Exhibit 99.1
[LOGO]
STOCK ORDER FORM
DEADLINE
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This order form, properly executed ----------------------------------------
and with the full payment must be
received by 12:00 noon, Eastern Total
Time on ________ __, 1996, and will Number of Purchase Total
be deemed received upon the date Shares Price Amount
and the time of delivery of the
form to one of our offices. Please X $10.00 = $
submit your order using the --------- --------- ------
enclosed postage-paid envelope or
hand-delivering the order form to
the office of Amsterdam Federal
Savings and Loan Association. ----------------------------------------
NUMBER OF SHARES
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Fill in the number of shares you ----------------------------------------
wish to purchase and the total [ ] Enclosed is a check or money order
amount due. No fractional shares payable to AFSALA Bancorp, Inc.
will be issued. The minimum order for $
is 25 shares and the maximum order --------------.
is $150,000 of the total shares
sold in the Conversion. See the [ ] I authorize withdrawal from the
Prospectus for a description of following Amsterdam Federal
purchase limitations, including how accounts(s):
to determine whether your purchases
will be aggregated with any Account Number(s) Amount
associates or persons acting in
concert. $
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$
METHOD OF PAYMENT ------------------ -----------
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Check the appropriate box(es). You
may pay by cash, check, or money Total withdrawal $
order. If paying by check or money -----------
order, please make it payable to No penalty for early withdrawal.
AFSALA Bancorp, Inc. If paying by
cash, please hand-deliver your ----------------------------------------
order form. For orders of $25,000
or more, payment must be made by
certified check or money order.
Your funds will earn interest at
the interest rate paid on passbook ----------------------------------------
savings accounts from the date of
receipt until the offering is ----------------------------------------
completed. You may also wish to pay Names(s) in which stock is to be
by authorizing withdrawal from your registered.
Amsterdam Federal Savings and Loan
Association savings or certificate ----------------------------------------
account(s). If paying by Names(s) in which stock is to be
withdrawal, please list the registered.
appropriate account number(s);
these designated funds will
continue to earn interest at the ----------------------------------------
contractual rate, but cannot be Address
withdrawn by you. (For IRA
transactions, please call the stock
center as soon as possible.) ----------------------------------------
City County
STOCK REGISTRATION
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Print the name(s) in which you want State Zip Code
the stock registered. If you are a
voting member, to protect your
priority over other purchasers as ----------------------------------------
described in the Prospectus and Social Security # or Tax ID #
Proxy Statement, you must take
ownership in at least one of the
account holders' names.
Enter the Social Security Number [ ] Individual [ ] Joint Tenants
(or Tax I.D. Number) of a
registered owner. Only one number [ ] Tenants in Common
is required.
[ ] Uniform Transfer to Minors
Indicate the manner in which you
wish to take ownership by checking [ ] Other
the appropriate box. If necessary,
check "Other" and note ownership
such as corporation, estate or -----------------------------------------
trust. If stock is purchased for a
trust, the date of the trust
agreement and trust title must be
included. See the reverse side of
this form for registration
guidelines.
AFSALA BANCORP, INC.
GUIDELINES FOR REGISTERING STOCK
For reasons of clarity and standardization, the stock transfer industry has
developed uniform stockholder registrations which we will utilize in the
issuance of your AFSALA Bancorp, Inc. stock certificate(s). If you have any
questions, please consult your legal advisor. Stock ownership must be registered
in one of the following manners:
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INDIVIDUAL Avod the use of two initials. Include the first given name, middle
initial and last name of the stockholder. Omit words of limitation
that do not affect ownership rights such as "special account,"
"single man," "personal property," etc.
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JOINT Jointownership of stock by two or more persons shall be inscribed on
the certificate with one of the following types of joint ownership.
Names should be joined by "and," do not connect with "or". Omit titles
such as "Mrs.," "Dr.," etc. JOINT TENANTS Joint Tenancy with Right of
Survivorship and not as Tenants in Common may be specified to identify
two or more owners where ownership is intended to pass automatically
to the surviving tenant(s). TENANTS IN COMMON Tenants in common may be
specified to identify two or more owners. When stock is held in a
tenancy in common, upon the death of one co-tenant, ownership of the
stock will be held by the surviving co-tenant(s) and by the heirs of
the deceased co-tenant. All parties must agree to the transfer or sale
of shares held in this form of ownership.
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REVISED Stock may be held in the name of a custodian for a minor under the
UNIFORM Revised Uniform Gifts to Minors (or, the Uniform Transfers to Minors)
GIFTS laws of the individual states. There may be only one custodian and one
TO MINORS minor designated on a stock certificate. The standard abbreviation of
custodian is "CUST," while the description "Revised Uniform Gifts to
Minors Act" is abbreviated "REV UNIF GIFT MIN ACT." Standard U.S.
Postal Service state abbreviations should be used to describe the
appropriate state. For example, stock held by John P. Jones under the
New York Revised Uniform Gifts to Minors Act will be abbreviated.
JOHN P. JONES CUST SUSAN A. JONES
REV UNIF GIFT MIN ACT
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FIDUCIARIES
Stock held in a fiduciary capacity must contain the following:
1. The name(s) of the fiduciary --
* If an individual, list the first given name, middle
initial, and last name.
* If a corporation, list the corporate title.
