EX-4.9
from S-3
2 pages
With Respect to Any Instructions to Exercise (Or Not to Exercise) Rights, the Undersigned Acknowledges That This Form Must Be Completed and Returned Such That It Will Actually Be Received by You by 5:00 P.M., New York City Time, on , 2016, the Last Business Day Prior to the Scheduled Expiration Date of the Rights Offering of , 2016 (Which May Be Extended by the Company)
12/34/56