	 	 
	5.

	 	o
	 	Corporation/Partnership/Limited

Liability Company
	 	 	11.	 	 	o
	 	Tenants by the Entirety
	 
	 	 	 	 	 	 	 	 	 	 	 	 
	6.

	 	o
	 	IRA
	 	 	12.	 	 	o
	 	Foundation described in
Section 501(c)(3) of the
Internal Revenue Code of
1986, as amended.

IF MORE THAN ONE SUBSCRIBER, EACH SUBSCRIBER MUST SIGN:

	 	•	 	INDIVIDUAL SUBSCRIBERS MUST COMPLETE PAGE A-10

	 
	 	•	 	SUBSCRIBERS WHICH ARE ENTITIES MUST COMPLETE PAGE A-11

 

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EXECUTION BY NATURAL PERSONS

	 	 	 
	 

Exact Name in Which Title is to be Held

	 
	 	 
	 

Name (Please Print)

	 	 

Name of Additional Subscriber
	 
	 	 
	 

Residence: Number and Street

	 	 

Address of Additional Subscriber
	 
	 	 
	 

City, State and Zip Code

	 	 

City, State and Zip Code
	 
	 	 
	 

Social Security Number

	 	 

Social Security Number
	 
	 	 
	 

Telephone Number

	 	 

Telephone Number
	 
	 	 
	 

Fax Number (if available)

	 	 

Fax Number (if available)
	 
	 	 
	 

E-Mail (if available)

	 	 

E-Mail (if available)
	 
	 	 
	 

(Signature)

	 	 

(Signature of Additional Subscriber)

	 	 	 	 	 
	 	ACCEPTED this
 ____ 
day of
 ___________ 
2009, on behalf of Genesis Fluid Solutions Holdings, Inc.

 	 
	 	By:  	 	 
	 	 	Name:  	 	 
	 	 	Title:  	 	 

 

A-10

 

	 	 	 	 	 

EXECUTION BY SUBSCRIBER WHICH IS AN ENTITY

	 	 	 	 	 
	(Corporation, Partnership, Trust, Etc.)
	 	 	 	 
	 
	 	 	 	 
	 

Name of Entity (Please Print)    
	Date of Incorporation or Organization:
	 	 	 	 
	 
	 	 	 	 
	State of Principal Office: 
	 	 
	 
	 	 	 	 
	Federal Taxpayer Identification Number: _______________________________________
	 	 
	 
	 	 	 	 
	 
	 	 	 	 
	 

Office Address
	 	 	 	 
	 
	 	 	 	 
	 

City, State and Zip Code
	 	 	 	 
	 
	 	 	 	 
	 

Telephone Number
	 	 	 	 
	 
	 	 	 	 
	 

Fax Number (if available)
	 	 	 	 
	 
	 	 	 	 
	 

E-Mail (if available)
	 	 	 	 

	 	 	 	 	 	 	 
	[seal]

	 	 	 	By:
	 	 

	 

	 	 	 	 	 	Name:
	Attest:

	 	 

	 	 	 	Title:
	(If Entity is a Corporation)	 	 	 	 
	 
	*If
Subscriber is a Registered
Representative with a FINRA member firm,
have the following acknowledgement signed
by the appropriate party:

	 
	The undersigned FINRA member firm
acknowledges receipt of the notice required by Rule 3050 of the
FINRA
Conduct Rules

	 	 	 	 	 	 	 
	 

Name of FINRA Firm	 	ACCEPTED this ____ day of
__________ 2009, on behalf of
Genesis Fluid Solutions
Holdings, Inc.
	 