* If an individual and a corporation, list the corporation's
title before the initial.
2. The fiduciary capacity --
* Administrator
* Conservator
* Committee
* Executor
* Trustee
* Personal Representative
* Custodian
3. The type of document governing the fiduciary relationship.
Generally, such relationships are either under a form of
living trust agreement or pursuant to a court order. Without
a document establishing a fiduciary relationship, your stock
may not be registered in a fiduciary capacity.
4. The date of document governing the relationship. The date of
the document need not be used in the description of a trust
created by a will.
5. Either of the following:
The name of the maker, donor or testator
or
The name of the beneficiary
Example of Fiduciary Ownership:
JOHN D. SMITH, TRUSTEE FOR TOM A. SMITH
UNDER AGREEMENT DATED ___/___/93
NASD AFFILIATIONS
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Please refer to the National [ ] Check here and initial below if
Association of Securities Dealers, you are a member of the NASD or a
Inc., ("NASD") affiliation section person associated with an NASD
and check the box, if applicable. member or a partner with a
The NASD Interpretation With securities brokerage firm or a
Respect to Free-Riding and member of the immediate family of
Withholding (the "Interpretation") any such person to whose support
restricts the sale of a "hot issue" such person contributes directly
(securities that trade at a premium or indirectly or if you have an
in the aftermarket) to NASD account in which a NASD member or
members, persons associated with a person associated with a NASD
NASD members (i.e., an owner, member has a beneficial interest.
director, officer, partner, I agree (i) not to sell, transfer
employee, or agent of a NASD or hypothecate the stock for a
member) and certain members of period of 150 days following
their families. Such persons are issuance, and (ii) to report this
requested to indicate that they stock purchase in writing to the
will comply with certain conditions applicable NASD member I am
required for an exemption from the associated with within one day of
restrictions. the payment for the stock.
(Initials)
TELEPHONE INFORMATION ------------------------
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Please enter both a daytime and an Daytime Phone ( )
evening telephone number where you ---------------
may be reached in the event we Evening Phone ( )
cannot execute your order as given. ---------------
Please include your area code.
ACKNOWLEDGMENT
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I (WE) ACKNOWLEDGE THAT THIS I (we) understand that, after receipt
SECURITY IS NOT A SAVINGS ACCOUNT by AFSALA Bancorp, Inc., this order
OR DEPOSIT AND IS NOT FEDERALLY may not be modified or withdrawn
INSURED AND IS NOT GUARANTEED BY without the consent of AFSALA Bancorp,
AMSTERDAM FEDERAL SAVINGS AND LOAN Inc. or Amsterdam Federal Savings and
ASSOCIATION OR THE FEDERAL Loan Association. Further, I (we)
GOVERNMENT. certify that my (out) purchase does
not conflict with the purchase
I (we) further certify that I (we) limitations in the Plan of Conversion.
received a Prospectus prior to Under penalties of perjury, I (we)
purchasing the Common Stock of certify that: (1) the Social Security
AFSALA Bancorp, Inc. and Number or Tax Identification Number
acknowledge the terms and given above is correct; and (2) I (we)
conditions described therein. The am (are) not subject to backup
Prospectus that I (we) received withholdling. Instructions: You must
contains disclosure concerning the ----------------------
nature of the security being cross out #2 above if you have been
offered and describes the risks -------------------------------------
involved in the investment. See notified by the Internal Revenue
"Risk Factors" on pages 1 through 6 --------------------------------------
of the Prospectus. Service that you are subject to
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To purchase stock in the withholding because of under-reporting
Subscription Offering, this fully --------------------------------------
completed Stock Order Form must be interest or dividends on your tax
actually received by Amsterdam -------------------------------------
Federal no later than 12:00 noon, return.
Eastern Time on __________, 1996, -------
unless extended, otherwise this
Stock Order Form and all -------------------------------------
subscription rights will be void. Signature Date
Completed Stock Order Forms,
together with the required payment -------------------------------------
or withdrawal authorization and Additional Signature Date
signed Certification, may be (if required)
delivered to the Stock Center or
may be mailed to the address Sign and date the order form. Whe
indicated on the enclosed business purchasing as a custodian, corporate
reply envelope. All rights officer, etc., add you full title to
exercisable hereunder are not your signature. An additional signature
transferable and shares purchased is required only when payment is by
upon exercise of such rights must withdrawal from an account that
be purchased for the account of the requires more than one signature to
person exercising such rights. The withdraw funds. Your order will be
undersigned certifies that this filled according to the provisions of
stock order is for my account only the Plan of Conversion as described in
and there is no agreement or the Prospectus.
understanding regarding the
transfer of my subscription rights
or any further sales or transfers
of these shares.
It is understood that the Stock
Order Form will be accepted in
accordance with, and subject to,
the terms and conditions of the
Plan of Conversion of Amsterdam
Federal. If the minimum number of
shares cannot be sold, all orders
will be canceled and funds and
withdrawal authorizations received
as payment will be returned
promptly with interest or canceled,
respectively.
THIS ORDER NOT VALIDATED UNLESS SIGNED
AND ACCOMPANIED BY A COMPLETED CERTIFICATION
FOR ASSISTANCE, PLEASE CALL OUR STOCK CENTER AT
( ) -
FROM _:__ A.M. TO _:__ P.M., MONDAY THROUGH FRIDAY