Proxy Card

Proxy Card
KNOW ALL PERSONS BY THESE PRESENTS that I, the undersigned shareholder of
(national bank or Federal savings association name, city, state), do hereby appoint (name),
a person who is not an officer or employee of the national bank or Federal savings
association, as proxy. My proxy (or any one of them if more than one proxy is named) has
full power to act alone for me and in my name as my true and lawful attorney(s) with full
power of substitution to vote and act on all shares of common stock of the national bank or
Federal savings association, which I would be entitled to vote, at the meeting of
shareholders to be held on
(date)
at __.m., at (location) or at any adjournments
thereof, with all the powers I would possess if personally present, as follows:
1.

Fixing the number of directors to be
elected at

For
Against

2.

Election of the
persons
listed in the proxy statement dated
accompanying the
notice of the meeting.

For
Against

3.

Approval of organization expenses as
submitted.

For
Against

4.

Ratification of Articles of Association,
Organization Certificate, or Charter (for
Federal savings associations) and other
official acts of the organizers, organizing
directors, and officers.

For
Against

5.

Any other business.

This proxy confers authority to vote ”for” each listed proposition, unless ”against” is
indicated. If any other business is presented at the meeting, this proxy shall be voted
according to the recommendations of the Organizing Board of Directors.
The organizing board of directors recommends a vote ”for” each of the listed propositions.
This proxy is solicited on behalf of the Organizing Board of Directors and may be revoked
prior to its exercise. (Describe the way that a proxy may be revoked prior to its exercise.)
Dated:
(Signature of Shareholder)
When signing as attorney, executor, administrator, trustee or guardian, give full title. If
more than one trustee, all should sign. All joint owners must sign.