The enclosed Election Form and Letter of Transmittal is being delivered to you in connection with the Agreement and Plan of Merger (“Merger Agreement”), dated November 19, 2015, by and among County Bancorp, Inc. (“County”), County Acquisition LLC...
Exhibit 99.2
Fox River Valley Bancorp, Inc. |
Computershare Trust Company, N.A. P.O. Box 43011 Providence Rhode Island 02940-3011 xxx.xxxxxxxxxxxxx.xxx/xxxxxxxx |
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Tax ID certification on file: <Certified Y/N> | ||||||
TOTAL SHARES | 12345678901234 |
TIME IS CRITICAL. PLEASE COMPLETE AND RETURN PROMPTLY IN ACCORDANCE WITH THE ENCLOSED INSTRUCTIONS.
ELECTION FORM AND LETTER OF TRANSMITTAL
To accompany certificates of common shares of
Fox River Valley Bancorp, Inc. (“Fox River Valley”)
This Election Form and Letter of Transmittal may be used to make an election only with respect to Fox River Valley common shares you hold. You may receive additional Election Forms and/or Letters of Transmittal with respect to common shares held by you in another manner or in another name. Please complete and mail ALL the Election Forms you receive. The deadline for submitting election forms (the “Election Deadline”) has not yet been determined, but will be the fifth business day prior to the closing date of merger. County Bancorp, Inc. (“County”) will use its reasonable best efforts to provide notice to Fox River Valley shareholders of the anticipated Election Deadline at least ten business days prior to the Election Deadline. Election forms must be RECEIVED by the Exchange Agent no later than 5:00 p.m., central time, on the date of the Election Deadline.
Your < > Certificates:
Locate the listed certificates.
Certificate Numbers | <Shares> | Certificate Numbers | <Shares> | |||
XXXX12345678 | 12345678901234 | XXXX12345678 | 12345678901234 | |||
XXXX12345678 | 12345678901234 | XXXX12345678 | 12345678901234 | |||
XXXX12345678 | 12345678901234 | XXXX12345678 | 12345678901234 | |||
XXXX12345678 | 12345678901234 | XXXX12345678 | 12345678901234 | |||
XXXX12345678 | 12345678901234 | XXXX12345678 | 12345678901234 |
If you hold more than 10 certificates, not all certificates can be listed on this form. (See Instruction 9)
Other Certificate Total | Total Certificated Shares | Shares Held By Us | Total Shares | |||
12345678901234 | 12345678901234 | 12345678901234 | 12345678901234 |
028ZVC
Complete the box(es) below to make an election |
ELECTION CHOICES
I hereby elect to receive the following as consideration for my Fox River Valley common shares held in this account:
STOCK ELECTION | ||||||
¨ | Mark this box to elect to make a stock election with respect to ALL of your Fox River Valley common shares. | |||||
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Mark this box to elect to make a stock election with respect to the following number of your Fox River Valley common shares Please fill in the number of shares for which you would like to make a stock election. (See Instruction 1) |
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CASH ELECTION | ||||||
¨ | Mark this box to elect to make a cash election with respect to ALL of your Fox River Valley common shares. | |||||
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Mark this box to elect to make a cash election with respect to the following number of your Fox River Valley common shares. Please fill in the number of shares for which you would like to make a cash election. (See Instruction 1) |
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MIXED ELECTION (50% in shares of County common stock and 50% in cash without interest) | ||||||
¨ | Mark this box to elect to make a mixed election with respect to ALL of your Fox River Valley common shares. | |||||
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Mark this box to elect to make a mixed election with respect to the following number of your Fox River Valley common shares. Please fill in the number of shares for which you would like to make a mixed election. (See Instruction 1) |
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You will be deemed to have made a MIXED ELECTION if: | ||||||
A. | You fail to follow the instructions on the “Election Form and Letter of Transmittal” or otherwise fail properly to make an election; or | |||||
B. | A properly completed “Election Form and Letter of Transmittal,” together with your certificate(s), confirmation of book-entry transfer or a properly completed Notice of Guaranteed Delivery, is not actually received by the Exchange Agent at or before the Election Deadline. |
These elections will be subject to proration based on (i) a proration adjustment if cash consideration is oversubscribed or (ii) a proration adjustment if cash consideration is undersubscribed.
No guarantee can be made that you will receive the amount of cash consideration or stock consideration that you elect. No guarantee can be made as to the value of the consideration received relative to the value of the Fox River Valley common shares being exchanged. You are encouraged to obtain current market quotations for County common stock when making your election.
To be effective, this Election Form and Letter of Transmittal must be properly completed, signed and delivered to the Exchange Agent at one of the addresses listed in the Election and Transmittal Information Booklet, together with your certificate(s), confirmation of book-entry transfer or a properly completed Notice of Guaranteed Delivery, by the Election Deadline. Do not send your election materials to Fox River Valley or County.
SIGNATURE(S) REQUIRED. Signature of Registered Holder(s) or Agent
Must be signed by the registered holder(s) EXACTLY as name(s) appear(s) on your certificate(s). If signature is by a trustee, executor, administrator, guardian, attorney-in-fact, officer for a corporation in a fiduciary or representative capacity, or other person, please set forth full title.
By signing below, I represent and warrant as follows:
(1) I have full power and authority to surrender the Fox River Valley common shares represented by the certificate(s) surrendered herewith or transferred in book-entry form, or covered by a guarantee of delivery, free and clear of all liens, claims and encumbrances. I will, upon request, execute and deliver any additional documents reasonably deemed by the Exchange Agent to be appropriate or necessary to complete the surrender and exchange of my Fox River Valley common shares.
