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SHARE EXCHANGE AGREEMENT THIS SHARE EXCHANGE AGREEMENT (this "Agreement") is made and entered into as of the 21st day of July, 1994, by and between MOMED HOLDING CO., a Missouri corporation ("MOMED"), and MISSOURI STATE MEDICAL ASSOCIATION, a Missouri not-for-profit corporation ("MSMA"). In consideration of the premises and the mutual terms and provisions set forth in this Agreement, the parties hereto agree as follows: ARTICLE ONE ACQUISITION AND EXCHANGE OF SHARES Section 1.1. Acquisition of the MSMA Shares. Subject to the terms and conditions hereof, on the Closing Dale (as hereinafter defined), MSMA agrees to assign, transfer, deliver and convey unto MOMED, and MOMED agrees to acquire from MSMA for retirement, all of MSMA's right, title and interest in and to the 24,185 shares of MOMED's authorized and outstanding Class B Common Stock now owned by MSMA (the "MSMA Shares"). Section 1.2. Exchange of Shares: Nomination and Endorsement Agreement (a) In exchange for the transfer of the MSMA Shares, on the Closing Dale, MOMED agrees to issue to MSMA, subject to the terms and conditions hereof, 24,185 shares of MOMEDs Class A Common Stock and 24,185 shares of its Class C Common Stock When exchanged, the shares issued to MSMA hereunder shall be duly authorized and validly issued, filly paid and non- assessable, and not issued in violation of any preemptive rights. (b) The shares of MOMED's Class A Common Stock issued to MSMA in connection herewith (the "Class A Shares") shall, once issued, have the same dividend rights, conversion rights, voting powers, preferences, priorities and other special rights and powers as all other issued and outstanding shares of MOMED's Class A Common Stock (c) The shares of MOMED's Class C Common Stock issued to MSMA in connection herewith (the "Class C Shares") shall be non-voting. MSMA shall have an option to sell (i.e. "put") the Class C Shares to MOMED, and MOMED shall be required to purchase such shares, at any time from and after the Closing Date, in the maximum quantities set forth on Schedule attached hereto and incorporated herein by this reference and for the per share cash consideration hereinafter described. On the second and third anniversaries of the Closing Date, MOMED shall have an option to purchase (i.e. "call") those Class C Shares not yet put to MOMED in the maximum quantities set forth on Schedule A and for the per share cash consideration hereinafter described. The put or call cash consideration payable for the Class C Shares pursuant to this Section 1.2(c) shall be $24.81 per share (for an aggregate cash consideration not to exceed $600,000) plus an interest factor which shall accrue from the Closing Date through the date of sale or purchase pursuant to a put or call provided for in this Section 1.2(c). The interest shall be a fixed annual rate equal to the prime rate announced by The Boatmen's National Bank of St. Louis on the Closing Date plus one percent (1%). Any party exercising its rights to a put or call hereunder shall give written notice thereof to the other party in accordance with the provisions of Section 7.1 hereof. The notice shall specify the number of shares covered, the purchase price of such shares (including the interest factor to the date of payment and delivery) as well as the date of payment and delivery which shall be a date not less than seven (7) nor more than thirty (30) days following the date such notice shall be deemed to have been given or made as in Section 7.1 provided. On the delivery date, MSMA shall surrender to MOMED, or its duly authorized designee, possession of all certificates representing the Class C shares covered by the put or call notice, endorsed in blank or accompanied by duly executed stock powers, and such Class C shares shall be free and clear of any claims, liens, charges, encumbrances or other restrictions or commitments of any nature whatsoever(d) In the event of any voluntary or involuntary liquidation, dissolution or winding up of MOMED, the holders of the Class C Shares shall be entitled to receive out of the assets of MOMED available for distribution to the stockholders, before any distribution of assets shall be made to the holders of other shares of MOMED capital stock, an amount equal to the value of any unexercised put or call rights provided for in Section 1.2(c) above. Except for this preference payment, the holders of the Class C Shares shall have no other rights to share in the assets of MOMED upon the liquidation, dissolution or winding up of MOMED. (e) Concurrently with the exchange of the MSMA Shares far the Class C Shares, (i) MSMA and MOMED shall enter into a five (5) year nomination agreement substantially in the form of Exhibit A attached hereto (the "Nomination Agreement"), and (ii) MOMED and the Select Stockholders (as hereinafter defined) shall enter into a five (5) year voting agreement substantially in the form of Exhibit B attached hereto (the "Voting Agreement"). Section 1.3. Exchange Procedures: Surrender of Certificates. On the Closing Date, MSMA shall surrender to MOMED, or its duly authorized designee, possession of all certificates representing the MSMA Shares, endorsed in blank or accompanied by duly executed stock powers effectively transferring the MSMA Shares to MOMED, together with a duly executed letter indicating MSMA's intent to have the surrendered shares canceled (substantially in the form of Exhibit C attached hereto). Once the certificates representing the MSMA Shares have been surrendered to MOMED, those certificates shall be marked "canceled" and, together with all other authorized but unissued shares of MOMED Class B Common Stock, shall be deemed retired. Thereupon. MOMED shall issue, in the name of MSMA, certificates representing the Class A Shares and the Class C Shares. Section 1.4. The Closing. The closing of the transactions contemplated hereunder (the "Closing") shall take place at MOMEDs principal executive office, 8630 Delmar Blvd., Suite 100, St. Louis, Missouri 63124, at 2:00 p.m. St. Louis time on Tuesday; August 16,1994, or at such other date, time or place upon which the parties may mutually agree (the "Closing Date"). Section 1.5. Actions At Closing. At the Closing, the following deliveries shall be made, each to be deemed concurrent with all others: (a) MOMED shall deliver