	 	 	 	 	 	 
	By:

	 	 

	 	By:
	 	 

	 

	 	Name:
	 	 	 	Name:
	 

	 	Title:
	 	 	 	Title:

 

A-11Exhibit 10.2

Exhibit 10.2

WARRANT

					
	 	 	 	 	 
	NO.
 _____ 

	 	GENESIS FLUID SOLUTIONS HOLDINGS, INC.
	 	                     Shares

WARRANT TO PURCHASE COMMON STOCK

VOID AFTER 5:30 P.M., EASTERN

TIME, ON THE EXPIRATION DATE

THIS WARRANT AND ANY SHARES ACQUIRED UPON THE EXERCISE OF THIS WARRANT HAVE NOT BEEN REGISTERED
UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”), AND MAY NOT BE SOLD, PLEDGED,
HYPOTHECATED, DONATED OR OTHERWISE TRANSFERRED WITHOUT COMPLIANCE WITH THE REGISTRATION OR
QUALIFICATION PROVISIONS OF APPLICABLE FEDERAL AND STATE SECURITIES LAWS OR APPLICABLE EXEMPTIONS
THEREFROM.

FOR VALUE RECEIVED, GENESIS FLUID SOLUTIONS HOLDINGS, INC., a Delaware corporation (the
“Company”), hereby agrees to sell upon the terms and on the conditions hereinafter set
forth, but no later than 5:30 p.m., Eastern Time, on the Expiration Date (as hereinafter defined)
to                      or registered assigns (the “Holder”), under the terms as hereinafter
set forth,                      (                    ) fully paid and non-assessable shares of the Company’s
Common Stock, par value $0.001 per share (the “Warrant Stock”), at a purchase price of TWO
DOLLARS ($2.00) per share (the “Warrant Price”), pursuant to this warrant (this
“Warrant”). The number of shares of Warrant Stock to be so issued and the Warrant Price
are subject to adjustment in certain events as hereinafter set forth. The term “Common
Stock” shall mean, when used herein, unless the context otherwise requires, the stock and other
securities and property at the time receivable upon the exercise of this Warrant.

1. Exercise of Warrant.

a. The Holder may exercise this Warrant according to its terms by surrendering this Warrant to
the Company at the address set forth in Section 9, the Notice of Exercise attached hereto having
then been duly executed by the Holder, accompanied by cash, certified check or bank draft in
payment of the purchase price, in lawful money of the United States of America, for the number of
shares of the Warrant Stock specified in the Notice of Exercise, or as otherwise provided in this
Warrant, prior to 5:30 p.m., Eastern Time, on                     , 2012 (the “Expiration
Date”).

b. Notwithstanding anything contained herein to the contrary, if at any time after twelve (12)
months from the date of issuance of this Warrant there is no effective registration statement
registering, or no current prospectus available for, the resale of all of the shares of Warrant
Stock issuable hereunder, then the Holder may, in its sole discretion, exercise this Warrant in
whole or in part by means of a “cashless exercise” in lieu of making a cash
payment, and the Holder shall then be entitled to receive a certificate for the number of
shares of Warrant Stock equal to the quotient obtained by dividing [(A-B) (X)] by (A), where:

 

 

 

	 	(A) = 	 	VWAP (as defined below) on the business day immediately preceding the date of such
election;

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

	 
	 	(X) = 	 	the number of shares of Warrant Stock 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.

For purposes of this Warrant, “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 a
Trading Market (as defined below), the daily volume weighted average price of the Common Stock for
the ten (10) trading days prior to such date (or the nearest preceding date) on the Trading Market
on which the Common Stock is then listed or quoted as reported by Bloomberg L.P. (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 OTC
Bulletin Board is not a Trading Market, the volume weighted average price of the Common Stock for
the ten (10) trading days prior to such date (or the nearest preceding date) on the OTC Bulletin
Board; (c) if the Common Stock is not then listed or quoted on the OTC Bulletin Board and if prices
for the Common Stock are then reported in the “Pink Sheets” published by Pink Sheets, LLC (or a
similar organization or agency succeeding to its functions of reporting prices), the average bid
price per share of the Common Stock so reported for the twenty (20) trading days prior to such
date; or (d) in all other cases, the fair market value of a share of Common Stock as determined in
good faith by the Company’s board of directors. For purposes of this Warrant, “Trading
Market” means the following markets or exchanges on which the Common Stock is listed or quoted
for trading on the date in question: the New York Stock Exchange, NYSE Amex, NASDAQ Capital Market,
NASDAQ Global Market, NASDAQ Global Select Market, or OTC Bulletin Board.

