RIGHTS CERTIFICATE #:
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NUMBER OF RIGHTS
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THE TERMS AND CONDITIONS OF THE RIGHTS OFFERING ARE SET FORTH IN THE COMPANY'S PROSPECTUS DATED ______, 2011 (THE "PROSPECTUS") AND ARE INCORPORATED HEREIN BY REFERENCE. COPIES OF THE PROSPECTUS ARE AVAILABLE UPON REQUEST FROM THE COMPANY.
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Chairman and Chief Executive Officer
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FORM 1-EXERCISE OF SUBSCRIPTION RIGHTS
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FORM 3-SIGNATURE
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To subscribe for Warrants pursuant to your Subscription Right, please complete the items (a) and (b) and sign under Form 3 below.
(a) EXERCISE OF SUBSCRIPTION RIGHT:
I apply for _______ Units (consisting of 1 Class A Warrant and 1 Class B Warrant) x $0.04 = $________
(b) METHOD OF PAYMENT (CHECK ONE)
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TO SUBSCRIBE: I acknowledge that I have received the Prospectus for this Rights Offering and I hereby irrevocably subscribe for the number of units of Class A Warrants and Class B Warrants indicated above on the terms and conditions specified in the Prospectus.
Signature(s): ______________________________________
IMPORTANT: The signature(s) must correspond with the name(s) as printed on the reverse of this Subscription Rights Certificate in every particular, without alteration or enlargement, or any other change whatsoever.
FORM 4-SIGNATURE GUARANTEE
This form must be completed if you have completed any portion of Form 2.
Signature
Guaranteed:_________________________________________
(Name of Bank or Firm)
By: _______________________________________________
(Signature of Officer)
IMPORTANT: The signature(s) should be guaranteed by an eligible guarantor institution (bank, stockbroker, savings & loan association or credit union) with membership in an approved signature guarantee medallion program pursuant to Securities and Exchange Commission Rule 17Ad-15.
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Check or bank draft drawn on a U.S. bank payable to “Chanticleer Holdings, Inc.” Funds paid by an uncertified check may take at least five business days to clear.
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Wire transfer of immediately available funds directly to wire transfer to _________ FBO USA Technologies, Inc.
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FORM 2-DELIVERY TO DIFFERENT ADDRESS
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If you wish for the Warrants underlying your Rights or a certificate representing unexercised Rights to be delivered to an address different from that shown on the face of this Subscription Rights Certificate, please enter the alternate address below, sign under Form 3 and have your signature guaranteed under Form 4.
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