the following documents to MSMA: (1) A certificate signed by an authorized officer of MOMED stating that each of the representations and warranties contained in Article Two is true and correct in all material respects at the time of Closing with the same force and effect as if such representations and warranties had been made at Closing; (2) A copy of the resolutions duly adopted by the Board of Directors and stockholders of MOMED authorizing the execution and delivery of this Agreement and the consummation of the transactions contemplated hereby, duly certified, as of the Closing Date, by the secretary of MOMED; (3) Certificates representing the Class A Shares and the Class C Shares registered in the name of MSMA; and (4) The Nomination Agreement duly executed by MOMED and the Voting Agreement duly executed by MOMED and Richard V. Bradley M.D., Kriete H. Hollrah and Leonard L. Davis, Jr., M.D. (collectively referred to as the "Select Stockholders"); and (5) The opinion of MOMED's counsel substantially in the form of Exhibit D attached hereto. (b) MSMA shall deliver the following documents to MOMED: (1) A certificate signed by an authorized officer of MSMA stating that each of the representations and warranties contained in Article Three is true and correct in all material respects at the time of Closing with the same force and effect as if such representations and warranties had been made at Closing; (2) A copy of the resolutions duly adopted by the Executive Committee of MSMA authorizing the execution and delivery of this Agreement and the consummation of the transactions contemplated hereby, duly certified, as of the Closing Date, by the secretary of MSMA; (3) The certificates representing the MSMA Shares, endorsed in blank or accompanied by duly executed stock powers effectively transferring the MSMA Shares to MOMED for retirement, together with a duly executed letter indicating MSMA's intent to have the surrendered shares canceled (substantially in the form of Exhibit C attached hereto); and (4) The Nomination Agreement and the Voting Agreement, each duly executed by MSMA. ARTICLE TWO REPRESENTATIONS AND WARRANTIES OF MOMED Section 2.1. Corporate Organization and Capital Stock. (a) MOMED is a corporation duly organized, validly existing and in good standing under the law of the State Missouri with full power and authority to carry on its business as now being conducted. (b) The authorized capital stock of MOMED, consists of (i) 500,000 shares of Class A Common Stock, of which, as of the date hereof, 219,881 shares are issued and outstanding, and (ii) 125,000 shares of Class B Common Stock, of which, as of the date hereof, 24,185 shares are issued and outstanding. All of the issued and outstanding shares of MOMED's capital stock are duly and validly issued and outstanding and are fully paid and non-assessable. None of the outstanding shares of MOMED's capital stock has been issued in violation of any preemptive rights of the current or past stockholders of MOMED. (c) The Class A Shares and the Class C Shares that are to be issued to MSMA hereunder, when so issued in accordance with the terms of this Agreement, will be validly issued and outstanding, fully paid and non-assessable. Section 2.2. Authorization. On the Closing Date, (i) there will be no provision in MOMED's Restated Articles of incorporation or in its By-Laws, as amended, which prohibits or limits MOMED's ability to consummate the transactions contemplated hereby, (ii) MOMED shall have the right, power and authority to enter into this Agreement and to consummate all of the transactions and fulfill all of the obligations contemplated hereby and (iii) the execution and delivery of this Agreement and the due consummation by MOMED of the transactions contemplated hereby will have been duly authorized by all necessary corporate action of the Board of Directors and stockholders of MOMED. This Agreement constitutes a legal, valid and binding agreement of MOMED enforceable against MOMED in accordance with its terms. Section 2.3. No Conflict or Violation. Subject to the fulfillment of all of the conditions set forth in Article Five hereof, neither the execution and delivery of this Agreement, nor the consummation of the transactions contemplated hereby in accordance herewith, nor compliance by MOMED with any of the provisions hereof will result in, as of the Closing Date: (i) a violation of or a conflict with any provision of MOMED's Restated Articles of Incorporation or By-Laws, as amended, (ii) a breach of or default under any term, condition or provision of any obligation, agreement or undertaking, whether oral or written to which MOMED is a party, or an event which, with the giving of notice, lapse of time, or both, would result in any such breach, (iii) a violation of any applicable law, rule, regulation, order, decree or other requirement having the force of law, or order, judgment, writ, injunction, decree or award, or an event which, with the giving of notice, lapse of time, or both, would result in any such violation, or (iv) any person having the right to enjoin, rescind or otherwise prevent or impede the transactions contemplated hereby or to obtain damages from MSMA or to obtain any other judicial or administrative relief as a result of any transaction carried out in accordance with the provisions of this Agreement.Section 2.4. Litigation and Proceedings. There is no action, suit, proceeding or investigation pending or, to the knowledge of MOMED, threatened which challenges the validity of this Agreement or the transactions contemplated hereby, or otherwise seeks to prevent, directly or indirectly the consummation of such transactions. ARTICLE THREE REPRESENTATIONS AND WARRANTIES OF MSMA Section 3.1. Corporate Organization. MSMA is a not-for-profit corporation duly organized, validly existing and in good standing under the laws of the State Missouri with full power and authority to carry on its business as it is now being conducted. Section 3.2. Authorization. MSMA has full right, power and authority to enter into this Agreement and to consummate or cause to be consummated all of the transactions and to fulfill all of the obligations contemplated hereby The execution and delivery of this Agreement and the due consummation by MSMA of the transactions contemplated hereby have been duly authorized by all necessary corporate