c. This Warrant may be exercised in whole or in part so long as any exercise in part hereof
would not involve the issuance of fractional shares of Warrant Stock. If exercised in part, the
Company shall deliver to the Holder a new Warrant, identical in form, in the name of the Holder,
evidencing the right to purchase the number of shares of Warrant Stock as to which this Warrant has
not been exercised, which new Warrant shall be signed by the Chairman, Chief Executive Officer or
President and the Secretary or Assistant Secretary of the Company. The term Warrant as used herein
shall include any subsequent Warrant issued as provided herein.

d. No fractional shares or scrip representing fractional shares shall be issued upon the
exercise of this Warrant. The Company shall pay cash in lieu of fractions with respect to the
Warrants based upon the fair market value of such fractional shares of Common Stock (which shall be
the closing price of such shares on the exchange or market on which the Common Stock is then
traded) at the time of exercise of this Warrant.

 

-2-

 

e. In the event of any exercise of the rights represented by this Warrant, a certificate or
certificates for the Warrant Stock so purchased, registered in the name of the Holder,
shall be delivered to the Holder within a reasonable time after such rights shall have been so
exercised. The person or entity in whose name any certificate for the Warrant Stock is issued upon
exercise of the rights represented by this Warrant shall for all purposes be deemed to have become
the holder of record of such shares immediately prior to the close of business on the date on which
the Warrant was surrendered and payment of the Warrant Price and any applicable taxes was made,
irrespective of the date of delivery of such certificate, 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 opening of business on the
next succeeding date on which the stock transfer books are open. The Company shall pay any and all
documentary stamp or similar issue or transfer taxes payable in respect of the issue or delivery of
shares of Common Stock on exercise of this Warrant.

2. Disposition of Warrant Stock and Warrant.

a. The Holder hereby acknowledges that this Warrant and any Warrant Stock purchased pursuant
hereto are, as of the date hereof, not registered: (i) under the Securities Act of 1933, as amended
(the “Act”), on the ground that the issuance of this Warrant is exempt from registration
under Section 4(2) of the Act as not involving any public offering or (ii) under any applicable
state securities law because the issuance of this Warrant does not involve any public offering; and
that the Company’s reliance on the Section 4(2) exemption of the Act and under applicable state
securities laws is predicated in part on the representations hereby made to the Company by the
Holder that it is acquiring this Warrant and will acquire the Warrant Stock for investment for its
own account, with no present intention of dividing its participation with others or reselling or
otherwise distributing the same, subject, nevertheless, to any requirement of law that the
disposition of its property shall at all times be within its control.

The Holder hereby agrees that it will not sell or transfer all or any part of this Warrant
and/or Warrant Stock unless and until it shall first have given notice to the Company describing
such sale or transfer and furnished to the Company either (i) an opinion, reasonably satisfactory
to counsel for the Company, of counsel (skilled in securities matters, selected by the Holder and
reasonably satisfactory to the Company) to the effect that the proposed sale or transfer may be
made without registration under the Act and without registration or qualification under any state
law, or (ii) an interpretative letter from the Securities and Exchange Commission to the effect
that no enforcement action will be recommended if the proposed sale or transfer is made without
registration under the Act.

b. If, at the time of issuance of the shares issuable upon exercise of this Warrant, no
registration statement is in effect with respect to such shares under applicable provisions of the
Act, the Company may at its election require that the Holder provide the Company with written
reconfirmation of the Holder’s investment intent and that any stock certificate delivered to the
Holder of a surrendered Warrant shall bear legends reading substantially as follows:

“THE SHARES REPRESENTED BY THIS CERTIFICATE HAVE NOT BEEN REGISTERED UNDER THE SECURITIES
ACT OF 1933, AND MAY NOT BE SOLD, TRANSFERRED, PLEDGED OR OTHERWISE DISPOSED OF IN THE
ABSENCE OF AN EFFECTIVE REGISTRATION STATEMENT UNDER THE
SECURITIES ACT OF 1933 OR AN OPINION OF COUNSEL SATISFACTORY TO THE ISSUER OF THIS
CERTIFICATE THAT REGISTRATION IS NOT REQUIRED UNDER SAID ACT.”

