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Cross Receipt (Type 1)Chapter 21 B. Forms and Documents Note: The following forms and documents are prepared by the above under the laws and practice prevailing as of [Date]. Seldom is a model form or document directly suitable to a transaction without adaptation to the particularities and circumstances of the matter. CROSS RECEIPT [Letterhead of Lead Underwriter] XYZ Corporation _______________ _______________ Dear Sirs: Referring to the Underwriting Agreement dated ____________, _____ (the "Underwriting Agreement") relating, among other things, to the issuance and sale by XYZ Corporation (the "Company") to the undersigned of ____________ shares as of Common Stock, $.01 par value, of the Company (the "Shares"), the undersigned hereby delivers to you a certified or official bank check in next day funds in {city in which closing occurs] in the amount of $__________________ constituting full payment for the Shares at the purchase price of $______________ per Share. Kindly acknowledge receipt of the check hereinabove referred to in the space provided below. Very truly yours, LEAD UNDERWRITER By: ____________________ Name: Title: The undersigned hereby acknowledges receipt of the check referred to in the foregoing letter. XYZ CORPORATION By: _______________________
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