FIRST ALLEN PARISH BANCORP, INC.
NUMBER OF SHARES
Fill in the number of shares you wish to purchase and the total amount due. No
fractional shares will be issued. The minimum purchase is _____ shares.
METHOD OF PAYMENT
Check the appropriate box(es). You may pay by check, bank draft or money order
and/or authorize withdrawal from your First Federal Savings and Loan Association
of Allen Parish savings or certificate account(s). If paying by certified or
teller's check, please make it payable to First Federal Savings and Loan
Association of Allen Parish. Your funds will earn interest at the Bank's
certificate rate per annum until the offering is completed. If paying by
withdrawal, please list the appropriate account number(s); these designated
funds will continue to earn interest from a savings or certificate account at
the same account rate and cannot be withdrawn by you until the Closing Date, as
defined on the front page of the Prospectus.
STOCK REGISTRATION
Print the name(s) in which you want the stock registered. See the reverse side
of this form for registration guidelines.
Enter the social security number (or tax I.D. number) of the registered owner.
Only one number is required.
Indicate the manner in which you wish to take ownership by checking 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.
NASD AFFILIATION
Please refer to the National Association of Securities Dealers, Inc. (NASD)
affiliation section and check the box if applicable. Under the guidelines of
the NASD, members of the NASD and their associates are subject to certain
restrictions on the transfer of securities purchased in accordance with
subscription rights and to certain reporting requirements upon the purchase of
such securities, as established by the NASD.
_____ Check here and initial below if you are a member of the NASD or a person
associated with an NASD member or a member of the immediate family of any such
person to whose support such person contributes directly or indirectly or if you
have an account in which an NASD member or person associated with an NASD member
has a beneficial interest. I agree (i) not to sell, transfer or hypothecate the
stock for a period of 150 days following issuance, and (ii) to report this
purchase order in writing to the applicable NASD member I am associated with
within one day of the payment for the stock. (Initials)_________
ACKNOWLEDGMENT
Sign and date the form. When purchasing as a custodian, corporate officer,
etc., add your full title to your signature. An additional signature is
required only when payment is by withdrawal from an account that requires more
than one signature to withdraw funds.
DEADLINE
This form along with the Form of Acknowledgment, properly executed and with the
correct payments must be received by ____ _.m., Louisiana Time, ___________,
1996 and will be deemed received upon the date and the time of delivery of the
form to our office. Please submit your order using the enclosed postage-paid
envelope or hand-delivering to any First Federal Savings and Loan Association of
Allen Parish office.
TELEPHONE INFORMATION
Please enter both a daytime and evening telephone number where you may be
reached in the event we cannot execute your order as given.
Daytime Phone ( ) ____________________
Evening Phone ( ) ____________________
STOCK ORDER FORM
NUMBER OF SHARES OFFERING PRICE TOTAL AMOUNT DUE
_____________ X $ 10.00 =_______________
---------------------
_____ Enclosed is a certified teller's check, bank draft, or money order
PAYABLE TO FIRST FEDERAL SAVINGS AND LOAN ASSOCIATION OF ALLEN PARISH for
$________.
_____ I authorize withdrawal from the following First Federal Savings and Loan
Association of Allen Parish account(s):
Account Number(s) Amount
$
$
Total Withdrawal $
________________________________________________________________________________
Name(s) in which your stock is to be registered
________________________________________________________________________________
Name(s) in which your stock is to be registered
________________________________________________________________________________
Address
________________________________________________________________________________
City Parish
________________________________________________________________________________
State Zip Code
________________________________________________________________________________
Social Security # or Tax ID #
_______ Individual _______ Joint Tenants _______ Tenants in Common
_______ Uniform Gift or Transfer to Minors
_______ Other __________________________________________________
I (we) acknowledge receipt of the Prospectus and the terms and conditions
described therein. I (we) understand that, after receipt by First Federal
Savings and Loan Association of Allen Parish, this order may not be modified or
withdrawn without the consent of First Federal Savings and Loan Association of
Allen Parish. Further, I (we) certify that my (our) purchase does not conflict
with the purchase limitations in the Plan of Conversion, and that the shares
being purchased are for my (our) account only and that there is no present
agreement or understanding regarding any subsequent sale or transfer of such
shares. Under penalties of perjury, I (we) certify that: (1) the Social
Security number or Taxpayer Identification number given above is correct; and
(2) I am not subject to backup withholding. INSTRUCTIONS: YOU MUST CROSS OUT #2
ABOVE IF YOU HAVE BEEN NOTIFIED BY THE INTERNAL REVENUE SERVICE THAT YOU ARE
SUBJECT TO WITHHOLDING BECAUSE OF UNDER-REPORTING INTEREST OR DIVIDENDS ON YOUR
TAX RETURN.
