1
Exhibit 99.9
XXXX-XXXXX CORPORATION
EMPLOYEE STOCK PURCHASE PLAN ("ESPP")
ENROLLMENT/CHANGE FORM
Action Complete Sections:
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SECTION 1: [ ] New Enrollment 2, 3, 7 and sign attached
---------- Stock Purchase Agreement
ACTION
[ ] Change Payroll Deductions 2, 4, 7
[ ] Terminate Payroll Deductions 2, 5, 7
[ ] Leave of Absence 2, 6, 7
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SECTION 2: Name
---------- --------------------------------------------------------------------------------
PERSONNEL Last First MI Dept.
DATA
Home Address
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City State Zip Code
Social Security #: [ ][ ][ ]-[ ][ ]-[ ][ ][ ][ ]
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SECTION 3: Effective with the Purchase Payroll Deduction Amount: % of base salary*
---------- Period Beginning: ----
NEW [ ] February 1, 199_ *Must be a multiple of 1% up to a maximum of 10%
ENROLLMENT [ ] August 1, 199_ of base salary
[ ] Initial Purchase Period
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SECTION 4: Effective with the I authorize the following new level of payroll
---------- Pay Period Beginning: deductions: % of base salary*
CHANGE -----
PAYROLL -----------------------
DEDUCTIONS Month, Day and Year
* Must be a multiple of 1% up to a maximum of
10% of base salary
NOTE: You may reduce your rate of payroll deductions once per purchase period 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 the start date of the next purchase period.
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SECTION 5: Effective with the Your election to terminate your payroll
---------- Pay Period Beginning: deductions for the balance of the purchase
TERMINATE period cannot be changed, and you may not
PAYROLL ----------------------- rejoin the purchase period at a later date.
DEDUCTIONS Month, Day and Year You will not be able to resume participation
in the ESPP until a new purchase period begins.
In connection with my voluntary termination of payroll deductions, I elect the
following action with respect to my ESPP payroll deductions to date in the current
payment period:
[ ] Purchase shares of Xxxx-Xxxxx at the end of the period
OR
[ ] Refund ESPP payroll deductions collected
NOTE: If your employment terminates for any reason or your eligibility status changes
<20 hrs/wk or <5 months/yr), you will immediately cease to participate in the
ESPP, and your ESPP payroll deductions collected in that purchase period will
automatically be refunded to you.
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SECTION 6: In connection with my unpaid leave of absence, I elect the following action with
---------- respect to my ESPP payroll deductions to date in the current purchase period:
LEAVE OF
ABSENCE [ ] Purchase shares of Xxxx-Xxxxx at the end of the period
OR
[ ] Refund ESPP payroll deductions collected
NOTE: If you take an unpaid leave of absence, your payroll deductions will immediately
cease.
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SECTION 7:
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AUTHORIZATION
I hereby authorize the specific action or actions indicated above.
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Date Signature of Employee