 

-3-

 

In addition, so long as the foregoing legend may remain on any stock certificate delivered to the
Holder, the Company may maintain appropriate “stop transfer” orders with respect to such
certificates and the shares represented thereby on its books and records and with those to whom it
may delegate registrar and transfer functions.

3. Reservation of Shares. The Company hereby agrees that at all times there shall be
reserved for issuance upon the exercise of this Warrant such number of shares of its Common Stock
as shall be required for issuance upon exercise of this Warrant. The Company further agrees that
all shares which may be issued upon the exercise of the rights represented by this Warrant will be
duly authorized and will, upon issuance and against payment of the exercise price, be validly
issued, fully paid and non-assessable, free from all taxes, liens, charges and preemptive rights
with respect to the issuance thereof, other than taxes, if any, in respect of any transfer
occurring contemporaneously with such issuance and other than transfer restrictions imposed by
federal and state securities laws.

4. Exchange, Transfer or Assignment of Warrant. This Warrant is exchangeable, without
expense, at the option of the Holder, upon presentation and surrender hereof to the Company or at
the office of its stock transfer agent, if any, for other Warrants of different denominations,
entitling the Holder or Holders thereof to purchase in the aggregate the same number of shares of
Common Stock purchasable hereunder. Upon surrender of this Warrant to the Company or at the office
of its stock transfer agent, if any, with the Assignment Form annexed hereto duly executed and
funds sufficient to pay any transfer tax, the Company shall, without charge, execute and deliver a
new Warrant in the name of the assignee named in such instrument of assignment and this Warrant
shall promptly be canceled. This Warrant may be divided or combined with other Warrants that carry
the same rights upon presentation hereof at the office of the Company or at the office of its stock
transfer agent, if any, together with a written notice specifying the names and denominations in
which new Warrants are to be issued and signed by the Holder hereof.

5. Capital Adjustments. This Warrant is subject to the following further provisions:

a. Adjustment Upon Issuance of Common Stock. If and whenever on or after the date
hereof and through the earlier to occur of (i) first anniversary of the date hereof and (ii) date
that there is an effective registration statement on file with the Securities and Exchange
Commission covering the resale of all of the shares of Warrant Stock and all of the shares of
Common Stock issued in the Offering (as defined in the Company’s Confidential Private Placement
Memorandum dated June 25, 2009, as supplemented to date), the Company issues or sells any shares of
Common Stock or securities convertible into Common Stock, other than an Exempt Issuance (as defined
below), for a consideration per share of Common Stock (the “New Issuance Price”) less than
a price equal to $1.00 (subject to appropriate adjustment for any stock dividend, stock split,
stock combination, reclassification or similar transaction after the date hereof) (a “Dilutive
Issuance”), then immediately after such Dilutive Issuance, the Warrant Price then in effect
shall be reduced to an amount equal to the New Issuance Price multiplied by 2. For

 

-4-

 

purposes of this Warrant, “Exempt Issuance” shall mean the issuance of (a) shares of
Common Stock or options to employees, officers, directors, or consultants of the Company pursuant
to any stock or option plan duly adopted for such purpose by a majority of the non-employee members
of the Board of Directors of the Company or a majority of the members of a committee of
non-employee directors, (b) securities upon the exercise or exchange of or conversion of any
securities issued hereunder and/or other securities exercisable or exchangeable for or convertible
into shares of Common Stock issued and outstanding on the date of this Warrant, provided that such
securities have not been amended since the date of this Warrant to increase the number of such
securities or to decrease the exercise, exchange or conversion price of such securities; and (c)
securities issued pursuant to acquisitions or strategic transactions approved by a majority of the
disinterested directors of the Company, provided that any such issuance shall only be to a person
which is either an owner of, or an entity that is, itself or through its subsidiaries, an operating
company in a business synergistic with the business of the Company and in which the Company
receives benefits in addition to the investment of funds, but shall not include a transaction in
which the Company is issuing securities primarily for the purpose of raising capital or to an
entity whose primary business is investing in securities.

