DELIVERY OPTIONS FOR SUBSCRIPTION RIGHTS CERTIFICATE
Delivery other than in the manner or to the addresses listed below will not constitute valid delivery.
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If delivering by mail: | | If delivering by hand or courier: |
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American Stock Transfer & Trust Company | | American Stock Transfer & Trust Company |
Operations Center | | Operations Center |
Attn: Reorganization Department | | Attn: Reorganization Department |
P.O. Box 2042 | | 6201 15th Avenue |
New York, New York 10272-2042 | | Brooklyn, New York 11219 |
PLEASE PRINT ALL INFORMATION CLEARLY AND LEGIBLY.
FORM 1-EXERCISE OF SUBSCRIPTION RIGHTS
To subscribe for shares pursuant to your Basic Subscription Privilege, please complete lines (a) and (c) and sign under Form 3 below. To subscribe for shares pursuant to your Over-subscription Privilege, please also complete line (b) and sign under Form 5 below.
(a) EXERCISE OF BASIC SUBSCRIPTION PRIVILEGE:
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I apply for | | | | shares x | | $ | | = $ |
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| | (no. of new shares) | | | | (subscription price) | | (amount enclosed) |
(b) EXERCISE OF OVER-SUBSCRIPTION PRIVILEGE
If you have exercised your Basic Subscription Privilege in full and wish to subscribe for additional shares pursuant to your Over-Subscription Privilege:
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I apply for | | | | shares x | | $ | | = $ |
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| | (no. of new shares) | | | | (subscription price) | | (amount enclosed) |
Total Amount of Payment Enclosed = $
METHOD OF PAYMENT (CHECK ONE)
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o | | Certified or Cashier’s draft drawn on a U.S. bank, or postal telegraphic or express money order payable to “American Stock Transfer & Trust Company, as Subscription Agent.” Funds paid by an uncertified check may take at least five business days to clear. |
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o | | Wire transfer of immediately available funds directly to the account maintained by American Stock Transfer & Trust Company, as Subscription Agent, for purposes of accepting subscriptions in this Rights Offering at JP Morgan Chase Bank, 55 Water Street, New York, New York 10005, ABA #021000021, Account # 957-341-237. |
FORM 2-DELIVERY TO DIFFERENT ADDRESS
If you wish for the Common Stock underlying your subscription rights, a certificate representing unexercised subscription rights of subscription rights to be delivered to an address different from that shown on the face of this Subscription Rights Certificate, please enter the alternate address below, sign under Form 3 and have your signature guaranteed under Form 4.
FORM 3-SIGNATURE
I acknowledge that I have received the Prospectus for this Rights Offering and I hereby irrevocably subscribe for the number of shares indicated above on the terms and conditions specified in the Prospectus.
Signature(s)
IMPORTANT: The signature(s) must correspond with the name(s) as printed on the reverse of this Subscription Rights Certificate in every particular, without alteration or enlargement, or any other change whatsoever.
FORM 4-SIGNATURE GUARANTEE
This form must be completed if you have completed any portion of Form 2.
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Signature Guaranteed: | | | | |
| | (Name of Bank or Firm) | | |
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By: | | (Signature of Officer) | | |
IMPORTANT: The signature(s) should be guaranteed by an eligible guarantor institution (bank, stock broker, savings & loan association or credit union) with membership in an approved signature guarantee medallion program pursuant to Securities and Exchange Commission Rule 17Ad-15.
FOR INSTRUCTIONS ON THE USE OF BROOKE CORPORATION SUBSCRIPTION RIGHTS CERTIFICATES, CONSULT THE ALTMAN GROUP, THE INFORMATION AGENT, AT (866) 207-2239 AND BANKS AND BROKERS MAY CALL THE INFORMATION AGENT AT (201) 806-7300.