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Fill and Sign the General Form of Corporate Proxy Vote

Fill and Sign the General Form of Corporate Proxy Vote

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General Form of Corporate Proxy I, ___________________ (name of stockholder) , do constitute and appoint ___________________ (name) , attorney and agent for me, and in my name, place, and stead, to vote as my proxy at any stockholders' meetings to be held between the date of this proxy and __________________ (date) , unless sooner revoked, with full power to cast the number of votes that all my shares of stock in ________________________ ( corporation ) should entitle me to cast as if I were then personally present, and authorize ____________________ (name of proxy ) to act for me and in my name and stead as fully as I could act if I were present, giving to ___________________ (name of proxy ) , attorney and agent, full power of substitution and revocation, and I revoke all previous proxies . I have executed this proxy on ________________ (date) . _________________________ (Printed Name of Stockholder) _________________________ (Signature of Stockholder) _________________________ (Printed Name of Witness) _________________________ (Signature of Witness)

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