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THE OFFER AND WITHDRAWAL RIGHTS WILL EXPIRE AT 5:00 P.M.,
EASTERN TIME, ON NOVEMBER 28, 2022, UNLESS THE OFFER IS EXTENDED OR EARLIER TERMINATED. |
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By Mail:
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If Delivering via UPS, FedEx or Overnight Courier:
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Computershare Trust Company, N.A.
Attn: Corporate Actions Voluntary Offer P.O. Box 40311 Providence RI 02940-3011 |
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Computershare Trust Company, N.A.
Attn: Corporate Actions Voluntary Offer 150 Royall St, Suite V Canton MA 02021 |
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DESCRIPTION OF SHARES SURRENDERED
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Certificated Shares**
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Name(s) and Address(es) of
Registered Holder(s) (Please fill in, if blank, exactly as name(s) appear(s) on certificate(s)) (Attach additional signed list if necessary) |
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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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Name of Tendering Institution:
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Transaction Code Number:
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DTC Account Number:
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Name(s) of Tendering Stockholder(s):
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Window Ticket Number (if any):
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Date of Execution of Notice of Guaranteed Delivery:
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Name of Eligible Institution that Guaranteed Delivery:
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SPECIAL PAYMENT INSTRUCTIONS
(See Instructions 1, 5, 6 and 7) |
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| | | To be completed ONLY if the check for the purchase price of Shares accepted for payment and/or Certificates not tendered or not accepted for payment are to be issued in the name of someone other than the undersigned. | | |
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(Please Print)
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(Include Zip Code)
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(Taxpayer Identification No. (e.g., Social Security No.))
(Also complete, as appropriate, IRS Form W-9 included below) |
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SPECIAL DELIVERY INSTRUCTIONS
(See Instructions 1, 5, 6 and 7) |
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| | | To be completed ONLY if the check for the purchase price of Shares accepted for payment and/or Certificates evidencing Shares not tendered or not accepted are to be mailed to someone other than the undersigned or to the undersigned at an address other than that shown above. | | |
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(Please Print)
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(Include Zip Code)
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IMPORTANT
STOCKHOLDER: YOU MUST SIGN BELOW (U.S. Holders: Please complete and return the IRS Form W-9 included below) (Non-U.S. Holders: Please obtain, complete and return appropriate IRS Form W-8) |
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(Signature(s) of Holder(s) of Shares)
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(Please Print)
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(Include Zip Code)
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Tax Identification No. (e.g., Social Security No.) (See IRS Form W-9 included below):
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| | | (Must be signed by registered holder(s) exactly as name(s) appear(s) on Certificate(s) or on a security position listing or by person(s) authorized to become registered holder(s) by Certificates and documents transmitted herewith. If signature is by a trustee, executor, administrator, guardian, agent, officer of a corporation or other person acting in a fiduciary or representative capacity, please set forth full title and see Instruction 5.) | | |
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Guarantee of Signature(s)
(If Required — See Instructions) |
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| | | [Place Stamp Here] | | |
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(Include Zip Code)
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| | | Dated: [•], 2022 | | |
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By Mail:
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If Delivering via UPS, FedEx or Overnight Courier:
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Computershare Trust Company, N.A.
Attn: Corporate Actions Voluntary Offer P.O. Box 40311 Providence RI 02940-3011 |
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Computershare Trust Company, N.A.
Attn: Corporate Actions Voluntary Offer 150 Royall St, Suite V Canton MA 02021 |
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