TPTX » Topics » LOAN ADVANCE/PAYDOWN REQUEST FORM

This excerpt taken from the TPTX 8-K filed Jun 17, 2008.

LOAN ADVANCE/PAYDOWN REQUEST FORM

DEADLINE FOR SAME DAY PROCESSING IS [3:00* P.M., Pacific Time/ 3:30 P.M. Eastern Time]

FORMULA BASED LINES: DEADLINE FOR NEXT DAY PROCESSING IS [3:00* P.M., Pacific Time/ 3:30 P.M. Eastern Time]

DEADLINE FOR EQUIPMENT ADVANCES IS [3:00 P.M., Pacific Time/ 3:30 P.M. Eastern Time ]**

DEADLINE FOR WIRE TRANSFERS IS [1:30 P.M., Pacific Time/ 3:30 P.M. Eastern Time]

[*At month end and the day before a holiday, the cut off time is 1:30 P.M., Pacific Time]

**Subject to 3 day advance notice.

  To: Loan Analysis                                                               DATE: ________________    TIME: _________________

  FAX #: (650) 846-6840

FROM:

  

TPTX, INC.

Borrower’s Name

   TELEPHONE REQUEST (For Bank Use Only):
FROM:   

__________________________

Authorized Signer’s Name

  

The following person is authorized to request the loan payment

transfer/loan advance on the designated account and is known to me.

FROM:   

__________________________

Authorized Signer’s Name

  

_________________________________________________

Authorized Request & Phone #

PHONE #:    __________________________   

_________________________________________________

Received by (Bank) & Phone #

FROM

ACCOUNT#:

     
(please include Note number, if applicable)   
TO ACCOUNT #:       Authorized Signature (Bank)
(please include Note number, if applicable)   
REQUESTED TRANSACTION TYPE    REQUESTED DOLLAR AMOUNT    For Bank Use Only
PRINCIPAL INCREASE* (ADVANCE)    $______________________________    Date Rec’d:   
PRINCIPAL PAYMENT (ONLY)    $______________________________    Time:   
         Comp. Status:    YES        NO    
OTHER INSTRUCTIONS:       Status Date:   
_______________________________________________________________________________    Time:   
_______________________________________________________________________________    Approval:      
              

All representations and warranties of Borrower stated in the Loan Agreement are true, correct and complete in all material respects as of the date of the telephone request for and advance confirmed by this Borrowing Certificate; provided, however, that those representations and warranties the date expressly referring to another date shall be true, correct and complete in all material respects as of such date.

 

*IS THERE A WIRE REQUEST TIED TO THIS LOAN ADVANCE? (PLEASE CIRCLE ONE        YES    NO
If YES, the Outgoing Wire Transfer Instructions must be completed below.      
OUTGOING WIRE TRANSFER INSTRUCTIONS    Fed Reference Number    Bank Transfer Number
The items marked with an asterisk (*) are required to be completed.

*Beneficiary Name

 

*Beneficiary Account Number

 

*Beneficiary Address

 

Currency Type

  US DOLLARS ONLY

*ABA Routing Number (9 Digits)

 

*Receiving Institution Name

 

*Receiving Institution Address

 

*Wire Account

  $


EXHIBIT C

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