Attached files
EXHIBIT 99.5
FORM OF BENEFICIAL OWNER ELECTION FORM
GROWLIFE, INC.
The
undersigned acknowledge(s) receipt of your letter and the enclosed
materials referred to therein relating to the rights offering (the
“Rights Offering”) by GrowLife, Inc., a Delaware
corporation (the “Company”), of non-transferable
subscription rights (each a “Subscription Right”) to
purchase one Unit per share for each share of Common Stock owned as
of the Record Date. Each Unit entitles the holder to one share of
common stock of the Company, $0.0001 par value (the “Common
Stock”) and two ½ Warrants, one ½ warrant which
will be exercisable for one share of our Common Stock at an
exercise price of $0.018 and one ½ warrant which with an
exercise price of $0.024 per share. Each whole Warrant will be
exercisable for one share of Common Stock. This will instruct you
whether to exercise Subscription Rights to purchase Units held by
you for the account of the undersigned, pursuant to the terms and
subject to the conditions set forth in the Prospectus. (Check the
applicable boxes and provide all required
information.)
☐
Please DO NOT
EXERCISE SUBSCRIPTION RIGHTS for
Units.
☐
Please EXERCISE
SUBSCRIPTION RIGHTS for Units as set forth below:
|
No. of Units
|
|
Per Units
Subscription Price
|
|
Payment
|
|
Basic
Subscription Right
|
|
X
|
$[______]
|
=
|
$[______]
|
|
Over
Subscription Right
|
|
X
|
$[______]
|
=
|
$[______]
|
|
|
|
|
Total Payment Required
|
|
$[______]
|
If you
spoke with a broker who solicited such exercise, please indicate
the name of the person or entity you spoke with:
______________________________________________
☐
Payment in the
following amount is enclosed $_________ (must match Total Payment
Required above)
☐
Please deduct
payment from the following account as follows:
Type of
Account: ______________________
Account
Number: ______________________
Amount
to be deducted:
$______________________
I (we)
on my (our) own behalf, or on behalf of any person(s) on whose
behalf, or under whose directions, I am (we are) signing this
form:
●
Irrevocably elect
to purchase the number of Units indicated above upon the terms and
conditions specified in the Prospectus; and
●
Agree that if I
(we) fail to pay for the Units I (we) have elected to purchase, the
exercise will be invalid.
Signature:
Name:
Title
Address:
Telephone:
Date:
-1-