Exhibit 99.9
REVISED BENEFICIAL OWNER ELECTION FORM
relating to
BLUE VALLEY BAN CORP.
RIGHTS TO PURCHASE COMMON STOCK
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NOTE FROM YOUR NOMINEE: YOU SHOULD RETURN THIS FORM ON A TIMELY BASIS TO ENSURE THAT WE ARE ABLE TO ACT PURSUANT
TO YOUR INSTRUCTIONS. ACCORDINGLY, IF YOU ELECT TO EXERCISE YOUR RIGHTS, PLEASE ENSURE THAT ALL REQUIRED FORMS
AND PAYMENTS ARE ACTUALLY RECEIVED BY US PRIOR TO 5:00 P.M., EASTERN TIME ON DECEMBER 21, 2008, THE LAST BUSINESS
DAY PRIOR TO THE SCHEDULED EXPIRATION DATE OF THE RIGHTS OFFERING TO ENSURE THAT WE HAVE SUFFICIENT TIME TO
DELIVER SUCH FORMS AND PAYMENTS TO THE RELEVANT SUBSCRIPTION AGENT BY 5:00 P.M., EASTERN TIME ON DECEMBER 22,
2008, THE SCHEDULED EXPIRATION DATE.
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The undersigned acknowledge(s) receipt of your letter and the enclosed
materials relating to the rights offering by Blue Valley Ban Corp. (the
"Company"), of nontransferable rights to purchase shares of common stock, par
value $1.00 per share, of the Company ("Common Stock"), including the prospectus
and the prospectus supplement previously provided and the accompanying
prospectus supplement No. 2 (collectively, the "Prospectus"). The undersigned
also acknowledge(s) that the exercise of rights is not revocable.
I (we) hereby instruct you as follows:
(CHECK THE APPLICABLE BOX OR BOXES AND PROVIDE ALL REQUIRED INFORMATION)
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IF YOU HAVE PREVIOUSLY PROVIDED INSTRUCTION TO YOUR NOMINEE REGARDING THIS OFFERING AND DO NOT WISH TO MAKE CHANGES:
Box 1. |_| Please EXERCISE RIGHTS to purchase shares of Common Stock in
ACCORDANCE WITH THE EARLIER INSTRUCTION.
-OR-
IF YOU HAVE PREVIOUSLY PROVIDED INSTRUCTION TO YOUR NOMINEE REGARDING THIS OFFERING AND WISH TO MAKE CHANGES:
Box 2. |_| Please CANCEL the earlier instruction, and DO NOT EXERCISE RIGHTS to purchase shares of Common
Stock
Box 3. |_| Please REPLACE the earlier instruction, and EXERCISE RIGHTS to purchase shares of Common Stock as
set forth below
REPLACE EXERCISE OF RIGHTS INSTRUCTION (Complete if Box 3 is checked):
Basic Subscription Right: ________________ Rights x .1352 = _________________________
(no. of rights) (no. of shares to be
purchased)
Over Subscription Right: In addition to my Basic Subscription Right, I apply for
_________________________ additional shares=
(no. of shares to be purchased)
Therefore, I apply for ___________________ x $18.00 = $_______________
(total no. of new shares) (subscription price) (payment required)
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IF YOU HAVE NOT PREVIOUSLY PROVIDED INSTRUCTION TO YOUR NOMINEE REGARDING THIS OFFERING:
Box 1. |_| Please DO NOT EXERCISE RIGHTS to purchase shares of Common Stock
Box 2. |_| Please EXERCISE RIGHTS to purchase shares of Common Stock as set forth below
EXERCISE OF RIGHTS INSTRUCTION (Complete if Box 2 is checked):
Basic Subscription Right: ________________ Rights x .1352 = ________________________
(no of rights) (no. of shares to be
purchased)
Over Subscription Right: In addition to my Basic Subscription Right, I apply for
________________________additional shares
(no. of shares to be purchased)
Therefore, I apply for ________________ x $18.00 = $_______________
(total no. of new shares) (subscription price) (payment required)
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PAYMENT
|_| Payment of $_____________ is enclosed.
|_| Please deduct payment of $____________ from the following account
maintained by you as follows:
Type of Account: ______________________ Account No.: ______________________
SIGNATURE(S) I (we) on my (our) own behalf, or on behalf
of any person(s) on whose behalf, or under whose directions, I am (we are)
signing this form:
o Irrevocably elect to purchase the number of shares of Common Stock
indicated above upon the terms and conditions specified in the
Prospectus; and
o Agree that if I (we) fail to pay for the shares of Common Stock that I
(we) have elected to purchase, you may exercise any remedies available
to you under law.
Name of beneficial owner(s):
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Signature of beneficial owner(s):
If you are signing in your capacity as a trustee, executor, administrator,
guardian, attorney-in-fact, agent, officer of a corporation or another acting in
a fiduciary or representative capacity, please provide the following
information:
Name:
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Capacity:
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Address (including Zip Code):
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Telephone Number:
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