Exhibit 99.3
Page 1 of 2
Request for Waiver Form
EPR Properties Dividend Reinvestment and Direct Share Purchase Plan
This form is to be used only by Participants in the EPR Properties (“EPR Properties”) Dividend Reinvestment and Direct Share Purchase Plan (the “Plan”) who are requesting authorization from EPR Properties to make an optional cash investment under the Plan in excess of the $10,000 monthly maximum. In submitting this Request for Waiver, the Participant is representing to EPR Properties that the Participant has received and read the Prospectus covering the Plan and understands the terms and conditions of the Plan as set forth in the Prospectus.
A new form must be completed each month the Participant wishes to make a cash investment in excess of the $10,000 monthly maximum limit. This form will not be accepted by EPR Properties unless it is completed in its entirety.
This form should be completed and returned (via facsimile) to EPR Properties, Attention: DSPP Waiver Request, fax number (816)472-5794.
To be Completed by Participant
Monthly Terms (to be approved by EPR Properties)
| Applicable Waiver Discount % | Pricing Period beginning date | |||||
| $ | ||||||
| Threshold Price | Pricing Period (number of separate days) | |||||
| Extension Feature Activated/up to # of days? (max 5) | Continuous Settlement Feature Activated? | |||||
| Participant Information | ||||||
| Today’s Date | Name as appears on share certificate, or beneficial owner (if applicable) | |||||
| $ | ||||||
| Optional Cash Investment Requested | ||||||
| Contact Name | Participant’s Signature | |||||
| Contact Phone Number Fax Number | Participant’s Social Security or Tax ID Number | |||||
| Contact Email Address | Participant’s Address | |||||
| DTC Number | City State Zip Code | |||||
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To be Completed by Participant (continued)
Participant Financial Institution Information
In the event that the threshold price is not satisfied or there are no trades reported for a day in the Pricing Period, the following information will be used to return the applicable portion of your Optional Cash Investment as soon as practical after the Pricing Period.
| Name of Financial Institution | Bank ABA / Routing Number | |||
| Bank Account Name | Bank Account Number | |||
Participant Instruction—Disposition of shares (circle 1)
| 1. Hold all shares in plan account | 2. Issue certificate for full shares | 3. DWAC full shares to DTC# | ||
| ($100 fee for DWAC) |
To Be Completed By EPR Properties
| $ | ||||
| Optional Cash Investment Accepted | Approving Signature | |||
| Date | Name Title | |||
Administrator Wire Instructions
| Financial Institution: | Harris Trust and Savings | |
| Bank ABA #: | 071-000-288 | |
| Bank Account Name: | DRP Pulls Account | |
| Bank Account Number: | 226-527-0 | |
| Reference: | Waiver funds for EPR Properties, ATTN: Investment Services |