action of the Executive Committee of MSMA. This Agreement constitutes a legal, valid and binding agreement of MSMA enforceable against MSMA in accordance with its terms. Section 3.3. No Conflict or Violation. Neither the execution and delivery of this Agreement, nor the consummation of the transactions contemplated hereby nor compliance by MSMA with any of the provisions hereof will result in: (i) a violation of or a conflict with any provision of the Articles of Incorporation or By-Laws of MSMA, (ii) a breach of or default under any term, condition or provision of any obligation, agreement or undertaking, whether oral or written to which MSMA is a party, or an event which, with the giving of notice, lapse of time, or both, would result in any such breach, (iii) a violation of any applicable law, rule, regulation, order, decree or other requirement having the force of law, or order, judgment, writ, injunction, decree or award, or an event which, with the giving of notice, lapse of time, or both, would result in any such violation, or (iv) any person having the right to enjoin, rescind or otherwise prevent or impede the transactions contemplated hereby or to obtain damages from MOMED or to obtain any other judicial or administrative relief as a result of any transaction carried out in accordance with the provisions of this Agreement. Section 3.4. Litigation and Proceedings. There is no action, suit, proceeding or investigation pending or, to the knowledge of MSMA, threatened which challenges the validity of this Agreement or the transactions contemplated hereby, or otherwise seeks to prevent, directly or indirectly, the consummation of such transactions. Section 3.5. Title to MSMA Shares. MSMA possesses good and marketable title to the MSMA Shares and has full right to transfer the same as contemplated herein. The MSMA Shares are, and will be as of the Closing Date, free and clear of any claims, lien, charges, encumbrances or other restrictions or commitments of any nature whatsoever. Section 3.6 Sale of Substantially All Assets. The MSMA Shares do not constitute all or substantially all of the assets of MSMA. ARTICLE FOUR AGREEMENTS OF PARTIES Section 4.1. Agreements of MOMED. (a) MOMED shall, in the event it has knowledge of the occurrence, or impending or threatened occurrence, of any event or condition which would cause or constitute a breach (or would have caused or constituted a breach had such event occurred or been known prior to the date hereof) of any of its representations, warranties or agreements contained or referred to herein, give prompt written notice thereof to MSMA and use reasonable efforts to prevent or promptly remedy the same. (b) MOMED shall submit the following matters for the approval of the MOMED stockholders at the next annual meeting of such stockholders, or at any adjournment or adjournments thereof: (I) This Agreement, (ii) The Nomination Agreement; (iii) An amendment to MOMED's Restated Articles of incorporation authorizing the issuance of a new class of non-voting common stock to be designated "Class C Common Stock" with the rights and preferences set forth in Section 1.2 above, and (r,) Such other amendments to MOMED's Restated Articles of Incorporation and By-Laws, as amended, as may be required to effect this Agreement and the transactions contemplated hereby The Board of Directors of MOMED shall (subject to compliance with its fiduciary duties as advised by counsel) recommend to its stockholders the approval of such matters and shall use reasonable efforts to obtain such stockholder approval (c) MOMED shall use reasonable efforts to perform and fulfill all conditions and obligations on its part to be performed or fulfilled under this Agreement and to effect the exchange contemplated hereby in accordance with the terms and conditions hereof. Section 4.2. Agreements of MSMA. (a) MSMA shall, in the event it has knowledge of the occurrence, or impending or threatened occurrence, of any event or condition which would cause or constitute a breach (or would have caused or constituted a breach had such event occurred or been known prior to the date hereof) of any of its representations, warranties or agreements contained or referred to herein, give prompt written notice thereof to MOMED and use reasonable efforts to prevent or promptly remedy the same. (b) At the next annual meeting of MOMED stockholders, or at any adjournment or adjournments thereof, MSMA shall, as record holder of all 24,185 shares of the issued and outstanding MOMED Class B Common Stock, vote all such shares of MOMED Class B Common Stock in favor of this Agreement, the Nomination Agreement, an amendment to MOMED's Restated Articles of Incorporation authorizing the issuance of a new class of non-voting common stock to be designated `Class C Common Stock" with the rights and preferences set forth in Section 1.2 above, and such other amendments to MOMED's Restated Articles of Incorporation and By- laws, as amended, as may be required to effect this Agreement and the transactions contemplated hereby (c) MSMA shall use reasonable efforts to perform and fulfill all conditions and obligations on its part to be performed or fulfilled under this Agreement and to effect the exchange contemplated hereby in accordance with the terms and conditions hereof. ARTICLE FIVE CONDITIONS PRECEDENT TO THE EXCHANGE Section 5.1. Conditions to the Obligations of MOMED. MOMED's obligations to effect the exchange shall be subject to the satisfaction (or waiver by MOMED) of the following conditions prior to or on the Closing Date: (a) The representations and warranties made by MSMA in this Agreement shall be true in all material respects on and as of the Closing Date with the same effect as though such representations and warranties had been made or given on and as of the Closing Date; (b) MSMA shall have performed and complied in all material respects with all of its obligations and agreements required to be performed prior to the Closing Date under this Agreement; (c) No temporary restraining order, preliminary or permanent injunction or other order issued by any court of competent jurisdiction or other legal restraint or prohibition preventing the consummation of the exchange contemplated herein shall be in effect, nor shall any proceeding by any authority or other person seeking any of the foregoing be