XXXXXXX HOMES, INC.
EMPLOYEE STOCK PURCHASE PLAN ("ESPP")
ENROLLMENT/CHANGE FORM
Action Complete Sections:
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SECTION 1: / / New Enrollment 2, 3, 6, 7 AND sign attached
ACTIONS Stock Purchase Agreement
/ / Payroll Deduction Change 2, 4, 7
/ / Terminate Payroll Deductions 2, 5, 7
/ / Beneficiary Change 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
Interval Beginning: Payroll Deduction Amount: _____% of cash earnings*
NEW / / March 1, 199_
ENROLLMENT / / September 1, 199_
* Must be a multiple of 1% up to a maximum of 15% of
/ / Initial Offering Period -- August 1, 1998 cash earnings
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SECTION 4: Effective with the I authorize the following new level of payroll
PAYROLL Pay Period Beginning: _________________________ deduction: _______ % of cash earnings*
DEDUCTION Month, Day and Year
CHANGE * Must be a multiple of 1% up to a maximum of 15% of cash
earnings
NOTE: You may reduce your rate of payroll deductions once per 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 purchase interval.
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SECTION 5: Effective with the Your election to terminate your payroll deductions for the
TERMINATE Pay Period Beginning: _________________________ balance of the offering period cannot be changed, and
PAYROLL Month, Day and Year you may not rejoin the offering period at a later date. You
DEDUCTIONS will not be able to resume participation in the ESPP prior to
the commencement of the next offering period.
In connection with my voluntary termination of payroll deductions (or an approved leave of absence), I elect the
following action regarding my ESPP payroll deductions to date in the current purchase interval:
/ / Purchase shares of Xxxxxxx Homes, Inc. at 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
interval will automatically be refunded to you.
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SECTION 6: Beneficiary(ies) Relationship of beneficiary(ies)
BENEFICIARY ---------------- --------------------------------
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SECTION 7:
AUTHORIZATION
/ / My certificates will be issued in street name and delivered to the brokerage account designated by Xxxxxxx Homes, Inc..
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Date Signature of Employee
