Exhibit 99.4
Stockholder Dividend Reinvestment and Employee
Stock Purchase Plan Authorization
I hereby appoint the Plan Administrator of Isabella Bank Corporation’s Stockholder Dividend Reinvestment and Employee Stock Purchase Plan as my agent under the terms and conditions of the Stockholder Dividend Reinvestment and Employee Stock Purchase Plan as described in the Prospectus of the Plan which accompanied this authorization to receive and apply to the purchase of shares without charge as provided in the Plan the following:
$_________________________ (not less than $5) of my bi-weekly payroll check from Isabella Bank. I acknowledge that amounts deducted from my payroll checks will be subject to all applicable federal, state and local taxes even though I do not actually receive the deducted amount but, instead, it is applied to the purchase of Common Stock.
I acknowledge that my employer recommends a broad based investment portfolio.
Please reinvest dividends received on shares accumulated and held under the Plan.
I understand that this authorization will continue in effect without further action on my part, until I change or revoke it. I may change or revoke this authorization at any time by notifying the Plan Administrator, in writing, of my desire to change or withdraw my participation. However, I also understand that my request to change or withdraw my participation will be effective as of my next regular payroll check only if my employer receives notice thereof not less than 96 hours before payroll checks are distributed.
Date ___________________________________________________________
Signature _____________________________________________________
Please return with date and signature to Isabella Bank Corporation, 401 N. Main St., Mt. Pleasant, MI 48858. Attention: Plan Administrator of the Isabella Bank Corporation Stockholder Dividend Reinvestment and Employee Stock Purchase Plan.
In conjunction with my payroll deduction for purchase of stock, please register my stock as follows:
Employee: _____________________________________________________________
Social Security #: _______________________________________________________
Address: _____________________________________________________________
_____________________________________________________________
