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OMB Number 3235-0104
Expires: December 31, 2001
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U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 3
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
Filed pursuant to Section 16(a) of the Securities Exchange Act of
1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or
Section 30(f) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Bloch Jonathan R.
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(Last) (First) (Middle)
11100 Santa Monica Blvd., Suite 830
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(Street)
Los Angeles CA 90025
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(City) (State) (Zip)
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2. Date of Event Requiring Statement (Month/Day/Year)
11/10/1999
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3. IRS Identification Number of Reporting Person,
if an entity (voluntary)
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4. Issuer Name and Ticker or Trading Symbol
ASD Systems, Inc. (ASDS)
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
[ X ] Director [ ] 10% Owner
[ ] Officer (give title below) [ ] Other (specify below)
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6. If Amendment, Date of Original (Month/Day/Year)
N/A
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7. Individual or Joint/Group Filing (Check Applicable Line)
[ X ] Form filed by One Reporting Person
[ ] Form filed by More than One Reporting Person
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<TABLE>
<CAPTION>
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Table I -- Non-Derivative Securities Beneficially Owned
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2. 3.
1. Amount of Securities Ownership Form
Title of Security Beneficially Owned Direct (D) or 4.
(Instr. 4) (Instr. 4) Indirect (I) Nature of Indirect Beneficial Ownership
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<S> <C> <C> <C>
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Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
* If the form is filed by more than one reporting person, See Instruction
5(b)(v).
</TABLE>
<PAGE>
FORM 3 (continued)
<TABLE>
<CAPTION>
Table II -- Derivative Securities Beneficially Owned (e.g., puts, calls, warrants,
options, convertible securities)
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3.
Title and Amount
2. of Securities
Date Exercisable and Underlying 5.
Expiration Date Derivative Security 4. Ownership
(Month/Day/Year) (Instr. 4) Conversion Form of 6.
1. -------------------- ------------------- or Exercise Derivative Nature
Title of Date Expira- Amount or Price of Security: of Indirect
Derivative Security Exer- tion Number of Derivative Direct (D) Beneficial
(Instr. 4) cisable Date Title Shares Security or Indirect (I) Ownership
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<S> <C> <C> <C> <C> <C> <C> <C>
Stock Options (Right to common
Purchase) (1) 03/12/2009 stock 10,000 $1.00 D
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Stock Options (Right to common
Purchase (2) 02/05/2004 stock 800,000 (3) I (4)
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Explanation of Responses:
(1) The Options vested 50% on the date of grant (March 12, 1999) with
the remainder vesting on the first anniversary of the date of
grant.
(2) The Options vest upon consummation by the Issuer of an IPO.
(3) The exercise prices of the Options are as follows: 400,000 exercisable
at $1.00 per share, 240,000 exercisable at $2.00 per share and 160,000
exercisable at $3.00 per share.
(4) Represents shares held directly by CKM Software Partners, a California
general partnership, of which the Reporting Person is a partner. The
Reporting Person disclaims beneficial ownership of these securities
except to the extent of his pecuniary interest therein.
/s/ JONATHAN R. BLOCH November 10, 1999
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**Signature of Reporting Person Date
** Intentional misstatements or omissions of facts constitute Federal
Criminal Violations.
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually
signed. If space provided is insufficient, see Instruction 6
for procedures.
