Stock Purchase Form - I hereby appoint the PLAN ADMINISTRATOR as my agent under the terms and conditions of the Plan, as described in the Prospectus for the Plan, to receive and apply the following to the purchase of shares, without charge, as provided in the Plan:
Optional Cash Investment
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¨ | CHECK OR MONEY ORDER - The amount payable on the enclosed check or money order made payable to Isabella Bank Corporation. Check Amount: _______________ |
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¨ | AUTOMATIC BANK WITHDRAWAL - $_______________, automatically deducted from the bank account identified below. |
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| Type of account: ¨ Checking ¨ Savings. Account #:____________________ |
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¨ | I do NOT wish to have my shares reinvested. |
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| Date: ___________________________________________________________________________________________ |
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| Signature(s): _____________________________________________________________________________________ |
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| Signature(s): _____________________________________________________________________________________ |
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| Please print names(s)_________________________________________#_____________________________________ |
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| and Shareholder ID # |
| __________________________________________#____________________________________ |
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| Social Security Number: ____________________________________________________________________________ |
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| Address: _________________________________________________________________________________________ |
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| City, State, Zip ____________________________________________________________________________________ |
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| Phone Number ____________________________________________________________________________________ |
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| E-Mail Address ___________________________________________________________________________________ |
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| Please sign and return to Shareholder Services Department |
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| Shareholder Department Use Only |
| Number of Shares _______________ Price _______________ |