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EXHIBIT 99-B
AGREEMENT AND APPLICATION FOR TRU*SERV
VARIABLE DENOMINATION FLOATING RATE DEMAND NOTE
INVESTMENT PROGRAM
Please print or type all items except signature. Complete this application and
mail in the enclosed self-addressed envelope.
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ACCOUNT INFORMATION
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Name 1
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FIRST MIDDLE LAST SSN OR TAX I.D. NO.
Name 2 (Joint Tenancy Partner 1)
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FIRST MIDDLE LAST SSN OR TAX I.D. NO.
Registered Address
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City, State, and Zip Code
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Area Code
Telephone ( )
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Name 3 (Joint Tenancy Partner 2)
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FIRST MIDDLE LAST SSN OR TAX I.D. NO.
Name 4 (Joint Tenancy Partner 3)
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FIRST MIDDLE LAST SSN OR TAX I.D. NO.
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PLEASE CHECK ONE AND COMPLETE THE REQUIRED INFORMATION:
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/ / Xxxxxx & Company Member/Investor - Member Number: -
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/ / Current Xxxxxx & Company Investment Program - Investor Account
Number:942----------
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INITIAL INVESTMENT (By Check Only): $___________ ($250 minimum)
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PLEASE ENTER ALL THE FOLLOWING INFORMATION BELOW:
W-9 INFORMATION MUST BE COMPLETED OR APPLICATION WILL NOT BE PROCESSED.
TYPE OF ACCOUNT: (SELECT ONE)
/ / Individual Ownership
/ / Joint Tenancy With Rights of Survivorship
/ / Tenancy of Custodian (Under the Uniform Gift to Minor Act)*
/ / Living Trust (A copy of the first & last page of Trust Agreement)
*A minor is the beneficial owner of the account. An adult Custodian manages the
account until the minor comes of age as specified in the Uniform Gift to Minors
Act in the applicable state of residence. Custodian's signature is required
for all transactions.
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SUBSEQUENT INVESTMENTS (Not less than $50)
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By Wire Transfer Subsequent Investments can be made by wire to:
The Northern Trust Company, Chicago, Illinois
ABA # 000000000
After your initial investment, you will be assigned an
account number. For subsequent investments, please
provide this account number in your wire transfer
instructions. The minimum amount for subsequent
investments is $50.00
By Check Investments can be mailed to:
Tru*Serv Investment Program
X.X. Xxx 00000
Xxxxxxx, Xx 00000-0000
The minimum amount for subsequent investments is $50.00
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REDEMPTIONS (YOU MUST CHECK ONE OR BOTH)
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[ ] By Bank Wire If you want to make redemptions by wire transfer, please
Transfer complete the "Designated Bank" information below and
attach a voided blank check (minimum by wire transfer
redemption of $2,500). You can wire funds to your
designated bank account If you call The Northern Trust
Company before 2:00 p.m. EST, you will receive a wire
transfer no later than the next business day.
[ ] By Check The Northern Trust Company will mail you your free
supply of checks shortly after your account is opened
(minimum check redemption of $250).
Written Redemption: Subject to the terms of the Program as amended, you may
also redeem any (but not less than $250 at a time) or all of your account by
writing: Xxxxxx & Company Investment Program, Investor Services Attn: Agent of
Issuer, X.X. Xxx 00000, Xxxxxxx, XX 00000-0000. All Signatures of registered
owners are required. Checks will be sent only to your registered account
address.
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DESIGNATED BANK
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If you elected "Bank Wire Transfer Redemption," you must complete this section
and attach a voided blank check.
Checking [ ]
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Name of Bank Account Bank Account Number
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Bank Name/Branch ABA Bank Routing Number (9-digit number)
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Bank Address
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W-9 TAX INFORMATION
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[ ] W-9 Information must be completed or application
will not be processed. Unless the box is checked, I
am not subject to backup withholding because I have
X Box If Applicable not been notified by the IRS that I am subject to
such withholding, or the IRS has notified me that I
am no longer subject to backup withholding.
[ ] I am subject to backup withholding under provisions
of selection 340(a)(1)(c) of the Internal Revenue
Code. The Social Security or Taxpayer ID number
provided on this form is correct.
Instructions for Completing Payees Request for Taxpayers Identification
Certification: Under Federal tax law, you must provide your correct Social
Security Number or other Taxpayer ID Number, a certification that the number
provided is correct and a certification that you are not subject to backup
withholding. Failure to furnish your correct Social Security or Taxpayer ID
Number or to so certify will result in 31% of interest paid to your account
being withheld and paid to the IRS. In addition, you may be subject to a
penalty imposed by the IRS if you fail to provide your correct Social Security
or Taxpayer ID Number or if you make an incorrect certification.
