Delta Airlines 2003 Annual Report Download - page 246

FORM OF CONVERSION NOTICE
To: DELTA AIR LINES, INC.
The undersigned beneficial owner of this Note hereby irrevocably
exercises the option to convert this Note, or portion hereof (which is $1,000 or
an integral multiple thereof) below designated, into shares of Common Stock of
Delta Air Lines, Inc. in accordance with the terms of the Indenture referred to
in this Note, and directs that the shares issuable and deliverable upon the
conversion, together with any check in payment for fractional shares and Notes
representing any unconverted principal amount hereof, be issued and delivered to
the beneficial owner hereof unless a different name has been indicated below. If
shares or any portion of this Note not converted are to be issued in the name of
a person other than the undersigned, the undersigned will pay all transfer taxes
payable with respect thereto. Any amount required to be paid by the undersigned
on account of interest and taxes accompanies this Note.
Dated: ___________________________________
Fill in for registration of shares if to be ___________________________________
delivered, and Notes if to be issued, other
than to and in the name of the beneficial ___________________________________
owner (Please Print): Signature(s)
___________________________
(Name) Principal amount to be converted
(if less than all):
___________________________ $___________,000
(Street Address)
___________________________________
Social Security or other Taxpayer
___________________________ Identification Number
(City, State and Zip Code)
Signature Guarantee:*
---------------------------
* Signatures must be guaranteed by an eligible Guarantor Institution
(banks, brokers, dealers, savings and loan associations and credit
unions) with membership in an approved signature guarantee medallion
program pursuant to Securities and Exchange Commission Rule 17Ad-15 if
shares are to be issued, or Notes are to be delivered, other than to
and in the name of the registered Holder(s).
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