EX-99.6 11 ex99-6.htm ADVSER CONTR

 

 

EXHIBIT 99.6

 

THE TERMS AND CONDITIONS OF THE RIGHTS OFFERING ARE SET FORTH IN THE COMPANY’S PROSPECTUS DATED [●], 2014 (THE “PROSPECTUS”) AND ARE INCORPORATED HEREIN BY REFERENCE. COPIES OF THE PROSPECTUS ARE AVAILABLE UPON REQUEST FROM BROADRIDGE CORPORATE ISSUER SOLUTIONS, INC., THE SUBSCRIPTION AGENT, BY CALLING (855) 793-5068.

 

PRO-DEX, INC.

 

SHARES OF COMMON STOCK

ISSUABLE UPON EXERCISE OF SUBSCRIPTION RIGHTS

 

NOMINEE HOLDER CERTIFICATION

 

The undersigned, a bank, broker, trustee, depository or other nominee holder of subscription rights (the “Subscription Rights”) to purchase shares of common stock, no par value per share (“Common Stock”), of Pro-Dex, Inc., a Colorado corporation (the “Company”), pursuant to the rights offering described in the Company’s prospectus dated [●], 2014 (the “Prospectus”), hereby certifies to the Company and Broadridge Corporate Issuer Solutions, Inc., as subscription agent for the rights offering, that the undersigned has exercised on behalf of the beneficial owners thereof (which may include the undersigned), the subscription privilege as to the number of shares of Common Stock specified below on behalf of beneficial owners of Subscription Rights:

 

    NUMBER OF SHARES
OWNED ON RECORD DATE
  NUMBER OF SHARES
SUBSCRIBED FOR PURSUANT
TO SUBSCRIPTION PRIVILEGE
 
1.          
2.          
3.          
4.          
5.          

 

Name of Bank, Broker, Trustee, Depository or Other Nominee

 

By:    
  Authorized Signature  
     
Name:    
  (Please print or type)  
     
Title:    
  (Please print or type)  

  

Provide the following information if applicable:

 

   
Depository Trust Company (“DTC”) Participant Number  

 

Participant:    

 

By:    
  Authorized Signature  
     
Name:    
  (Please print or type)  
     
Title:    
  (Please print or type)  

 

DTC Subscription Confirmation Number(s)