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I/We agree to all terms and conditions of the Xxxxxx & Company TruServ Variable
Denomination Floating Rate Demand Note Investment Program (the "Program") as set
forth in the Prospectus. I/We acknowledge that I/we have received and reviewed
the Prospectus and have reviewed and approved all schedules, including IRS W-9
Taxpayer Certification Form. I/We agree that Xxxxxx & Company may amend the
Program from time to time and that such amendments shall be binding upon me/us.
I/We agree that Xxxxxx & Company may comply with any levies, garnishments and
court orders at the sole and absolute discretion of Xxxxxx & Company.
I/We jointly and severally hereby agree to defend, indemnify, reimburse,
exonerate, save and hold harmless Xxxxxx & Company and its agents for, from and
against any and all losses, damages, claims, demands, and expenses including
reasonable attorneys fees of any and every nature actually or allegedly arising
in whole or in part out of the written information, tax identification number,
certifications, notice or instructions provided by me/us or out of my/our bad
faith, negligence, willful misconduct, strict liability of breach of this
agreement/application.
I/We agree that this Agreement and Application may be terminated by Xxxxxx &
Company at any time upon Xxxxxx & Company's written notice mailed to me/us at
the address stated herein.
I/We understand that the Program is administered by The Northern Trust Company
on behalf of Xxxxxx & Company. The Northern Trust Company is not a
co-principal of the Program and no investment dollars will be held by The
Northern Trust Company. First Trust National Association is the acting
indenture trustee of the Xxxxxx & Company Investment Program pursuant to a
written trust indenture between Xxxxxx & Company and First Trust National
Association.
Additional copies of the Prospectus are available upon request by writing to:
Xxxxxx & Company Investment Program, Investor Services Attn: Agent of Issuer,
X.X. Xxx 00000, Xxxxxxx, XX 00000-0000.
This form is intended for the sole use of Investors in the Xxxxxx & Company
Investment Program. INCOMPLETE FORMS, MISSING SUPPORTING DOCUMENTATION FOR THE
PURCHASE OF NOTE OR NOTES, WILL RESULT IN THE RETURN OF YOUR INVESTMENT.
Summary of Key Features of the Program include, (full Program provisions are
detailed in the Prospectus):
- The Notes are registered under the Federal Securities Act of 1933
- It is not insured by the FDIC
- It is an obligation of Tru*Serv Corporation, and is not an obligation of any
bank. The Notes will be subordinated in right of payment to senior notes,
indebtedness to banking institutions, trade creditors and other indebtedness
of the Company. The Notes are unsecured and rank equally and rateably with
all other unsecured and subordinated indebtedness of the Company.
- It is administered by The Northern Trust Company
- It provides a quarterly statement of all activity
- It provides you a checkbook to write checks against, in the minimum amount
of $250.00
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ARBITRATION
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This Program shall be enforced and interpreted under the laws of the State
of Illinois. Any controversy or claims arising out of or relating to this
Offer, or any breach thereof, including, without limitation, any claim that
this Offer or any portion thereof is invalid, illegal or otherwise voidable,
shall be submitted to arbitration before and in accordance with the rules of
the American Arbitration Association unless another extra judicial dispute
resolution process has been agreed to in writing by the parties, provided
however, that any matters arising under the federal securities laws will not be
subject to or in any way affected, waived or compromised by this arbitration
provision. Judgment upon the award may be entered in any court having
jurisdiction thereof. The location of the arbitration proceedings shall be at
the American Arbitration Association office geographically or physically
located closest to the Investor's domicile, unless otherwise agreed upon in
writing by the parties.
By signing below, I/We certify that I/We have received the Prospectus and agree
to be bound by its terms, and that (1) the information on this application,
including Social Security or Tax Identification Number, is correct and complete
and (2) I/We are not currently subject to IRS backup withholding unless the
box on W-9 information has been checked.
APPLICATIONS WILL BE REJECTED IF THIS FORM IS NOT COMPLETE. ALL APPLICANTS
SIGNATURES ARE REQUIRED.
PLEASE SIGN HERE
PRIMARY SIGNATURE DATE
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CO-APPLICANT SIGNATURE
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CO-APPLICANT SIGNATURE DATE
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CO-APPLICANT SIGNATURE
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11/95 NM