pending. There shall not be any action taken, or any statute, rule, regulation or order enacted, entered, enforced or deemed applicable to the exchange which makes the consummation of the exchange illegal; and (d) All necessary approvals, consents and authorizations required by law for consummation of the exchange including, without limitation, (i) approval by the MOMED stockholders of this Agreement, all other agreements required to be submitted to such stockholders in connection herewith, and those amendments to MOMED's Restated Articles of Incorporation as are required to effect the transactions herein contemplated, and (II) approval by the MSMA Executive Committee of this Agreement on or before August 1,1994, shall have been obtained. (e) MOMED shall have received all executed documents required to be received from MSMA on or prior to the Closing Date; all in form and substance reasonably satisfactory to MOMED, including, without limitation, the Nomination Agreement duly executed by MSMA and the Voting Agreement duly executed by MSMA and the Select Stockholders. Section 5.2. Conditions to the Obligations of MSMA. MSMA's obligations to effect the exchange shall be subject to the satisfaction (or waiver by MSMA) of the following conditions prior to or on August 1, 1994: (a) The representatives and warranties made by MOMED in this Agreement shall be true in all material respects on and as of the Closing Date with the same effect as though such representations and warranties had been made or given on and as of the Closing Date; (b) MOMED shall have performed and complied in all material respects with all of its obligations and agreements required to be performed prior to the Closing Date under this Agreement; (c) No temporary restraining order, preliminary or permanent injunction or other order issued by any court of competent jurisdiction or other legal restraint or prohibition preventing the consummation of the exchange contemplated herein shall be in effect, nor shall any proceeding by any authority or other person seeking any of the foregoing be pending. There shall not be any action taken, or any statute, rule, regulation or order enacted, entered, enforced or deemed applicable to the exchange which makes the consummation of the exchange illegal; and (d) All necessary approvals, consents and authorizations required by law for consummation of the exchange including, without limitation, approval by the MSMA Executive Committee of this Agreement on or before August 1, 1994, shall have been obtained. (e) MSMA shall have received the opinion of MOMED's counsel substantially in the form of Exhibit D attached hereto. (f) MSMA shall have received all executed documents required to be received from MOMED on or prior to the Closing Date; all in form and substance reasonably satisfactory to MSMA. ARTICLE SIX TERMINATION OR ABANDONMENT Section 6.1. Mutual Agreement. This Agreement may be terminated by the mutual written consent of the parties at any time prior to the Closing Date, regardless of whether stockholder approval of this Agreement and the transactions contemplated hereby shall have been previously obtained. Section 6.2. Breach of Agreements. In the event there is a material breach in any of the representations and warranties or agreements of MSMA or MOMED, which breach is not cured within thirty (30) days after notice to cure such breach is given by the non-breaching party, then the non-breaching party, regardless of whether stockholder approval of this Agreement and the transactions contemplated hereby shall have been previous obtained, may terminate and cancel this Agreement by providing written notice of such action to the other party hereto. Section 6.3. Failure of Conditions. In the event any of the conditions to the obligations of either party are not satisfied or waived as specified in Article Five hereof, and if any applicable cure period provided in Section 6.2 hereof has lapsed, then the party for whose benefit such conditions were imposed may, regardless of whether stockholder approval of this Agreement and the transactions contemplated hereby shall have been previously obtained, terminate and cancel this Agreement by delivery of written notice of such action to the other party on such date. Section 6.4. Authorization of MOMED Class C Common Stock. In the event that the MOMED stockholders are unable or fail to take such action as may be required to authorize the transactions herein provided, then MSMA may terminate this Agreement by giving written notice to MOMED. The Board of Directors of MOMED, by its approval of the execution and delivery hereof, agrees to use all reasonable efforts to cause the stockholders of MOMED to vote in favor of the transactions herein contemplated. ARTICLE SEVEN MISCELLANEOUS PROVISIONS Section 7.1. Notices. Any notice or other communication shall be in writing and shall be deemed to have been given or made on the date of delivery in the case of hand delivery, or three (3) business days after deposit in the United States Registered Mail, postage prepaid, or upon receipt if transmitted by facsimile telecopy or any other means, addressed (in any case) as follows: (a) if to MOMED: MOMED Holding Co. 8630 Delmar Boulevard Suite 100 St Louis, Missouri 63124 Attention: President and Chief Executive Officer with a copy to: Lewis, Rice & Fingersh 500 N. Broadway, Suite 2000 St Louis, Missouri 63102 Attention: Mr. John K Pruellage, Esq. and (b) if to MSMA: Missouri State Medical Association 113 Madison Street P.O. Box 1028 Jefferson City, Missouri 65102 Attention: President with copies to: Bryan Cave One Metropolitan Square, Suite 3600 St. Louis, Missouri 63102 Attention: ME Mark H. Goran, Esq. or to such other address as any party may from time to time designate by notice to the others.Section 7.2. Liabilities. In the event that this Agreement is terminated pursuant to the provisions of Section 6.2 or Section 6.3 hereof on account of a breach of any of the representations and warranties set forth herein or any breach of any of the agreements set forth herein or any failure of conditions precedent to the exchange herein contained, then the non-breaching party or the party for whose benefit such conditions were imposed shall be entitled to recover appropriate damages from the breaching party; provided, however, that notwithstanding the foregoing. in the event