Direct Registration Transaction Request Form

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Computershare Trust Company, N.A.
P.O. Box 43078
Providence, Rhode Island 02940-0378
Telephone 312 360 5104
www.computershare.com/investor
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Name
Address
Holder Account Number
City, State, Zip
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Direct Registration Transaction Request Form
Please mark one box only. This form is only applicable to shares held in Direct Registration (DRS).
Deposit the enclosed
certificate(s)
Sell share(s) *
Quantity of shares to be sold.
Quantity of shares to be
deposited into your Direct
Registration account.
You will receive a check for the net proceeds of the sale, less a transaction fee of
$20.00 plus 12 cents per whole share sold.
Issue share(s)
Electronic transfer
Quantity of whole shares for which
you would like a certificate issued
from Direct Registration.
Electronically transfer the Direct
Registration shares to the broker
customer account number
designated below.
There is no fee for requesting a certificate.
* For sales requests for Partnerships or Corporations, please have your signature(s) medallion
guaranteed and provide us with a copy of the corporate resolution/partnership agreement.
Broker Name
Indicate the number of shares to be transferred electronically.
Note: Medallion Guarantee of owner’s signature will be required.
Broker Participant Number
Broker Customer Account Number
Signatures: The instructions given above must be signed by all registered holder(s). If held in joint name, both owners must sign. If requesting an electronic transfer, all signature(s) must be
guaranteed by a participant in the Medallion Signature Guarantee Program. Banks, brokers and credit unions often have membership in the Medallion Signature Guarantee Program.
Note: Be sure to supply broker information above if requesting an electronic transfer.
By signing, I/We agree to the information on the reverse side.
Medallion Guarantee Stamp
Signature 1 - Please keep signature within the box.
Signature 2 - Please keep signature within the box.
Date (mm/dd/yyyy)
Daytime Telephone Number
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(Notary Public Is Not Acceptable)
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How To Fill Out the Direct Registration Transaction Request Form
Deposit - To deposit certificates into your Direct Registration account: Check the “Deposit” box on the reverse side and mail your certificates with the
Transaction Request Form to Computershare Investor Services; Attn: Stock Transfer Department; 250 Royall Street; Canton, MA 02021.
We recommend that you ship the certificates via courier services. Do not endorse the certificates. Within two business days of receipt, a confirmation of
the transaction will be mailed to you for your records.
Sell - To sell your Direct Registration shares: Check the “Sell” box on the reverse side, indicating the number of shares you wish to sell, and return to
Computershare Investor Services; Attn: Sales Team; P.O. Box 43078; Providence, RI 02940-3078. Any questions regarding your sale can be referred to
the telephone number located on the reverse side. When selling through Computershare, you are unable to direct the time or price at which the shares
may be sold and you are unable to select the broker through whom sales are made. There is a transaction fee for each sale processed.
Issue - To request issuance of a physical stock certificate: Check the “Issue” box on the reverse side, indicating the number of shares you wish to have
certificated, and return to Computershare Investor Services; Attn: DRS Transfer Team; P.O. Box 43078; Providence, RI 02940-3078. Enclose a check
if required. A certificate will be sent to you by first class mail within approximately three business days of receipt of your instructions. Any certificated
shares are not in Direct Registration.
TO ELECTRONICALLY TRANSFER YOUR SHARES TO YOUR BROKER
If you elect to transfer Direct Registration shares from Computershare to your broker:
Add Broker Information - Complete the broker name, broker customer account number, and the broker’s participant number; i.e. 4-digit DTC
Participant Number.
Please verify your broker account information. Computershare must rely entirely on the broker information that you provide and is not responsible for any
error that may occur in the transfer of your shares due to an inaccurate account number furnished by you or your broker. A Medallion Guarantee is
required to transfer shares to your broker. The Medallion Guarantee is a form of signature verification which can be obtained from a commercial bank,
trust company, securities broker, credit union or savings institution participating in the Medallion Signature Guarantee Program. For holders outside the
U.S. and Canada, a bank signature guarantee, embassy seal, or equivalent is acceptable to Computershare. Within approximately two business days of
receipt of your completed Transaction Request Form, your instructions will be processed by Computershare.
Electronic Transfer - To request an electronic transfer: Check the “Electronic Transfer” box on the reverse side, indicating the number of shares to be
transferred to your designated broker. Mail the Transaction Request Form to Computershare Investor Services; Attn: Stock Transfer Department;
P.O. Box 43078; Providence, RI 02940-3078.
The most effective way to electronically transfer your shares to your broker is through the DRS Profile System (Profile). Transactions processed
through Profile are acted on within two business days of transmission. Your broker will require the following information from you to successfully
complete this request: 1) your account number at Computershare; 2) your tax identification number; 3) Computershare’s participant number, 7807; and
4) the exact registration and number of shares in your account at Computershare. If your broker is unfamiliar with the electronic delivery of shares
through the DRS Profile System, your broker should contact its DTC Operations Manager. Your broker will send an electronic message to
Computershare via the DRS Profile System. If all the information above matches exactly what Computershare has on file, your shares will be
electronically transferred to your broker.
OTHER TRANSACTIONS
To obtain forms for transferring your Direct Registration shares to another person or to make changes to your account, such as an address change,
please call the telephone number shown on the reverse side of this form or visit our website at www.computershare.com.
DEFINITIONS
DTC Participant Number: A 4-digit number assigned by the Depository Trust Company (DTC) to represent the clearing broker or financial institution.
This number is usually the participant’s Financial Institution Number (FIN).
DRS Profile System: An electronic system between transfer agents and brokers to facilitate the electronic movement of shares directly registered to
investors. This system allows the broker to request DRS share movements from the investor’s account at the transfer agent to the investor’s account at
the broker as directed by the investor.
SSN/TIN Certified: If your account is not certified, you must complete a W-9 or W-8BEN tax form or taxes will be withheld from any dividends or sales
proceeds per Internal Revenue Service requirements.
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