b. Recapitalization, Reclassification and Succession. If any recapitalization of the
Company or reclassification of its Common Stock or any merger or consolidation of the Company into
or with a corporation or other business entity, or the sale or transfer of all or substantially all
of the Company’s assets or of any successor corporation’s assets to any other corporation or
business entity (any such corporation or other business entity being included within the meaning of
the term “successor corporation”) shall be effected, at any time while this Warrant remains
outstanding and unexpired, then, as a condition of such recapitalization, reclassification, merger,
consolidation, sale or transfer, lawful and adequate provision shall be made whereby the Holder of
this Warrant thereafter shall have the right to receive upon the exercise hereof as provided in
Section 1 and in lieu of the shares of Common Stock immediately theretofore issuable upon the
exercise of this Warrant, such shares of capital stock, securities or other property as may be
issued or payable with respect to or in exchange for a number of outstanding shares of Common Stock
equal to the number of shares of Common Stock immediately theretofore issuable upon the exercise of
this Warrant had such recapitalization, reclassification, merger, consolidation, sale or transfer
not taken place, and 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.

c. Subdivision or Combination of Shares. If the Company at any time while this
Warrant remains outstanding and unexpired shall subdivide or combine its Common Stock, the number
of shares of Warrant Stock purchasable upon exercise of this Warrant and the Warrant Price shall be
proportionately adjusted.

d. Stock Dividends and Distributions. If the Company at any time while this Warrant
is outstanding and unexpired shall issue or pay the holders of its Common Stock, or take a record
of the holders of its Common Stock for the purpose of entitling them to receive, a dividend payable
in, or other distribution of, Common Stock, then (i) the Warrant Price shall be adjusted in
accordance with Section 5(f) and (ii) the number of shares of Warrant Stock purchasable upon
exercise of this Warrant shall be adjusted to the number of shares of Common
Stock that the Holder would have owned immediately following such action had this Warrant been
exercised immediately prior thereto.

 

-5-

 

e. Stock and Rights Offering to Shareholders. If the Company shall at any time after
the date of issuance of this Warrant distribute to all holders of its Common Stock any shares of
capital stock of the Company (other than Common Stock) or evidences of its indebtedness or assets
(excluding cash dividends or distributions paid from retained earnings or current year’s or prior
year’s earnings of the Company) or rights or warrants to subscribe for or purchase any of its
securities (excluding those referred to in the immediately preceding paragraph) (any of the
foregoing being hereinafter in this paragraph called the “Securities”), then in each such case, the
Company shall reserve shares or other units of such Securities for distribution to the Holder upon
exercise of this Warrant so that, in addition to the shares of the Common Stock to which such
Holder is entitled, such Holder will receive upon such exercise the amount and kind of such
Securities which such Holder would have received if the Holder had, immediately prior to the record
date for the distribution of the Securities, exercised this Warrant.

f. Warrant Price Adjustment. Except as otherwise provided herein, whenever the number
of shares of Warrant Stock purchasable upon exercise of this Warrant is adjusted, as herein
provided, the Warrant Price payable upon the exercise of this Warrant shall be adjusted to that
price determined by multiplying the Warrant Price immediately prior to such adjustment by a
fraction (i) the numerator of which shall be the number of shares of Warrant Stock purchasable upon
exercise of this Warrant immediately prior to such adjustment, and (ii) the denominator of which
shall be the number of shares of Warrant Stock purchasable upon exercise of this Warrant
immediately thereafter.

g. Certain Shares Excluded. The number of shares of Common Stock outstanding at any
given time for purposes of the adjustments set forth in this Section 5 shall exclude any shares
then directly or indirectly held in the treasury of the Company.