this Agreement is terminated by reason of a failure of a condition precedent set forth in Sections 5.1(c) or (d), or Sections 5.2(c) or Cd), no party hereto shall have any liability to any other party for costs, expenses, damages or otherwise. Section 7.3. Entire Agreement. This Agreement constitutes the entire agreement between the parties and supersedes and cancels any and all prior discussions, negotiations, undertakings and agreements between the parties relating to the subject matter hereof. Section 7.5. Headings and Captions. The captions of Articles and Sections hereof are for convenience only and shall not control or affect the meaning or construction of any of the provisions of this Agreement. Section 7.6. Waiver. Amendment or Modification. The conditions of this Agreement which may be waived may only be waived by notice to the other party waiving such condition. The failure of any party at any time or times to require performance of any provision hereof shall in no manner affect the right at a later time to enforce the same. This Agreement may not be amended or modified except by a written document duly executed by the parties hereto. Section 7.7. Rules of Construction. Unless the context otherwise requires: (a) a term has the meaning assigned to it; (b) an accounting term not otherwise defined has the meaning assigned to it in accordance with generally accepted accounting principles; Cc) "or" is not exclusive; and (d) words in the singular may include the plural and in the plural include the singular Section 7.8. Counterparts. This Agreement may be executed in two or more counterparts, each of which shall be deemed an original and all of which shall be deemed one and the same instrument. Section 7.9. Successors and Assigns. This Agreement shall be binding upon and inure to the benefit of the parties hereto and their respective heirs, administrators, successors and assigns, including any successor by merger, reorganization or acquisition of substantially all the assets of a party hereto. There shall be no third part'. beneficiaries hereof. Section 7.10. Governing Law; Assignment. This Agreement shall be governed by the law of the State of Missouri. This Agreement may not be assigned by either of the parties hereto. Section 7.11. Severability. Ant' provision of this Agreement which is prohibited, unenforceable or not authorized in any jurisdiction is, as to such jurisdiction, ineffective to the extent of any such prohibition, unenforceability or nonauthorization without invalidating the remaining provisions hereof, or affecting the validity enforceability or legality of such provision in any other jurisdiction, unless the ineffectiveness of such provision would result in such a material change as to cause completion of the transactions contemplated hereby to be unreasonable. IN WITNESS WHEREOF, the undersigned have set their hand on the date first above written. MOMED HOLDING CO. By: _____________________________ Richard V. Bradley, M.D., President and Chief Executive Officer MISSOURI STATE MEDICAL ASSOCIATION By:______________________________ H. Jerry Murrell, M.D., President Schedule A Maximum Maximum Shares that Time of Shares that May be Exercise May be put Called Closing through day prior to 1st 4,031 0 anniversary of closing 1st anniversary of Closing through 4,031 (up to 8,062 if no prior 0 day prior to 2nd anniversary of puts) Closing 2nd anniversary of Closing through 8,062 (up to 16,124 if no prior 24,185 (if no prior day prior to 3rd anniversary of puts) puts) Closing 3rd anniversary of Closing and 8,061 (up to 24,185 if no prior 24,185 (if no prior thereafter puts or call) Call or puts) Exhibit ANOMINATION AGREEMENT THIS NOMINATION AGREEMENT (this "Agreement") is made and entered into as of the ____ day of _______, 1994, by and between MOMED HOLDING CO, a Missouri corporation ("MOMED"), and MISSOURI STATE MEDICAL ASSOCIATION, a Missouri not-for-profit corporation ("MSMA"). RECITALS A. MOMED and MSMA entered into that certain Share Exchange Agreement dated July 21, 1994 (the "Share Exchange Agreement"), wherein MSMA has agreed to transfer to MOMED the 24,185 shares of MOMED's Class B Common Stock owned by MSMA and MOMED has agreed to issue to MSMA 24,185 shares of MOMED's Class A Common Stock and 24,185 shares of its Class C Common Stock B. In connection with the Share Exchange Agreement, MOMED desires to assist MSMA in directly participating in the management of MOMED through the nomination of at least one (1) MSMA representative at each annual election of Directors of MOMED. C. The Board of Directors of MOMED has determined that it is in the best interests of MOMED to include on the Board an otherwise qualified representative of MSMA, all on the terms and conditions set forth in this Agreement. In consideration of the prentises and the mutual terms and provisions set forth in this Agreement, the parties hereto agree as follows: 1. Nomination Covenants. During the term of this Agreement, the MSMA Council shall submit annually in writing, on or before December 1 of each year, the name of a candidate (the "MSMA Candidate") to the MOMED Nominating Committee for election to the MOMED Board of Directors. The MSMA Candidate must be, or must have been, an active officer or member of the MSMA Council or other person reasonably acceptable to MOMED. Subject to the exercise in good faith of its responsibilities to MOMED and its shareholders, giving due consideration to MOMED's relationship with MSMA and the intent of this Agreement, the MOMED Nominating Committee shall include the name of the MSMA Candidate so submitted as one of its nominees for election to the MOMED Board of Directors that year, and shall, in each war, nominate only that number of candidates for election to the MOMED Board of Directors as shall equal the total number of Directors to be elected for such year. The MOMED Nominating Committee shall place no name in opposition to the MSMA Candidate. 