EXHIBIT 99.6
BENEFICIAL OWNER ELECTION FORM
The undersigned acknowledge(s) receipt of the letter and the enclosed materials relating to the grant of non-transferable rights to purchase shares of common stock, par value $0.01 per share, of PVF Capital Corp.
I (we) hereby instruct you as follows:
(Check the one applicable box and provide all required information)
Box 1. | o | Please DO NOT EXERCISE RIGHTS to purchase shares of Common Stock. | ||
Box 2. | o | Please EXERCISE RIGHTS to purchase shares of Common Stock as set forth below: |
A. | Number of Shares Being Purchased: ____________________ (calculate as set forth below) (subject to the purchase and ownership limitations described in the Prospectus section entitled “The Rights Offering — Limit on How Many Shares of Common Stock You May Purchase in the Rights Offering”) | |
B. | Aggregate Subscription Price Payment Required: $ ________________ (calculate as set forth below) |
Basic Subscription Privilege
I wish to exercise my full Basic Subscription Privilege or a portion thereof as follows:
Number of Shares of Common Stock Subscribed for Under Your Basic Subscription Privilege | Subscription Price | Payment Due Under Basic Subscription Privilege | |||
X | $ __________ | = | $ | ||
Over-Subscription Privilege
I have exercised my full Basic Subscription Privilege and in addition to my full Basic Subscription Privilege I wish to subscribe for additional shares under my Over-Subscription Privilege as follows:
Number of Shares of Common Stock Subscribed for Under Your Over-Subscription Privilege* | Subscription Price | Payment Due Under Over-Subscription Privilege | |||
X | $ __________ | = | $ | ||
* | The maximum number of shares you may subscribe for under your Over-Subscription Privilege is equal to ______ shares less the number of shares you subscribed for under your full Basic Subscript Privilege. |
Total Shares and Total Payment Required
Total Shares (number of shares of Common Stock subscribed for under Basic Subscription Privilege plus Over Subscription Privilege) | Subscription price | Total Payment Required (total payments due under Basic Subscription Privilege plus Over Subscription Privilege | |||
X | $ ____________ | = | $ | ||
Payment Method (check one)
______________ Payment in the following amount is enclosed $_________
______________ Please deduct payment from the following account maintained by you as follows:
Type of Account: | ||
Account No: | ||
Amount to be Deducted: |
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: (a) irrevocably elect to purchase the number of shares of Common Stock indicated above, upon the terms and conditions specified in the prospectus; and (b) agree that if I (we) fail to pay for the shares of Common Stock I (we) have elected to purchase, you may exercise any remedies available to you under law.
Name(s) of beneficial owner(s): |
Signature(s) 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: |
Capacity (Full Title): |
Address (including Zip Code): |
Telephone Number: |