h. Deferral and Cumulation of De Minimis Adjustments. The Company shall not be
required to make any adjustment pursuant to this Section 5 if the amount of such adjustment would
be less than one percent (1%) of the Warrant Price in effect immediately before the event that
would otherwise have given rise to such adjustment. In such case, however, any adjustment that
would otherwise have been required to be made shall be made at the time of and together with the
next subsequent adjustment which, together with any adjustment or adjustments so carried forward,
shall amount to not less than one percent (1%) of the Warrant Price in effect immediately before
the event giving rise to such next subsequent adjustment.

i. Duration of Adjustment. Following each computation or readjustment as provided in
this Section 5, the new adjusted Warrant Price and number of shares of Warrant Stock purchasable
upon exercise of this Warrant shall remain in effect until a further computation or readjustment
thereof is required.

 

-6-

 

6. Call Right. Subject to the provisions of Section 7, this Warrant may be redeemed
prior to the Expiration Date, at the option of the Company, at a price of $0.001 per share of
Warrant Stock (“Redemption Price”), upon not less than 10 days prior written notice
(“Redemption Period”) to the Holder notifying Holder of the Company’s intent to exercise
such right and setting forth a time and date for such redemption; provided,
however, that no redemption under this Section 6 may occur unless (i) the Company’s Common
Stock has had a per share closing sales price of at least $3.50 for twenty (20) consecutive trading
days and (ii) at the date of the redemption notice and during the entire Redemption Period there is
an effective registration statement covering the resale of the Warrant Stock. This Warrant may be
exercised by the Holder, for cash, at any time after notice of redemption has been given by the
Company and prior to the time and date fixed for redemption, and the other provisions of this
Warrant shall remain in full force and effect through and including the redemption date. On and
after the redemption date, the Holder shall have no further rights except to receive, upon
surrender of this Warrant, the Redemption Price.

7. Limitation on Exercises. The Company shall not affect the exercise of this
Warrant, and the Holder shall not have the right to exercise this Warrant, to the extent that after
giving effect to such exercise, the Holder (together with such Holder’s affiliates) would
beneficially own in excess of 4.99% of the shares of Common Stock outstanding immediately after
giving effect to such exercise. For purposes of the foregoing sentence, the aggregate number of
shares of Common Stock beneficially owned by such Holder and its affiliates shall include the
number of shares of Common Stock issuable upon exercise of this Warrant with respect to which the
determination of such sentence is being made, but shall exclude shares of Common Stock which would
be issuable upon (A) exercise of the remaining, unexercised portion of this Warrant beneficially
owned by such Holder and its affiliates and (B) exercise or conversion of the unexercised or
unconverted portion of any other securities of the Company beneficially owned by such Person and
its affiliates (including, without limitation, any convertible notes or convertible preferred stock
or warrants) subject to a limitation on conversion or exercise analogous to the limitation
contained herein. Except as set forth in the preceding sentence, for purposes of this paragraph,
beneficial ownership shall be calculated in accordance with Section 13(d) of the Securities
Exchange Act of 1934, as amended. To the extent that the limitation contained in this Section 6
applies, the determination of whether this Warrant is exercisable (in relation to other securities
owned by the Holder together with any affiliate) and of which portion of this Warrant is
exercisable shall be in the sole discretion of the Holder, and the submission of a Notice of
Exercise shall be deemed to be the Holder’s determination of whether this Warrant is exercisable
(in relation to other securities owned by the Holder together with any affiliate) and of which
portion of this 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 the
determination. For purposes of this Warrant, in determining the number of outstanding shares of
Common Stock, the Holder may rely on the number of outstanding shares of Common Stock as reflected
in (1) the Company’s most recent Form 10-K, Form 10-Q, Current Report on Form 8-K or other public
filing with the Securities and Exchange Commission, as the case may be, (2) a more recent public
announcement by the Company or (3) any other notice by the Company setting forth the number of
shares of Common Stock outstanding. For any reason at any time, upon the written or oral request
of the Holder, the Company shall within one (1) business day confirm orally and in writing to the
Holder the number of shares of Common Stock then outstanding. In any case, the number of
outstanding shares of Common Stock shall be determined after giving effect to the conversion or
exercise of securities of the Company, including this Warrant, by the Holder and its affiliates
since the date as of which such number of outstanding shares of Common Stock was reported. The
restriction described in this Section 6 may be waived, in whole or in part, upon sixty-one (61)
days prior notice from the Holder to the
Company to increase such percentage up to 9.99%, but not in excess of 9.99%. The provisions
of this paragraph shall be construed and implemented in a manner otherwise than in strict
conformity with the terms of this Section 6 to correct this paragraph (or any portion hereof) which
may be defective or inconsistent with the intended beneficial ownership limitation herein contained
or to make changes or supplements necessary or desirable to properly give effect to such
limitation.

