Exhibit No. 99.1
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STOCK ORDER FORM
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DEADLINE
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This order form, properly executed and with the full payment Total
must be received by __:__ _.m., Eastern Time on ________ __, Number of Purchase Total
1997, and will be deemed received upon the date and the time of Shares Price Amount
delivery of the form to one of our offices. Please submit your
order using the enclosed postage-paid envelope or hand-delivering ________ X $10.00 = $______
the order form to any office of First Federal Savings and Loan
Association of Sistersville.
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NUMBER OF SHARES
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Fill in the number of shares you wish to purchase and the total [ ] Enclosed is a check or money order payable to
amount due. No fractional shares will be issued. The minimum Sistersville Bancorp, Inc. for $______.
order is 25 shares. With the exception of the ESOP, no person
(or persons who have subscription rights through a single account) [ ] I authorize withdrawal from the following First
may purchase in the Offerings more than 10,000 shares of Federal account(s):
Common Stock and no person (or persons who have subscription
rights through a single account), together with associates of Account Number(s) Amount
persons acting in concert with such person, may purchase in the
aggregate more than 10,000 shares of Common Stock. See the _______________ $__________
Prospectus for a description of purchase limitations, including how _______________ $__________
to determine whether your purchases will be aggregated with any _______________ $__________
associates or persons acting in concert. Total Withdrawal $__________
No penalty for early withdrawal.
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METHOD OF PAYMENT
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Check the appropriate box(es). You may pay by cash, check, or
money order. If paying by check or money order, please make it __________________________________________________
payable to Sistersville Bancorp, Inc.. If paying by cash, please Name(s) in which stock is to be registered.
hand-deliver your order form. Your funds will earn interest at
the interest rate paid on passbook savings accounts from the date __________________________________________________
of receipt until the offering is completed. You may also wish to Name(s) in which stock is to be registered.
pay by authorizing withdrawal from your First Federal Savings
and Loan Association of Sistersville savings or certificate __________________________________________________
account(s). If paying by withdrawal, please list the appropriate Address
account number(s); these designated funds will continue to earn
interest at the contractual rate, but cannot be withdrawn by you. __________________________________________________
City County
STOCK REGISTRATION
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State Zip Code
Print the name(s) in which you want the stock registered. If you
are a voting member, to protect your priority over other
purchasers as described in the Prospectus, you must take __________________________________________________
ownership in at least one of the account holders' names. Social Security # or Tax ID #
Enter the Social Security Number (or Tax I.D. Number) of a
registered owner. Only one number is required.
Indicate the manner in which you wish to take ownership by [ ] Individual [ ] Joint Tenants [ ]Tenants in Common
checking the appropriate box. If necessary, check "Other" and [ ] Uniform Transfer to Minors
note ownership such as corporation, estate or trust. If stock is [ ] Other ______________________________________
purchased for a trust, the date of the trust agreement and trust
title must be included. See the reverse side of this form for
registration guidelines. -----------------------------------------------------------------
SISTERSVILLE BANCORP, INC.
GUIDELINES FOR REGISTERING STOCK
For reasons of clarity and standardization, the stock transfer
industry has developed uniform stockholder registrations which we will utilize
in the issuance of your Sistersville Bancorp, Inc. stock certificate(s). If you
have any questions, please consult your legal advisor.
Stock ownership must be registered in one of the following
manners:
INDIVIDUAL Avoid the use of two initials. Include the first given name,
middle initial and last name of the stockholder. Omit words of
limitation that do not affect ownership rights such as "special
account," "single man," "personal property," etc.
JOINT Joint ownership of stock by two or more persons shall be
inscribed on the certificate with one of the following types of
joint ownership. Names should be joined by "and," do not connect
with "or". Omit titles such as "Mrs.," "Dr.," etc.
JOINT TENANTS Joint Tenancy with Right of Survivorship and not
as Tenants in Common may be specified to identify two or more
owners where ownership is intended to pass automatically to
the surviving tenant(s).
TENANTS IN COMMON Tenants in common may be specified to identify
two or more owners. When stock is held in a tenancy in common,
upon the death of one co-tenant, ownership of the stock will
be held by the surviving co-tenant(s) and by the heirs of the
deceased co-tenant. All parties must agree to the transfer or
sale of shares held in this form of ownership.
UNIFORM Stock may be held in the name of a custodian for a minor under
TRANSFER the Uniform Gifts to Minors laws of the individual states. There
TO MINORS may be only one custodian and one minor designated on a stock
certificate. The standard abbreviation of custodian is "CUST,"
while the description "Uniform Gifts to Minors Act" is
abbreviated "UNIF GIFT MIN ACT." Standard U.S. Postal Service
state abbreviations should be used to describe the appropriate
state. For example, stock held by Xxxx X. Xxxxx under the
Delaware Uniform Gifts to Minors Act will be abbreviated.
XXXX X. XXXXX CUST XXXXX X. XXXXX
UNIF GIFT MIN ACT
FIDUCIARIES Stock held in a fiduciary capacity must contain the following:
1. The name(s) of the fiduciary --
* If an individual, list the first given name, middle
initial, and last name.
