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If delivering by mail:
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If delivering by hand, express mail, courier, or other
expedited service: |
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American Stock Transfer & Trust Company, LLC
Operations Center Attn: Reorganization Department P.O. Box 2042 New York, New York 10272-2042 |
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American Stock Transfer & Trust Company, LLC
Operations Center Attn: Reorganization Department 6201 15th Avenue Brooklyn, New York 11219 |
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DESCRIPTION OF SHARES SURRENDERED
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Name(s) and Address(es) of Registered Owner(s)
(If blank, please fill in exactly as name(s) appear(s) on share certificate(s).) |
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Shares Surrendered
(attach additional list if necessary) |
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Certificated Shares**
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Certificate
Number(s)* |
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Total Number of
Shares Represented by Certificate(s)* |
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Number of Shares
Surrendered** |
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Book Entry
Shares Surrendered |
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Total Shares
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*
Need not be completed by book-entry stockholders.
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**
Unless otherwise indicated, it will be assumed that all shares of common stock represented by certificates described above are being surrendered hereby.
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HOLDERS OF ONE SHARE ONLY
(See Instruction 13) |
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| | | To be completed only if shares are being tendered by or on behalf of a person owning, beneficially or of record, only ONE share. DO NOT COMPLETE THIS SECTION IF YOU OWN MORE THAN ONE SHARE. SEE INSTRUCTION 13. The undersigned either (check one box): | | | |||
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☐
is the beneficial or record owner of only one share; or
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is a broker, dealer, commercial bank, trust company, or other nominee that (a) is tendering one share with respect to which it is the record holder on behalf of the beneficial owner(s) thereof, and (b) believes, based upon representations made to it by such beneficial owner(s), that each such person is the beneficial owner of one share only and is tendering such share.
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CONDITIONAL TENDER
(See Instruction 12) |
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| | | A shareholder may tender shares subject to the condition that a specified minimum number of the shareholder’s shares tendered pursuant to this Letter of Transmittal must be purchased if any shares tendered are purchased from such shareholder, all as described in the Offer to Purchase, particularly in Section 3 thereof. Any shareholder desiring to make a conditional tender must so indicate by checking the box below. Unless the minimum number of shares indicated below is purchased by the Company in the tender offer, none of the shares tendered by such shareholder will be purchased. It is the shareholder’s responsibility to calculate the minimum number of shares that must be purchased if any are purchased, and each shareholder is urged to consult his or her own tax advisor before completing this section. Unless this box has been checked and a minimum specified, the shareholder’s tender will be deemed unconditional. | | | |||
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The minimum number of shares that must be purchased from me, if any are purchased from me, is: shares.
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If, because of proration, the minimum number of shares designated will not be purchased, the Company may accept conditional tenders by random lot, if necessary. However, to be eligible for purchase by random lot, the tendering shareholder must have tendered all of his or her shares and checked this box:
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The tendered shares represent all shares held by the undersigned.
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SPECIAL PAYMENT INSTRUCTIONS
(See Instructions 1, 4, 5 and 7) |
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| | | To be completed ONLY if Share Certificate(s) for shares not tendered or not accepted for payment and/or the check for payment of the purchase price of shares accepted for payment are to be issued in the name of someone other than the undersigned or if shares tendered by book-entry transfer which are not accepted for payment are to be returned by credit to an account maintained at DTC other than that designated above. | | | |||
| | | Issue: | | | ☐ Check and/or ☐ Share Certificate(s) to: | | |
| | | Name: | | |
(Please Print)
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| | | Address: | | |
(Street Address)
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(City, State and Zip code)
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| | | Tax identification or Social Security Number: | | | |||
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Credit shares tendered by book-entry transfer that are not accepted for payment to the set forth below:
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(DTC account)
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SPECIAL DELIVERY INSTRUCTIONS
(See Instructions 1, 4, 5 and 7) |
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| | | To be completed ONLY if Share Certificate(s) not tendered or not accepted for payment and/or the check for the purchase price of shares accepted for payment are to be sent to someone other than the undersigned or to the undersigned at an address other than that shown in the box titled “Description of Shares Tendered” above. | | | |||
| | | Deliver: | | | ☐ Check(s) and/or ☐ Share Certificate(s) to: | | |
| | | Name: | | |
(Please Print)
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| | | Address: | | |
(Street Address)
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(City, State and Zip code)
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IMPORTANT — SIGN HERE
(U.S. Holders Please Also Complete the Enclosed IRS Form W-9) (Non-U.S. Holders Please Obtain and Complete IRS Form W-8BEN or Other Applicable IRS Form W-8) |
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(Signature(s) of Stockholder(s))
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| | | Dated: , 2016 | | | |||
| | | (Must be signed by the registered owner(s) exactly as the name(s) of such owner(s) appear(s) on Share Certificate(s) for the shares or on a security position listing or by person(s) authorized to become registered owner(s) thereof by certificates and documents transmitted herewith. If signature is by trustees, executors, administrators, guardians, attorneys-in-fact, agents, officers of a corporation or other person acting in a fiduciary or representative capacity, please provide the signatory’s full title below and see Instruction 5. For information concerning signature guarantees, see Instruction 1.) | | | |||
| | | Print or Type Name(s): | | | |||
| | | Capacity (full title): | | | |||
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Address:
(Street Address)
(City, State and Zip Code)
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| | | Telephone Number including Area Code: ( ) - | | | |||
| | | Tax Identification or Social Security No.: | | | |||
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GUARANTEE OF SIGNATURE(S)
(For use by Eligible Institutions only; see Instructions 1 and 5) |
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| | | Name of Firm: | | | |||
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Address of Firm:
(Street Address)
(City, State and Zip Code)
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| | | Authorized Signature: | | | |||
| | | Print or Type Name(s): | | | |||
| | | Telephone Number including area code: ( ) - | | | |||
| | | Dated: , 2016 | | | |||
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Place medallion guarantee in space below:
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If delivering by mail:
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If delivering by hand or courier:
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American Stock Transfer & Trust Company, LLC
Operations Center Attn: Reorganization Department P.O. Box 2042 New York, New York 10272-2042 |
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American Stock Transfer & Trust Company, LLC
Operations Center Attn: Reorganization Department 6201 15th Avenue Brooklyn, New York 11219 |
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