Document:

ex10_3.htm

    
      

    

    Exhibit
10.2

       

      STOCK
SUBSCRIPTION AGREEMENT

      

      

      THIS AGREEMENT is effective
from the ___________ day of ______________,  2007 between Water Chef,
Inc., a Delaware corporation (the “Company”), and ______________________________
residing at ________________________________ ______________________ (the
“Purchaser”).

      

      WHEREAS,
__________________________ desires to purchase ___________________ shares of the
Company’s Common Stock (the “Shares”) pursuant to the terms of this Agreement,
and the Board of Directors of the Company has determined that it is in the best
interests of the Company to provide  with an opportunity to purchase
the aforesaid Shares.

      

      NOW THEREFORE, the parties
agree as follows:

      

      ISSUANCE
AND SALE OF THE SHARES. In consideration of the receipt of
_________

      Thousand
Dollars
($                         )
by wire transfer to the Company’s bank account, as contained below, the Company
agrees to issue to __________________ , _______________________ Shares of Water
Chef Common Stock at a purchase price of  _________cents ($.0___) per
share, such amount representing the ask closing price of Water chef common stock
over the three previous days on the OTCBB.  The Shares to be issued
are “restricted” Shares under the definition of Rule 144 of the Securities and
Exchange Commission, and the sale of these securities is prohibited for a
minimum of one year after purchase.

      

      
        COMMON
STOCK PURCHASE WARRANT.  In consideration of your investment you will
also receive a three-year common stock purchase warrant for common Shares equal
to twenty percent (20%) of the Shares purchased in Paragraph #1 above, at a
price equal to one hundred twenty percent (120%) of the price listed in
paragraph #1 above.

      

      

      
        REPRESENTATIONS
OF THE BUYER.  ________________ hereby represents and warrants to the
Company that he/she is purchasing the Shares for investment purposes and not
with a view to their redistribution or resale. He/she has the full power, right,
legal capacity, and authority to enter into and perform his/her obligations
under this Agreement, and no approval or consent of third parties is necessary
in connection herewith. He/She has had the opportunity to review the merits of
the purchase of the Shares with tax and legal counsel and financial advisors as
deemed appropriate. ____________________ understands that the Shares acquired
pursuant to this Agreement have not been registered under the Securities Act of
1933, as amended (the “Act”), and have not been registered under the blue sky
laws of any state. _________________________ understands that without such
registration, the Shares may not be sold, pledged, hypothecated, or otherwise
transferred, except pursuant to an exemption from registration or such
registration.  The Shares are therefore what is commonly referred to
as “restricted stock” and the stock certificate to be issued will bear a
restrictive legend.

      

       

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

       

      ENTIRE
AGREEMENT; MODIFICATION; WAIVER. This Agreement constitutes the entire agreement
between the parties pertaining to the subject matter contained herein and
supersedes all prior and contemporaneous agreements, representations, and
understandings of the parties. No supplement, modification, or amendment of this
Agreement shall be binding unless executed in writing by both of the parties. No
waiver of any of the provisions of this Agreement shall be deemed, or shall
constitute, a waiver of any other provision, whether or not similar,
nor

      

      
        4.
GOVERNING LAW. This Agreement shall be construed in accordance and governed by
the laws of the State of New York.

      

      

      DISCLAIMER:

      The
Investor has had an opportunity to ask questions of and receive answers from
representatives of the Company concerning the terms and conditions of this
investment.  The Investor has substantial experience in the evaluating
non-liquid investments such as the investment in the company and is capable of
evaluating the merits and risks of an investment in the Company.  The
Investor is an “accredited investor” as that term is defined in Rule 501 of
regulation D promulgated under the Securities Act.  The Investor
acknowledges that he has had an opportunity to evaluate all information
regarding the Company as it has deemed necessary or desirable in connection with
the transactions contemplated by this Agreement, has independently evaluated the
transactions contemplated by this Agreement and has reached its own decision to
enter into this Agreement.  The Investor acknowledges that he has been
advised that the Company did not have any revenues and incurred losses during
the last several years.  The Investor acknowledges that the investment
is speculative, includes high degree of risk and, accordingly, the Investor
could lose this entire investment.

      

      IN
WITNESS WHEREOF the parties hereto have executed this Agreement the day and year
first above written.

      

      
        	
                The
      Purchaser:

              	 
      
	 
      	 
      	 
      
	 
      	 
      	 
      
	
                By:

              	 
      	 
      
	 
      	 
      	 
      
	
                Water
      Chef Inc.

              	 
      
	 
      	 
      	 
      
	
                By:

              	 
      	 
      
	 
      	 
      	 
      
	
                Its:

              	 
      	 
      

      

      
        
           

        

        
           

          
            

          

        

        
           

        

      

      WIRE
TRANSFER INSTRUCTIONS

      

      Please
wire funds to:

      

      
        	
                Bank:

              	 
      	
                Citibank,
      N. A.

              
	 
      	 
      	
                1075
      Northern Boulevard

              
	 
      	 
      	
                Roslyn,
      New York 11576

              
	
                ABA
      #:

              	 
      	
                021000089

              
	
                For
      the acct. of:

              	 
      	
                Water
      Chef, Inc.

