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FORM 8-A
Securities and Exchange Commission
Washington, D.C. 20549
FOR REGISTRATION OF CERTAIN CLASSES OF SECURITIES
PURSUANT TO SECTION 12(b) OR 12(g) OF THE
SECURITIES EXCHANGE ACT OF 1934
CLAIMSNET.COM INC.
(Exact name of registrant as specified in its charter)
DELAWARE 75-2649230
(State of incorporation (I.R.S. Employer
organization) Identification Number)
12801 NORTH CENTRAL EXPRESSWAY, DALLAS, TEXAS 75243
(Address of principal executive offices, including zip code)
SECURITIES TO BE REGISTERED PURSUANT TO SECTION 12(B) OF THE ACT:
TITLE OF EACH CLASS TO NAME OF EACH EXCHANGE ON WHICH EACH
BE SO REGISTERED EACH CLASS IS TO BE SO REGISTERED
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Common Stock, NASDAQ SmallCap Market
par value $.001 per share Boston Stock Exchange
SECURITIES TO BE REGISTERED PURSUANT TO SECTION 12(g) OF THE ACT:
None.
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Copies of correspondence should be forwarded to:
ROBERT STEVEN BROWN, ESQ.
BROCK SILVERSTEIN MCAULIFFE LLC
ONE CITICORP CENTER
153 EAST 53RD STREET
NEW YORK, NEW YORK 10022
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ITEM 1. DESCRIPTION OF REGISTRANT'S SECURITIES TO BE REGISTERED.
Incorporated by reference to the information set forth under the heading
"Description of Securities -- Common Stock" contained in the Registration
Statement on Form S-1 (Registration No. 333-36209) under the Securities Act
of 1933, as amended, as filed with the Securities and Exchange Commission on
October 30, 1998 and as such registration statement may be hereafter amended.
ITEM 2. EXHIBITS.
Exhibit No. Exhibit
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3.1 Articles of Incorporation, as amended (incorporated by
reference to Exhibit 3.1 to the Registration Statement on Form
S-1 (Registration No. 333-36209) under the Securities Act of
1933, as amended).
3.2 Bylaws (incorporated by reference to Exhibit 3.2 to the
Registration Statement on Form S-1 (Registration No.
333-36209) under the Securities Act of 1933, as amended).
4.2 Specimen of Common Stock Certificate (incorporated by
reference to Exhibit 4.2 to the Registration Statement on Form
S-1 (Registration No. 333-36209) under the Securities Act of
1933, as amended).
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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, thereunto duly authorized.
CLAIMSNET.COM INC.
Date: December 2, 1998 By: /s/ Bo W. Lycke
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Bo W. Lycke
President
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