Stockholders Cross Purchase Agreement by adc11023

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									                                     Cross Receipt




Document 1365A                                                                   www.leaplaw.com

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                                  CROSS RECEIPT

       [COMPANY NAME], a ____________________ corporation (“Purchaser”),
hereby acknowledges receipt of the stock certificates representing shares of stock of
[SELLING COMPANY NAME] (the “Company”) along with stock transfer powers
duly endorsed by each such holder transferring such shares to Purchaser.

        The undersigned Stockholders hereby acknowledge receipt from Purchaser of
cash in the total aggregate amount set forth opposite such Stockholder’s name on
Schedule A attached hereto in exchange for the above-referenced securities, pursuant to
the terms of the [NAME OF PURCHASE AGREEMENT] dated as of ________, 20__,
as amended and in effect as of the date hereof, by and among
___________________________________ (the “Purchase Agreement”).

       [Each of the undersigned Stockholders further acknowledge that the amounts set
forth opposite their names on Schedule A hereto have been retained by
_______________ in [his/her] capacity as Stockholders’ Representative for the
undersigned and that such funds will be disbursed by the Stockholders’ Representative in
accordance with the Stockholders’ Representative Agreement dated as of ________, by
and among _________________________.]

       OR

        [Each of the undersigned Stockholders further acknowledge that the amounts set
forth opposite such Stockholder’s name have been retained by the Escrow Agent and that
such funds will be disbursed by the Escrow Agent in accordance with the terms of the
Escrow Agreement.]

        Capitalized terms defined in the Purchase Agreement and not otherwise defined
herein are used herein with the meanings so defined.


                                           ____________________________________
                                           [Stockholder]


                                           ____________________________________
                                           [Stockholder]




Cross Receipt                                                           www.leaplaw.com
                                                              SCHEDULE A


                              [COMPANY NAME]

                               Stockholder List

                                   Aggregate Amount   Aggregate Amount
        Stockholder Name               Received       Held by Stockholder
                                                        Representative




Schedule A to Cross Receipt                                 www.leaplaw.com

								
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