OMB APPROVAL OMB NUMBER 3235-0287 EXPIRES: JANUARY 31, 2005 ESTIMATED AVERAGE BURDEN HOURS PER RESPONSE 0.5 U.S. SECURITIES AND EXCHANGE COMMISSION Washington, DC 20549 FORM 4 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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 [_] Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). ________________________________________________________________________________ 1. Name and Address of Reporting Person* Jensen, Jr. George R. - -------------------------------------------------------------------------------- (Last) (First) (Middle) 517 Legion Road - -------------------------------------------------------------------------------- (Street) West Chester PA 19382 - -------------------------------------------------------------------------------- (City) (State) (Zip) _______________________________________________________________________________ 2. Issuer Name and Ticker or Trading Symbol USA Technologies USTT ________________________________________________________________________________ 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) ________________________________________________________________________________ 4. Statement for Month/Day/Year December, 2002 ________________________________________________________________________________ 5. If Amendment, Date of Original (Month/Day/Year) ________________________________________________________________________________ 6. Relationship of Reporting Person to Issuer (Check all applicable) [X] Director [ ] 10% Owner [X] Officer (give title below) [_] Other (specify below) Chief Executive Officer ________________________________________________________________________________ 7. Individual or Joint/Group Filing (Check applicable line) [X] Form filed by one Reporting Person [_] Form filed by more than one Reporting Person ________________________________________________________________________________ ================================================================================ Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned ================================================================================ 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 4(b)(v). (Print or Type Response) (Over)
5. 6. 4. Amount of Owner- Securities Acquired (A) or Securities ship 2A. 3. Disposed of (D) Befeficially Form: 7. 2. Deemed Transaction (Instr. 3, 4 and 5) Owned Follow- Direct Nature of Trans- Executin Code ------------------------------- ing Reported (D) or Indirect 1. action Date, (Instr. 8) (A) Transaction(s) Indirect Beneficial Title of Security Date if any ------------ Amount or Price (Instr. 3 (I) Ownership (Instr. 3) (mm/dd/yy) (mm/dd/yy) Code V (D) and 4) (Instr.4)(Instr. 4) - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- =================================================================================================================================== FORM 4 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ================================================================================ Explanation of Responses: /s/ George Jensen January 20, 2003 - ---------------------------------------------- ---------------------- **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 procedure.
9. 10. Number Owner- of ship Deriv- Form 2. ative of Conver- 5. 7. Secur- Deriv- 11. sion Number of Title and Amount ities ative Nature or 3A. Derivative 6. of Underlying 8. Bene- Secur- of Exer- Deemed 4. Securities Date Securities Price ficially ity: In- cise 3. Exe- Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of Owned Direct direct Price Trans- cution action or Disposed Expiration Date ---------------- Deriv- Following (D) or Bene- 1. of action Date, Code of(D) (Month/Day/Year) Amount ative Reported In- ficial Title of Deriv- Date if any (Instr. (Instr. 3, ---------------- or Secur- Trans- direct Owner- Derivative ative (Month/ Month/ 8) 4 and 5) Date Expira- Number ity action (I) ship Security Secur- Day/ Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr.(Instr. (Instr. 3) ity Year) Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4) - ----------------------------------------------------------------------------------------------------------------------------------- Options 2.00 12/31/02 J(1) 180,000 06/17/99 06/17/04 Comm Stk 180,000 0 D Options 1.50 12/31/02 J(1) 200,000 10/17/00 06/17/03 Comm Stk 200,000 0 D Options 1.00 12/31/02 J(1) 33,333 08/26/01 08/26/06 Comm Stk 33,333 0 D Options 1.00 12/31/02 J(1) 33,333 05/26/02 05/26/07 Comm Stk 33,333 0 D Note Warrants 0.10 10/31/02 A 127,500 10/31/02 1/31/03 Comm Stk 127,500 127,500 D Note Warrants 0.10 10/31/02 A 7,500 10/31/02 1/31/03 Comm Stk 7,500 7,500 I Spouse ===================================================================================================================================