2. Proxy Materials. The name of the MSMA Candidate shall be included as a management nominee in the Proxy Statement circulated in advance of the annual meeting of the MOMED shareholders (the "Annual Meeting"). During the Term of this Agreement, all proxies relating to the election of MOMED Directors that are distributed to MOMED shareholders in connection with each Annual Meeting shall contain a statement notifying the MOMED shareholders that if a proxy is returned without express directions from the shareholder to the contrary MOMED management will vote the proxy cumulatively "For" all named nominees in such manner as MOMED management shall determine. MOMED management shall vote such proxies cumulatively in such manner as in the opinion of MOMED management will assure the election of the MSMA Candidate.3. Composition of the MOMED Board. During the term of this Agreement, each member of the MOMED Board of Directors shall serve a term of three (3) years. At least five (5) but no more than six (6). Directors shall be elected to the MOMED Board of Directors at each Annual Meeting, and the size of the MOMED Board of Directors shall not be permitted to exceed eighteen (18) Directors. 4. Issuance of Additional Shares. MOMED may issue additional shares, warrants, rights or options during the term of this Agreement, provided that the effect of such issuance, taking into account the Voting Agreement of even date herewith (the "Voting Agreement") among MOMED, MSMA and certain shareholders of MOMED, does not dilute MSMA's right to elect one (1) Director to the MOMED Board of Directors each term. MOMED shall not issue additional shares, warrants, rights or options which dilute the right of MSMA (taking into account the Voting Agreement) to elect one (1) Director to the MOMED Board of Directors each term without the prior written consent of the MSMA Executive Committee, which consent shall be timely and shall not be unreasonably withheld, it being the intent and agreement of the parties that MSMAs right to elect one (1) Director for each term, as provided herein, shall not be diluted. 5. Limitation of MSMA Ownership. During the term of this Agreement, including any extensions or renewals hereof, MSMA shall not, without the consent of a majority of the MOMED Board of Directors, directly or indirectly, acquire additional shares of the Class A Common Stock of MOMED so as to increase its percentage ownership of the outstanding Class A Common Stock of MOMED to more than fifteen percent (15%). In the event that MSMA's percentage ownership of the MOMED Class A Common Stock should be increased on account of any redemption of outstanding stock by MOMED, a reorganization of the capital structure of MOMED or any other action of MOMED or its shareholders (other than MSMA), MSMA shall not be deemed in default of this Paragraph 5. 6. Term. The term of this Agreement shall begin on the closing of the transactions contemplated in the Share Exchange Agreement and shall expire sixty (60) months thereafter, but may be renewed or extended by agreement of MOMED and MSMA. Any renewal or extension of this Agreement must be agreed upon, in writing, at least six (6) months prior to the end of the term of this Agreement. Failure to renew or extend this Agreement as provided in this Paragraph 6 shall cause this Agreement to automatically expire and to be of no further force or effect. 7. Shareholder Approval. This Agreement shall, with the full support of MOMED management, be presented to the MOMED shareholders for approval at the 1994 Annual Meeting of Shareholders. 8. Severability. Any provision of this Agreement which is prohibited, unenforceable or not authorized in any jurisdiction is, as to such jurisdiction, ineffective to the extent of any such prohibition, unenforceability or nonauthorization without invalidating the remaining provisions hereof, or affecting the validity, enforceability or legality of such provision in any other jurisdiction, unless the ineffectiveness of such provision would result in such a material change as to cause completion of the transactions contemplated hereby to be unreasonable. 9. Entire Agreement. This Agreement constitutes the entire agreement between the parties and supersedes and cancels any and all prior discussion, negotiations, undertakings and agreements between the parties relating to the subject matter hereof. 10. Captions. The captions used herein are for convenience only and shall not control or affect the meaning or construction of any of the provisions of this Agreement. 11. Waiver, Amendment or Modification. The conditions of this Agreement which may be waived may only be waived by notice to the other party waiving such condition. The failure of any party at any time or times to require performance of any provision hereof (other than by written waiver) shall in no manner affect the right at a later time to enforce the same. This Agreement may not be amended or modified except by a written document duly executed by all of the parties hereto. 12. Rules of Construction. Unless the context otherwise requires: (a) a term has the meaning assigned to it; (b) an accounting term not otherwise defined has the meaning assigned to it in accordance with generally accepted accounting principles; (c) "or" is not exclusive; and (d) words in the singular may include the plural and in the plural include the singular. 13. Counterparts. This Agreement may be executed in two or more counterparts, each of which shall be deemed an original and all of which shall be deemed one and the same instrument. 14. Successors and Assigns. This Agreement shall be binding upon and inure to the benefit of the parties hereto and their respective successors and assigns. There shall be no third party beneficiaries hereof. 15. Governing Law; Assignment. This Agreement shall be governed by the laws of the State of Missouri. This Agreement may not be assigned by any of the parties hereto. IN WITNESS WHEREOF, the parties hereto have duly executed this Agreement as of the date first above written. MOMED HOLDING CO. By______________________________ Richard V. Bradley M.D., President and Chief Executive Officer MISSOURI STATE MEDICAL ASSOCIATION By:__________________________ H. Jerry Murrell, MD., President Exhibit BVOTING AGREEMENT THIS VOTING AGREEMENT is made and entered into as of the ___ day of _______, 1994, by and between MOMED HOLDING CO., a Missouri corporation ("MOMED") and MISSOURI STATE MEDICAL ASSOCIATION, a Missouri not-for-profit corporation ("MSMA"), RICHARD V. BRADL.EY, M.D., KRIETE H. HOLLRAH and LEONARD L. DAVIS, JR, MD. (hereinafter collectively referred to as the "Select Shareholders"). RECITALS A. The Select Shareholders are the record and beneficial owners and have the power to vote the respective number of