EXHIBIT 4.3 SALIDA BUILDING AND LOAN ASSOCIATION 401(K) PROFIT SHARING PLAN & TRUST =============================================================================== Employee Name (Please Print) - ------------------------------------------------------------------------------- Street Address - ------------------------------------------------------------------------------- City, State, Zip - ------------------------------------------------------------------------------- Social Security Number - ------------------------------------------------------------------------------- Home Phone Number Work Phone Number =============================================================================== EMPLOYEE SALARY REDUCTION ELECTION For Period Beginning ______________________________ (Please fill in date) You may increase or decrease your salary reduction percentage or dollar amount as of any January 1, April 1, July 1 or October 1. --------------------------------------- You may revoke prospectively your Salary Reduction Agreement as of any January ------- 1, April 1, or July 1 or October 1. Once you revoke your Agreement, you may not - ---------------------------------- file a new Agreement earlier than the next January 1 or July 1. ------------------- PLEASE WITHHOLD FROM MY COMPENSATION EACH PAY PERIOD AN AMOUNT EQUAL TO: [_] ______________% OR [_] $____________ OR [_] I DO NOT WISH TO PARTICIPATE --- Signed _________________________________ Date___________________ Please return this form to Frank DeLay of the Advisory Committee within one week. SALIDA BUILDING AND LOAN ASSOCIATION 401(K) PROFIT SHARING PLAN & TRUST =============================================================================== Employee Name (Please Print) - ------------------------------------------------------------------------------- Street Address - ------------------------------------------------------------------------------- City, State, Zip - ------------------------------------------------------------------------------- Social Security Number - ------------------------------------------------------------------------------- Home Phone Number Work Phone Number =============================================================================== You may change the percentage you have allocated to the various investment options as of any January 1, April 1, July 1 or October 1. --------------------------------------- [_] I have received and reviewed a copy of the current prospectus on each mutual fund in which I am investing. INVESTMENT ELECTION =============================================================================== Investment Options -- Employee Salary Reduction -- For Period Beginning________ -- Loan Repayment -- (Please fill in date) =============================================================================== Flex Fund Account - ------------------------------------------------------------------------------- Money Market Account - ------------------------------------------------------------------------------- Stock Account - ------------------------------------------------------------------------------- High Country Bancorp Stock =============================================================================== Percentage Totals for Employee Salary Reduction, Employer Match and Employer Profit Sharing Must Add Up to 100%. 100% =============================================================================== INVESTMENT EXCHANGE ELECTION =============================================================================== Current Investment Options for For Period Beginning__________ --Employee Salary Reduction -- (Please fill in date) -- Loan Repayment -- All Exchanges from one account to another will be on a 100% basis only. - ------------------------------------------------------------------------------- [_] FLEX FUND ACCOUNT [_] No change [_] Money Market Account [_] Stock Account [_] High Country Bancorp Stock - ------------------------------------------------------------------------------- [_] MONEY MARKET ACCOUNT [_] No change [_] Flex Fund Account [_] Stock Account [_] High Country Bancorp Stock - ------------------------------------------------------------------------------- [_] STOCK ACCOUNT [_] No change [_] Flex Fund Account [_] Money Market Account [_] High Country Bancorp Stock - -------------------------------------------------------------------------------- [_] HIGH COUNTRY BANCORP [_] No change [_] Flex Fund Account [_] Money STOCK Market Account [_] Stock Account ================================================================================ Signed _____________________________ Date_________________ Please return this form to Frank DeLay of the Advisory Committee within one week.