* If a corporation, list the corporate title.
* If an individual and a corporation, list the
corporation's title before the initial.
2. The fiduciary capacity --
* Administrator
* Conservator
* Committee
* Executor
* Trustee
* Personal Representative
* Custodian
3. The type of document governing the fiduciary relationship.
Generally, such relationships are either under a form of
living trust agreement or pursuant to a court order.
Without a document establishing a fiduciary relationship,
your stock may not be registered in a fiduciary capacity.
4. The date of document governing the relationship. The date
of the document need not be used in the description of a
trust created by a will.
5. Either of the following:
The name of the maker, donor or testator
or
The name of the beneficiary
Example of Fiduciary Ownership:
XXXX X. XXXXX, TRUSTEE FOR XXX X. XXXXX
UNDER AGREEMENT DATED ___/___/93
NASD AFFILIATIONS
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Please refer to the National Association of Securities Dealers, Inc., [ ] Check here and initial below if you are a member of the
("NASD") affiliation section and check the box, if applicable. The NASD or a person associated with an NASD member or a
NASD Interpretation With Respect to Free-Riding and Withholding partner with a securities brokerage firm or a member of
(the "Interpretation") restricts the sale of a "hot issue" (securities the immediate family of any such person to whose support
that trade at a premium in the aftermarket) to NASD members, such person contributes directly or indirectly or if
persons associated with NASD members (i.e., an owner, director, you have an account in which a NASD member or a person
officer, partner, employee, or agent of a NASD member) and associated with a NASD member has a beneficial interest.
certain members of their families. Such persons are requested to I agree (i) not to sell, transfer or hypothecate the
indicate that they will comply with certain conditions required for stock for a period of three months following issuance,
an exemption from the restrictions. and (ii) to report this stock purchase in writing to the
applicable NASD member I am associated with within one
day of the payment for the stock. (Initials) __________
TELEPHONE INFORMATION
Please enter both a daytime and an evening telephone number Daytime Phone ( ) ________________
where you may be reached in the event we cannot execute your Evening Phone ( ) ________________
order as given. Please include your area code.
ACKNOWLEDGMENT
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Sign and date the order form. When purchasing as a custodian, I (we) understand that, after receipt by Sistersville
corporate officer, etc., add your full title to your signature. Bancorp, Inc., this order may not be modified or
An additional signature is required only when payment is by withdrawn without the consent of Sistersville Bancorp,
withdrawal from an account that requires more than one signature Inc. or First Federal Savings and Loan Association of
to withdraw funds. Your order will be filled according to the Sistersville. Further, I (we) certify that my (our)
provisions of the Plan of Conversion as described in the purchase does not conflict with the purchase limitations
Prospectus. in the Plan of Conversion and that the shares being
purchased are for my (our) account only and that there
I (WE) ACKNOWLEDGE THAT THIS SECURITY IS NOT A SAVINGS ACCOUNT is no present agreement or understanding regarding any
OR DEPOSIT AND IS NOT FEDERALLY INSURED AND IS NOT GUARANTEED BY subsequent sale or transfer of such shares. Under
FIRST FEDERAL SAVINGS AND LOAN ASSOCIATION OF SISTERSVILLE OR penalties of perjury, I (we) certify that:
THE FEDERAL GOVERNMENT. (1) the Social Security Number or Tax Identification
Number given above is correct; and (2) I (we) am (are)
I (we) further certify that I (we) received a Prospectus prior to not subject to backup withholding. Instructions:
purchasing the Common Stock of Sistersville Bancorp, Inc. and You must cross out #2 above if you have been notified
acknowledge the terms and conditions described therein. The by the Internal Revenue Service that you are subject
Prospectus that I (we) received contains disclosure concerning the to withholding because of under-reporting interest or
nature of the security being offered and describes the risks dividends on your tax return.
involved in the investment. These include, among others, (i) lack
of liquidity for the Common Stock; (ii) decreased return on equity
immediately after conversion; (iii) potential impact of changes in
interest rates; (iv) lack of growth in the Association's market area; ________________________________________________________
(v) decrease in profitability since 1994; (vi) anti-takeover Signature Date
provisions; (vii) possible voting control by management and the
board of directors; (viii) possible dilutive effect of RSP and stock
options and effect of purchases by RSP and ESOP; (ix) possible
negative impact caused by regulatory oversight; and (x) possible
adverse income tax consequences of the distribution of subscription ________________________________________________________
rights. See "Risk Factors" on pages 1 through 5 of the Prospectus. Additional Signature (if required) Date
If anyone asserts that this security is federally insured or
guaranteed, or is as safe as an insured deposit, I (we) should call
the Office of Thrift Supervision Regional Director for the
Northeast Region, at (000) 000-0000.
THIS ORDER NOT VALIDATED UNLESS SIGNED
FOR ASSISTANCE, PLEASE CALL OUR STOCK INFORMATION CENTER AT
(304) __________ (FIRST FEDERAL)
FROM 9:00 A.M. TO 4:00 P.M., MONDAY THROUGH FRIDAY