shares of MOMED Class A Common Stock, $1.00 par value, (the "MOMED Class A Common Stock") set forth on Schedule A hereto (collectively, the "Shares"). B. The Select Shareholders desire that MSMA and MOMED enter into a Share Exchange Agreement (the "Share Exchange Agreement") and a Nomination Agreement (the "Nomination Agreement"). C. The Select Shareholders are executing this Voting Agreement as an inducement to MSMA to enter into and execute the Share Exchange Agreement and the Nomination Agreement. In consideration of the premises and the mutual terms and provisions set forth in this Agreement, the parties hereto agree as follows: 1. Covenants of the Select Shareholders. a. At any meeting of MOMED shareholders called to vote upon the Share Exchange Agreement and the Nomination Agreement or at any adjournment thereof or in any other circumstances in which a vote or other approval of the shareholders of MOMED of the Share Exchange Agreement and the Nomination Agreement is sought, the Select Shareholders severally shall vote (or cause to be voted) the Shares in favor of the Share Exchange Agreement and the Nomination Agreement as well as in favor of such amendments to the Restated Articles of incorporation of MOMED as may be necessary or appropriate to effectuate the terms of any thereof. b. At any meeting of MOMED shareholders or at any adjournment thereof or in any other circumstances in which a vote or other approval of the shareholders of MOMED is sought, the Select Shareholders severally shall vote (or cause to be voted) the Shares against any transaction or proposal which would in any manner impede, frustrate, prevent, impair or nullify the Share Exchange Agreement or the Nomination Agreement or any of the other transactions contemplated by such agreements. c. During the term of this Voting Agreement, at any meeting of MOMED shareholders called to vote upon the election of Directors to the MOMED Board of Directors or at any adjournment thereof, the Select Shareholders severally shall vote (or cause to be voted) all Shares owned by them, as set forth opposite their respective names in Schedule A hereto, cumulatively in such manner as shall be necessary to elect as a Director the MSMA nominee whose name shall appear on the proxy materials distributed by or on behalf of MOMED. d. During the term of this Voting Agreement, each of the Select Shareholders severally agrees that this Voting Agreement and the obligations hereunder shall attach to the Shares and shall be binding upon any person or entity to whom legal or beneficial ownership of the Shares shall pass' whether by operation of law or otherwise, including without limitation its respective heirs, guardians, administrators or successors and to notify such transferee or prospective transferee of the existence of this Voting Agreement. In the event of any stock split, stock dividend, merger, reorganization, recapitalization or other change in the capital structure of MOMED affecting the MOMED Class A Common Stock, or acquisition of additional shares of MOMED Class A Common Stock by any of the Select Shareholders, the number of Shares listed in Schedule A beside the name of each such Select Shareholder shall be revised or adjusted appropriately and this Voting Agreement and the obligations hereunder shall attach to any such additional shares of MOMED Class A Common Stock. 2. Representations and Warranties. Each of the Select Shareholders severally represents and warrants to MSMA that such Select Shareholder is the beneficial and record owner of, and has full power and authority to dispose of and the unrestricted right to vote, the number of shares of MOMED Class A Common Stock set forth opposite such Select Shareholder's name in Schedule A hereto. 3. Legends. The Shares shall be legended to indicate that such Shares are subject to the terms and conditions of this Voting Agreement. 4. Limitation of MSMA Ownership. During the term of this Voting Agreement, including any extensions or renewals hereof, MSMA shall not, without the consent of a majority of the MOMED Board of Directors, directly or indirectly, acquire additional shares of the Class A Common Stock of MOMS) so as to increase its percentage ownership of the outstanding Class A Common Stock of MOMED to more than fifteen percent (15%). In the event that MSMA's percentage ownership of the MOMED Class A Common Stock should be increased on account of any redemption of outstanding stock by MOMED, a reorganization of the capital structure of MOMED or any other action of MOMED or its shareholders (other than MSMA), MSMA shall not be deemed in default of this Paragraph 4. 5. Term. The term of this Voting Agreement shall begin on the closing of the transactions contemplated in the Share Exchange Agreement and shall expire sixty (60) months thereafter, but may be renewed or extended by agreement of the parties hereto. Any renewal or extension of this Voting Agreement must be agreed upon, in writing, at least six (6) months prior to the end of the term of this voting Agreement. Failure to renew or extend this Voting Agreement as provided in this Paragraph 5 shall cause this Voting Agreement to automatically expire and to be of no further force or effect. 6. Severability. Any provision of this Voting Agreement which is prohibited, unenforceable or not authorized in any jurisdiction is, as to such jurisdiction, ineffective to the extent of an',' such prohibition, unenforceability or nonauthorization without invalidating the remaining provisions hereof, or affecting the validity, enforceability or legality of such provision in any other jurisdiction, unless the ineffectiveness of such provision would result in such a material change as to cause completion of the transactions contemplated hereby to be unreasonable. 7. Entire Agreement. This Voting Agreement constitutes the entire agreement between the parties and supersedes and cancels any and all prior discussion, negotiations, undertakings and agreements between the parties relating to the subject matter hereof. 8. Captions. The captions used herein are for convenience only and shall not control or affect the meaning or construction of any of the provisions of this Voting Agreement. 