 

-7-

 

8. Notice to Holders.

a. Notice of Record Date. In case:

(i) the Company shall take a record of the holders of its Common Stock (or other stock or
securities at the time receivable upon the exercise of this Warrant) for the purpose of
entitling them to receive any dividend (other than a cash dividend payable out of earned
surplus of the Company) or other distribution, or any right to subscribe for or purchase any
 shares of stock of any class or any other securities, or to receive any other right;

(ii) of any capital reorganization of the Company, any reclassification of the capital stock
of the Company, any consolidation with or merger of the Company into another corporation, or
any conveyance of all or substantially all of the assets of the Company to another
corporation; or

(iii) of any voluntary dissolution, liquidation or winding-up of the Company;

then, and in each such case, the Company will mail or cause to be mailed to the Holder hereof at
the time outstanding a notice specifying, as the case may be, (i) the date on which a record is to
be taken for the purpose of such dividend, distribution or right, and stating the amount and
character of such dividend, distribution or right, or (ii) the date on which such reorganization,
reclassification, consolidation, merger, conveyance, dissolution, liquidation or winding-up is to
take place, and the time, if any, is to be fixed, as of which the holders of record of Common Stock
(or such stock or securities at the time receivable upon the exercise of this Warrant) shall be
entitled to exchange their shares of Common Stock (or such other stock or securities) for
securities or other property deliverable upon such reorganization, reclassification, consolidation,
merger, conveyance, dissolution or winding-up. Such notice shall be mailed at least thirty (30)
days prior to the record date therein specified, or if no record date shall have been specified
therein, at least thirty (30) days prior to such specified date, provided, however, failure to
provide any such notice shall not affect the validity of such transaction.

b. Certificate of Adjustment. Whenever any adjustment shall be made pursuant to
Section 5 hereof, the Company shall promptly make a certificate signed by its Chairman, Chief
Executive Officer, President, Vice President, Chief Financial Officer or Treasurer, setting forth
in reasonable detail the event requiring the adjustment, the amount of the adjustment, the method
by which such adjustment was calculated and the Warrant Price and number of shares of Warrant Stock
purchasable upon exercise of this Warrant after giving effect to such adjustment, and shall
promptly cause copies of such certificates to be mailed (by first class mail, postage prepaid) to
the Holder of this Warrant.

 

-8-

 

9. Loss, Theft, Destruction or Mutilation. Upon receipt by the Company of evidence
satisfactory to it, in the exercise of its reasonable discretion, of the ownership and the loss,
theft, destruction or mutilation of this Warrant and, in the case of loss, theft or destruction, of
indemnity reasonably satisfactory to the Company and, in the case of mutilation, upon surrender and
cancellation thereof, the Company will execute and deliver in lieu thereof, without expense to the
Holder, a new Warrant of like tenor dated the date hereof.

10. Warrant Holder Not a Stockholder. The Holder of this Warrant, as such, shall not
be entitled by reason of this Warrant to any rights whatsoever as a stockholder of the Company.

11. Notices. Any notice required or contemplated by this Warrant shall be deemed to
have been duly given if transmitted by registered or certified mail, return receipt requested, or
nationally recognized overnight delivery service, to the Company at its principal executive offices
located at 6660 Delmonico Drive, Suite 242-D, Colorado Springs, Colorado 80919, Attention: Michael
Whaley, Chief Financial Officer, or to the Holder at the name and address set forth in the Warrant
Register maintained by the Company.