              
	 
      	 
      	
                68
      South Service Road

              
	 
      	 
      	
                Suite
      100

              
	 
      	 
      	
                Melville,
      NY  11747

              
	
                Account
      #:

              	 
      	
                95375947ex10_3.htm

    
      

    

    
      Exhibit 10.3

      

      
        	 
      	
                WARRANT

              	 
      
	
                NO.  07-B-XX

              	
                WATER
      CHEF, INC.

              	
                (#
      of
  shares     )  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, WATER CHEF, 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 Name of
the investor or
registered assigns (the “Holder”), under the terms as hereinafter set forth, One
Hundred Eleven Thousand, One Hundred and Eleven (# of shares) 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 (Price in writing) ($0.xxxx) 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.

       

      Capitalized
terms used and not otherwise defined herein shall have the respective meanings
attributed thereto in Section 10.

       

      1.          
  Exercise
of Warrant.

       

      The
Holder may exercise this Warrant according to its terms by surrendering this
Warrant to the Company at the address set forth in Section 10, the subscription
form 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 subscription form, or as otherwise provided in
this Warrant, prior to 5:30 p.m., Eastern Time, on (Date) (the “Expiration
Date”).

      
        
           

        

        
          
          

          
            

          

        

        
           

        

      

      a.           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 Chief Executive
Officer of the Company.  The term Warrant as used herein shall include
any subsequent Warrant issued as provided herein.

       

      b.           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.

       

      c.           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.

       

      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 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.

       

      
        
           

        

        
          2

          
            

          

        

        
           

        

      

      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.”

       

      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.

       

      
        
           

        

        
          3

          
            

          

        

        
           

        

      

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

       

      a.           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.

       

      b.           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.

       

      c.           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.

       

      d.           Warrant Price
Adjustment.  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.

       

      
        
           

        

        
          4

          
            

          

        

        
           

        

      

      e.           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.

       

      f.           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.

       

      g.           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.            
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.

       

      
        
           

        

        
          5

          
            

          

        

        
           

        

      

      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 Chief
Executive Officer 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.

       

      7.           
 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.

       

      8.          
  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.

       

      9.           
 Definitions.  As
used herein, unless the context otherwise requires, the following terms have the
respective meanings:

       

      a.           
“Affiliate”:  with
respect to any Person, the following:  (i) any other Person that at
such time directly or indirectly through one or more intermediaries controls, or
is controlled by or is under common control with such first Person or (ii) any
Person beneficially owning or holding, directly or indirectly, 10% or more of
any class of voting or equity interests of the Company or any Subsidiary or any
corporation of which the Company and its Subsidiaries beneficially own or hold,
in the aggregate, directly or indirectly, 10% of more of any class of voting or
equity interests.  As used in such definition, “controls,” “controlled
by” and “under common control,” as used with respect to an Person, shall mean
the possession, directly or indirectly, of the power to direct or cause the
direction of the management policies of such Person, whether through the
ownership of voting securities, by agreement or otherwise.

       

      b.           “Person”:  any
natural person, corporation, division of a corporation, partnership, limited
liability company, trust, joint venture, association, company, estate,
unincorporated organization or government or any agency or political subdivision
thereof.

       

      c.           “Subsidiaries”:  with
respect to any Person, any corporation, association or other business entity
(whether now existing or hereafter organized) of which at least a majority of
the securities or other ownership interests having ordinary voting power for the
election of directors is, at the time as of which any determination is being
made, owned or controlled by such Person or one or more subsidiaries of such
Person.

       

      10.           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 1007 68 South Service Road, Suite 100,
Melville, New York 11747, Attention: Chief Executive Officer, or to the Holder
at the name and address set forth in the Warrant Register maintained by the
Company.

       

      
        
           

        

        
          6

          
            

          

        

        
           

        

      

      11.           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.

       

      12.           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 Nassau County, New York and they
hereby submit to the exclusive jurisdiction of the federal and state courts of
the State of New York located in Nassau 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.

       

      
        
           

        

        
          7

          
            

          

        

        
           

        

      

      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
XXth day of __________, 200X.

       

      
        	 
      	
                WATER
      CHEF, INC.

              
	 
      	 
      	 
      
	 
      	
                By:

              	 
      
	 
      	 
      	
                Name:  Terry R. Lazar

              
	 
      	 
      	
                Title:  Chief
      Financial Officer

              

      

      
        
           

        

        
          8

          
            

          

        

        
           

        

      

      FORM OF
EXERCISE

       

      (to be
executed by the registered holder hereof)

      

       

      The
undersigned hereby exercises the right to purchase _________ shares of common
stock, par value $0.001 per share ("Common Stock"), of Water Chef, Inc.
evidenced by the within Warrant Certificate for an Applicable Exercise Price of
$  per
share and herewith makes payment of the purchase price in full of
$__________. Kindly issue certificates for shares of Common Stock (and for the
unexercised balance of the Warrants evidenced by the within Warrant Certificate,
if any) in accordance with the instructions given below.

       

      

       

      Dated:____________________
, 20__ .

      

      

      ______________________________

      

      Instructions
for registration of stock

      

      

      _____________________________

                 Name
(Please Print)

      

      Social
Security or other identifying Number:

      

      Address:__________________________________

                            City/State
and Zip Code

      

      

       Instructions
for registration of certificate representing

      the
unexercised balance of Warrants (if any)

      

      

      _____________________________

      Name
(Please Print)

      

      Social
Security or other identifying Number: ___________

      

      Address:____________________________________

                            City,
State and Zip Code

      

       

    

     9

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