(2) I understand that neither surrender nor an election is made in acceptable form until receipt by the Exchange Agent of this Election Form and Letter of Transmittal, duly completed and manually signed, together with any certificate(s) representing Fox River Valley common shares and all accompanying evidences of authority. I agree that all questions as to validity, form and eligibility of any surrender of the Fox River Valley shares will be determined by the Exchange Agent.
(3) I acknowledge that, until I properly surrender the certificate(s) representing the Fox River Valley common shares to which this Election Form and Letter of Transmittal relates or properly transfer such Fox River Valley shares in book-entry form, I will not receive any consideration issuable or payable. Delivery of such certificate(s) will be effected, and risk of loss and title to such certificate(s) will pass, only upon proper delivery thereof to the Exchange Agent in the appropriate manner to one of the addresses listed in the Election and Transmittal Information Booklet.
Sign and provide your tax ID number on the IRS Form W-9 provided herein (or the appropriate IRS Form W-8 if you are a non-U.S. holder, a copy of which can be obtained at xxx.xxx.xxx). See Instruction 9.
Signature of owner | Signature of co-owner, if any |
Area Code/Phone Number
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SIGNATURE(S) GUARANTEED (IF COMPLETING SPECIAL PAYMENT AND DELIVERY FORM).
Unless the shares were tendered by the registered holder(s) of the common shares, or for the account of a member of a Eligible Institution, your signature(s) must be guaranteed by an Eligible Institution.
Authorized Signature
Name of Firm
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Address of Firm – Please Print
SPECIAL PAYMENT AND DELIVERY FORM
The merger consideration will be issued in the name and address provided on the Election Form and Letter of Transmittal unless instructions are given in the boxes below.
If completing this page for Special Payment and Issuance Instructions or Special Delivery Instructions, please obtain an Original Medallion Signature Guarantee Stamp below.
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02901B
you can deliver to Computershare a properly completed Election Form. If Computershare does not receive a properly completed Election Form on or before the Election Deadline, you will have been deemed to have made a MIXED ELECTION for ALL Fox River Valley common shares that you own.
All holders of Fox River Valley shares will be required to surrender their Fox River Valley stock certificates to the Exchange Agent no later than 5 p.m., central time, on the fifth business day prior to the closing date of the merger, the Election Deadline, in order to receive the merger consideration that they elect. Failure to surrender the Election Form and Letter of Transmittal together with Fox River Valley stock certificates by such date will invalidate your election; you will be deemed to have made the Mixed Election. As described in the Proxy Statement, the merger consideration will be paid 50% in cash and 50% in County common stock. As a result, all elections are subject to the proration and allocation procedures described in the Merger Agreement and the Proxy Statement to ensure that the aggregate amount of cash and the aggregate amount of County common stock that would be paid in the Merger do not exceed those limits.
INSTRUCTION 2. Election Deadline. YOU MUST SUBMIT A COMPLETED ELECTION FORM AND LETTER OF TRANSMITTAL PROMPTLY AFTER RECEIPT OF THIS FORM. To make an election, an Election Form and Letter of Transmittal must be received by the Exchange Agent on or before 5:00 p.m., central time, on the Election Deadline, which you will be notified of at least ten business days prior thereto. The Exchange Agent will have reasonable discretion to determine whether any Election Form and Letter of Transmittal is received on a timely basis and whether the form has been properly completed and signed. Any such determinations are conclusive and binding.
INSTRUCTION 3. Revocation or Change of Election Form. After an Election Form is submitted to the Exchange Agent, the Election Form may not be revoked or changed.
INSTRUCTION 4. Signatures on Election Form and Letter of Transmittal.
a) All signatures must correspond exactly to the name written on the face of the Fox River Valley stock certificates without alteration, variation or any change whatsoever.
b) If the Election Form and Letter of Transmittal is signed by a person(s) other than the record holder(s) of the Fox River Valley stock certificates delivered (other than as set forth in paragraph (c) below), such certificates must be endorsed or accompanied by appropriate stock powers, in either case signed exactly as the name(s) of the record holder(s) appears on such certificate.
c) If the Election Form and Letter of Transmittal is signed by a trustee, executor, administrator, guardian, attorney-in-fact, officer of a corporation or other person acting in a fiduciary or representative capacity and such person is not the record holder of the Fox River Valley stock certificates, he or she must indicate the capacity when signing and must submit proper evidence of his or her authority to act.
INSTRUCTION 5. Delivery of Election Form and Letter of Transmittal and Stock Certificates. The Election Form and Letter of Transmittal, properly completed and duly executed, together with the Fox River Valley stock certificate(s) should be delivered to the Exchange Agent using the return envelope enclosed herewith. If the return envelope is lost, the Election Form and Letter of Transmittal, together with Fox River Valley stock certificate(s), should be mailed to the following address: Computershare Trust Company, N.A., P.O. Box 43011, Providence, Rhode Island 02940-3011. If you wish to return the Election Form and Letter of Transmittal and your stock certificates by a delivery method that cannot ship to post office boxes, please send the materials to the following address: Computershare, c/o Voluntary Corporate Actions, 000 Xxxxxx Xxxxxx, Xxxxx X, Xxxxxx, Xxxxxxxxxxxxx 00000.