12. Choice of Law. THIS WARRANT IS ISSUED UNDER AND SHALL FOR ALL PURPOSES BE
GOVERNED BY AND CONSTRUED IN ACCORDANCE WITH THE INTERNAL LAWS OF THE STATE OF NEW YORK, WITHOUT
GIVING EFFECT TO PRINCIPLES OF CONFLICTS OF LAW.

13. Jurisdiction and Venue. The Company and Holder hereby agree that any dispute
which may arise between them arising out of or in connection with this Warrant shall be adjudicated
before a court located in New York County, New York and they hereby submit to the exclusive
jurisdiction of the federal and state courts of the State of York located in New York County with
respect to any action or legal proceeding commenced by any party, and irrevocably waive any
objection they now or hereafter may have respecting the venue of any such action or proceeding
brought in such a court or respecting the fact that such court is an inconvenient forum, relating
to or arising out of this Warrant or any acts or omissions relating to the sale of the securities
hereunder, and consent to the service of process in any such action or legal proceeding by means of
registered or certified mail, return receipt requested, in care of the address set forth herein or
such other address as either party shall furnish in writing to the other.

[SIGNATURE PAGE FOLLOWS]

 

-9-

 

IN WITNESS WHEREOF, the Company has duly caused this Warrant to be signed on its behalf, in
its corporate name and by its duly authorized officers, as of this
 _____ 
day of                     ,
2009.

	 	 	 	 	 
	 	GENESIS FLUID SOLUTIONS HOLDINGS, INC.

 	 
	 	By:  	 	 
	 	 	Name:  	 	 
	 	 	Title:  	 	 

 

-10-

 

	 	 	 	 	 

NOTICE OF EXERCISE

	TO: 	 	Genesis Fluid Solutions Holdings, Inc.

6660 Delmonico Drive

Suite 242-D

Colorado Springs, Colorado 80919

Attn: Chief Financial Officer

Tel: (719) 359-5215

Fax: (719) 576-0370

(1) The undersigned hereby elects to purchase                      shares of Warrant Stock of the
Company pursuant to the terms of the attached Warrant to Purchase Common Stock, and tenders
herewith payment of the exercise price in full, together with all applicable transfer taxes, if
any.

(2) Payment shall take the form of (check applicable box):

o     in lawful money of the United States; or

o     if permitted, the cancellation of
 _____ 
shares of Warrant Stock in order to
exercise this Warrant with respect to
 _____ 
shares of Warrant Stock (using a VWAP of
$______ 
for this calculation), in accordance with the formula and procedure set forth in
subsection 1(b).

o    
if permitted, the cancellation of such number of shares of Warrant Stock as is
necessary, in accordance with the formula and procedure set forth in subsection 1(b), to
exercise this Warrant with respect to the maximum number of shares of Warrant Stock
purchasable pursuant to a cashless exercise.

(3) Please issue a certificate or certificates representing said shares of Warrant Stock in
the name of the undersigned or in such other name as is specified below:

 

The shares of Warrant Stock shall be delivered to the following DWAC Account Number, if
permitted, or by physical delivery of a certificate to:

 

 

 

(4) Accredited Investor. The undersigned is an “accredited investor” as defined in
Regulation D promulgated under the Securities Act of 1933, as amended.

 

-11-

 

[SIGNATURE OF HOLDER]

Name of
Investing Entity:  

Signature of Authorized Signatory of Investing Entity:  

Name and
Title of Authorized Signatory:  

Date:  

 

-12-

 

ASSIGNMENT FORM

(To assign the foregoing warrant, execute

this form and supply required information.

Do not use this form to exercise the warrant.)

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

whose address is
 

 

 

Dated:                     ,         

Holder’s Name:  

Holder’s Signature:  

Name and Title of Signatory:  

Holder’s Address:  

Signature
Guaranteed:  

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 whatsoever, and must be
guaranteed by a bank or trust company. Officers of corporations and those acting in a fiduciary or
other representative capacity should file proper evidence of authority to assign the foregoing
Warrant.

 

-13-

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