EXHIBIT 99.6
FORM OF ENROLLMENT/CHANGE FORM
XXXXX.XXX, INC.
1999 EMPLOYEE STOCK PURCHASE PLAN ("ESPP")
ENROLLMENT/CHANGE FORM
SECTION 1: Action Complete Sections:
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ACTIONS [_] New Enrollment 2, 3, 7 and sign attached Stock Purchase Agreement
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[_] Payroll Deduction Change 2, 4, 7
[_] Terminate Payroll Deductions 2, 5, 7
[_] Leave of Absence 2, 6, 7
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SECTION 2: Name
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PERSONNEL Last First MI Dept.
DATA
Home Address
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Street
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City State Zip Code
Social Security #
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SECTION 3: Effective with the Purchase Payroll Deduction Amount: ___________% of cash earnings*
Interval Beginning:
NEW [_] First Business Day of February, ______ * Must be a multiple of 1% up to a maximum of 10% of cash
ENROLLMENT [_] First Business Day of August, ______ earnings
[_] Initial Offering Period
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SECTION 4: Effective with the I authorize the following new level of payroll deduction:
PAYROLL Pay Period Beginning: ___________% of cash earnings*
DEDUCTION --------------------------- * Must be a multiple of 1% up to a maximum of 10% of
CHANGE Month, Day and Year cash earnings
NOTE: You may reduce your rate of payroll deductions once per 6-month purchase interval to become
effective as soon as possible following the filing of the change form. You may also increase your
rate of payroll deductions to become effective as of the start date of the next 6-month interval
(first business day of February or August).
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SECTION 5: Effective with the Your election to terminate your payroll deductions for
TERMINATE Pay Period Beginning: the balance of the offering period cannot be changed,
PAYROLL --------------------------- and you may not rejoin the offering period at a later
DEDUCTIONS Month, Day and Year date. You will not be able to resume participation in
the ESPP until the start of the next offering period.
In connection with my voluntary termination of payroll deductions, I elect the following action
regarding my ESPP payroll deductions to date in the current purchase interval:
[_] Purchase shares of XXXXX.XXX, INC. at the end of the purchase interval
OR
[_] Refund ESPP payroll deductions collected
NOTE: If your employment terminates for any reason or your eligibility status changes (greater than
20 hrs/week or greater than 5 months/year), you will immediately cease to participate in the ESPP,
and your ESPP payroll deductions collected in that purchase interval will automatically be refunded
to you.
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SECTION 6: In connection with my leave of absence, I elect the following action with respect to my ESPP payroll
deductions to date in the current purchase interval:
LEAVE OF
ABSENCE [_] Purchase shares of XXXXX.XXX, INC. at the end of the purchase interval
OR
[_] Refund ESPP payroll deductions collected
NOTE: If you take an unpaid leave of absence, your payroll deductions will immediately cease. If you
return to active status within 90 days after the start of your leave, your payroll deductions
will at that time automatically resume at the rate in effect for you when your leave began.
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SECTION 7:
AUTHORIZATION I hereby authorize the specific action or actions indicated above.
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Date Signature of Employee