9. Waiver. Amendment or Modification. The conditions of this Voting Agreement which may be waived may only be waived by notice to the other party waiving such condition. The failure of any party at any time or times to require performance of any provision hereof (other than by written waiver) shall in no manner affect the right at a later time to enforce the same. This Voting Agreement may not be amended or modified except by a written document duly executed by all of the parties hereto. 10. Rules of Construction. Unless the context otherwise requires: (a) a term has the meaning assigned to it; (b) an accounting term not otherwise defined has the meaning assigned to it in accordance with generally accepted accounting principles; (c) "or" is not exclusive; and (d) words in the singular may include the plural and in the plural include the singular. 11. Counterparts. This Voting Agreement may be executed in two or more counterparts, each of which shall be deemed an original and all of which shall be deemed one and the same instrument 12. Successors and Assigns. This Voting Agreement shall be binding upon and inure to the benefit of the parties hereto and their respective heirs, administrators, successors and assigns. There shall be no third party beneficiaries hereof 13. Governing Law Assignment. This Voting Agreement shall be governed by the laws of the State of Missouri. This Voting Agreement may not be assigned by any of the parties hereto. IN WITNESS WHEREOF, the parties hereto have duly executed this Voting Agreement as of the date first above written. MOMED HOLDING CO. Richard V Bradley M.D., President and Chief Executive Officer MISSOURI STATE MEDICAL ASSOCIATION By H. Jerry Murrell, M.D., President RICHARD V.BRADLEY, MD. KRIETE H. HOLLRAH LEONARD L DAVIS, JR, M.D. Schedule AShares of Common Stock Owned with Percentage of Total Shareholder Power to Vote Shares Outstanding Richard V. Bradley, M.D. 12,025 5.4% Kriete H. Hollrah 2,500 1.12% Leonard L. Davis, Jr., M.D. 13,062 5.9% Exhibit C [Missouri State Medical Association Letterhead ] August 16, 1994 MOMED Holding Co. 8630 Delmar Boulevard Suite 100 St. Louis, Missouri 63124 Re: Share Exchange Agreement dated as of July 21, 1994 between MOMED Holding Co. and Missouri State Medical Association Ladies and Gentlemen: In accordance with the requirements of that certain Share Exchange Agreement dated as of July 21,1994 (the Share Exchange Agreement") by and between MOMED Holding Co., a Missouri corporation ("MOMED") and Missouri State Medical Association, a Missouri not-for-profit corporation ("MSMA"), MSMA hereby surrenders to MOMED possession of the enclosed certificates representing all 24,185 shares of the issued and outstanding MOMED Class B Common Stock MSMA intends that these certificates, and the shares represented thereby be marked "canceled". MISSOURI STATE MEDICAL ASSOCIATION By: H. Jerry Murrell, M.D., President Exhibit D [Lewis, Rice & Fingersh Letterhead] August 16, 1994 Missouri State Medical Association 113 Madison Street P.O. Box 1028 Jefferson City; MO 65102 RE: Share Exchange Agreement dated as of July 21, 1994 between MOMED Holding Co. and the Missouri State Medical Association and certain related documents Ladies and Gentlemen:We have acted as counsel to MOMED Holding Co., a Missouri corporation ("MOMED") and its wholly owned subsidiary Missouri Medical Insurance Co., a Missouri corporation ("MOMEDICO") in connection with the execution and delivery of, and consummation of the transactions contemplated by (i) that certain Share Exchange Agreement dated as of July 21, 1994 (the "Share Exchange Agreement") by and between MOMED and Missouri State Medical Association, a Missouri not-for-profit corporation ("MSMA") pursuant to which MOMED is issuing and delivering to MSMA 24,185 shares of MOMED Class A Common Stock, par value $1.00 per share, (the "Class A Shares") and 24,185 shares of MOMED's non-voting Class C Common Stock, par value $1.00 per share, (the Class C Shares") in exchange for 24,185 shares of MOMED Class B Common Stock, par value $25.00 per share, (the "Class B Shares") owned by MSMA, (ii) that certain Nomination Agreement dated as of July ___, 1994 (the "Nomination Agreement" and together with the Share Exchange Agreement the "MOMED Documents") by and between MOMED and MSMA, (iii) that certain license Agreement dated as of July 21, 1994 (the "license Agreement") by and between MOMEDICO and MSMA, and (iv) that certain Reciprocal Assistance Agreement dated as of July 21, 1994 (the "Reciprocal Assistance Agreement" and together with the License Agreement the "MOMEDICO Documents") by and between MOMEDICO and MSMA. As such counsel, we have examined executed copies of the MOMED Documents and the MOMEDICO Documents, the Amended and Restated Articles of Incorporation of MOMED and the By-Laws of MOMED, as amended, the Articles of Incorporation and By-laws of MOMEDICO and such other laws, corporate records, documents and agreements as we deemed necessary to render the opinions expressed herein. Based thereon, we are of the opinion that 1. MOMED and MOMEDICO are corporations duly organized, validly existing and in good standing under the laws of the State of Missouri. 2. Each of MOMED and MOMEDICO has the requisite corporate power and authority to execute, deliver and perform its obligations, in the case of MOMED, under the MOMED Documents and, in the case of MOMEDICO, under the MOMEDICO Documents. 3. The MOMED shareholders and directors have taken all action necessary to authorize the execution and delivery by MOMED of the MOMS) Documents and consummation of the transactions contemplated thereby and the MOMED Documents have been duly authorized, executed and delivered by MOMED and constitute the valid and legally binding obligations of MOMS). 4. The MOMEDICO shareholders and directors have taken all action necessary to authorize the execution and delivery by MOMEDICO of the MOMEDICO Documents and consummation of the transactions contemplated thereby and the MOMEDICO Documents have been duly authorized, executed and delivered by MOMEDICO and constitute the valid and legally binding obligations of MOMEDICO. 5. The Class A Shares and the Class C Shares, when delivered by MOMED to MSMA in exchange for the Class B Shares owned by MSMA, will be duly authorized, validly issued and outstanding, fully paid and non-assessable, with no personal liability attached to the ownership thereof. Very truly yours, LEWIS, RICE & FINGERSH

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