SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 8-A
For Registration of Certain Classes of Securities
Pursuant to Section 12(b) or (g) of the
Securities Exchange Act of 1934
PROFILE TECHNOLOGIES, INC.
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(Exact name of registrant as specified in its charter)
Delaware 91-1418002
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(State of incorporation (I.R.S. Employer
or organization) Identification No.)
5 Strickland Place, Manhasset, NY 11030
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(Address of principal executive offices) (Zip Code)
If this Form relates to the registration of a class of debt securities and is
effective upon filing pursuant to General Instruction A.(c)(1), please check the
following box. []
If this Form relates to the registration of a class of debt securities and is to
become effective simultaneously with the effectiveness of a concurrent
registration statement under the Securities Act of 1933 pursuant to General
Instructions A.(c)(2), please check the following box. []
Securities to be registered pursuant to Section 12(b) of the Act:
Title of each class Name of each exchange on which
to be so registered each class is to be registered
NONE
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Securities to be registered pursuant to Section 12(g) of the Act:
.001 par value common stock
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(Title of class)
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(Title of class)
<PAGE>
Item 1. Description of Registrant's Securities to be Registered.
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$.001 par value common stock. This description is incorporated by reference
to the Registrant's registration statement No. 333-4714NY.
Item 2. Exhibits.
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1. Specimen stock certificate of $.001 par value common stock.
2. Constituent instruments defining the rights of all holders of each class
of such securities are:
a. Articles of Incorporation of Registrant incorporated by reference
to Exhibit 3.1 to Registration Statement No. 333- 4714NY.
b. Bylaws of Registrant incorporated by reference to Exhibit 3.4 to
Registration Statement No. 333-4714NY.
SIGNATURE
Pursuant to the requirements of Section 12 of the Securities Exchange
Act of 1934, the registrant has duly caused this registration statement to be
signed on its behalf by the undersigned, thereto duly authorized.
PROFILE TECHNOLOGIES, INC.
Date: August 5, 1996
By: /s/ Henry Gemino
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Henry Gemino
Executive Vice President
EXHIBIT 1 - Specimen Stock Certificate
The stock certificate contains the following language on the front of
the certificate:
NUMBER (corporate logo) SHARES
PROFILE TECHNOLOGIES, INC.
AUTHORIZED STOCK: 10,000,000 SHARES
PAR VALUE $.001 PER SHARE
THIS CERTIFIES THAT
IS THE RECORD HOLDER OF
transferable on the books of the Corporation in person or by duly authorized
attorney upon surrender of this Certificate properly endorsed. This Certificate
is not valid until countersigned by the Transfer Agent and registered by the
Registrar.
Witness the facsimile seal of the Corporation and the facsimile signatures of
its duly authorized officers.
(corporate seal)
Secretary President
<PAGE>
The stock certificate contains the following language on the back of
the certificate:
Notice: Signature must be guaranteed by a firm which is a member
of a registered national stock exchange, or by a bank
(other than a savings bank), or a trust company. The
following abbreviations, when used in the inscription on
the face of this certificate, shall be construed as
though they were written out in full according to
applicable laws or regulatio
TEN COM - as tenants in common UNIF GIFT MIN ACT - Custodian
TEN ENT - as tenants by the entireties -----------------
JF TEN - as joint tenants with right of (Cust) (Minor)
survivorship and not as tenants under Uniform Gifts to Minors
in common Act
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(State)
Additional abbreviations may also be used though not in the above list.
For Value Received, hereby sell, assign and transfer unto
PLEASE INSERT SOCIAL SECURITY OR OTHER
IDENTIFYING NUMBER OF ASSIGNEE
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(PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE OF ASSIGNEE)
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of the capital stock represented by the within certificate, and do hereby
irrevocably constitute and appoint
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to transfer the said stock on the books of the within named Corporation with
full power of substitution in the premises.
Dated
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NOTICE: THE SIGNATURE TO THIS ASSIGNMENT MUST CORRESPOND WITH THE NAME AS
WRITTEN UPON THE FACE OF THE CERTIFICATE IN EVERY PARTICULAR WITHOUT
ALTERATION OR ENLARGEMENT OR ANY CHANGE WHATEVER
