Stockholder Dividend Reinvestment and Employee Stock Purchase Plan Authorization Card SH -------------------- So that we may identify your account, please PRINT your name and address below in addition to signing the card.
____________________________________________ ____________________________________________ ____________________________________________ | Please enroll me in the Isabella Bank Corporation Stockholder Dividend Reinvestment and Employee Stock Purchase Plan (the “Plan”). I hereby appoint the Plan Administrator as my agent under the terms and conditions of the Plan, as described in the Prospectus of the Plan that accompanied this card, to receive and apply the following to the purchase of shares, without charge, as provided in the Plan: DIVIDEND REINVESTMENT (Please select only one option.) ¨ 1. FULL DIVIDEND REINVESTMENT—Any dividends that may become payable to me on all Isabella Bank Corporation Common Stock now or hereafter registered to me. ¨ 2. PARTIAL DIVIDEND REINVESTMENT—Any dividends that may become payable to me on the following shares of my Isabella Bank Corporation Common Stock. Shs OPTIONAL CASH INVESTMENT (Please select only one option.) ¨ 1. CHECK OR MONEY ORDER—The amount payable on the enclosed check or money order made payable to Isabella Bank Corporation, which amount is not less than $100. ¨ 2. AUTOMATIC BANK WITHDRAWAL—$____________, which amount is not less than $25 and shall be automatically deducted from my United States bank account identified below by either a: ¨ ONE-TIME AUTOMATIC BANK WITHDRAWAL, or ¨ MONTHLY AUTOMATIC BANK WITHDRAWAL. Account Number:___________________________ Routing Number: ___________________________ I understand that, if I selected Monthly Automatic Bank Withdrawals, my United States bank account identified above will be debited monthly in the amount requested on or about the 15th day of each month, until I change or revoke this authorization card. I understand that I may change or revoke this authorization card at any time by notifying the Plan Administrator, in writing, of my desire to change or withdraw my participation. Date ____________________________________ Stockholder ______________________________ Stockholder ______________________________ All joint owners must sign. |