I ACKNOWLEDGE THAT THIS SECURITY IS NOT A DEPOSIT OR ACCOUNT AND IS NOT
FEDERALLY INSURED AND IS NOT GUARANTEED BY FIRST FEDERAL SAVINGS AND LOAN
ASSOCIATION OF ALLEN PARISH OR ANY FEDERAL OR STATE GOVERNMENT OR AGENCY.
If anyone asserts that this security is federally insured or guaranteed, or is
as safe as an insured deposit, I should call the Southeast Regional Director of
the Office of Thrift Supervision, Atlanta, Georgia at (404) 888-0771.
I further certify that, before purchasing the Common Stock of First Allen Parish
Bancorp, Inc., I received a Prospectus. The Prospectus that I received contains
disclosure concerning the nature of the security being offered and describes the
risks involved in the investment. See the "Special Considerations" section of
the Prospectus. In executing this Stock Order Form I affirm that I have read
the Prospectus and am aware of the risks associated with investing in First
Allen Parish Bancorp, Inc. Common Stock.
____________________________________________________________
Signature Date
____________________________________________________________
Additional Signature (if required) Date
FOR ASSISTANCE, PLEASE CALL THE STOCK INFORMATION CENTER, FIRST FEDERAL SAVINGS
AND LOAN ASSOCIATION OF ALLEN PARISH,
AT (318) 335-2031 FROM 9:00 A.M. TO 5:00 P.M., LOUISIANA TIME, MONDAY THROUGH
FRIDAY.
GUIDELINES FOR REGISTERING STOCK
For reasons of clarity and standardization, the stock transfer industry has
developed uniform stock ownership registration which we will use in issuing your
stock certificate. Common ownership registrations are explained below. If you
have any questions about how your First Allen Parish Bancorp, Inc. common stock
should be registered, see your legal advisor.
To ensure correct registration, please follow the instructions for the
ownership you select.
________________________________________________________________________________
GENERAL INSTRUCTION: . Include the first name, middle initial, and last name
of each person listed. Avoid the use of an initial in
place of the first name.
. Do not use titles such as Mr., Mrs., Dr., etc.
. Omit words that do not affect ownership rights such as
special account, personal property, etc.
________________________________________________________________________________
INDIVIDUAL: Instructions: Print the first name, middle initial, and
last name of the person in whose name the stock is to be
registered. You may not list beneficiaries for this
ownership.
________________________________________________________________________________
JOINT TENANTS: Joint Tenancy with Right of Survivorship identifies two or
more persons as owners of the stock. Upon the death of one
of the owners, ownership automatically passes to the
surviving tenant(s).
Instructions: Print the first name, middle initial, and
last name of each co-tenant. You may not list
beneficiaries for this ownership.
________________________________________________________________________________
UNIFORM GIFTS TO For residents of certain states, stock may be held in the
MINORS/UNIFORM name of a custodian for the benefit of a minor
MINORS: under the Uniform Transfers to Minors Act. For residents
of most other states, stock may be held in a similar type
of TRANSFERS TO ownership under the Uniform Gifts to
Minors Act of the individual states. For either ownership,
the minor is the actual owner of the stock with the adult
custodian being responsible for the investment until the
minor reaches legal age.
Instructions: If you are a Louisiana resident and wish to
register stock in this ownership check Uniform Transfers
to Minors Act. For other states, see your legal advisor if
you are unsure about the correct registration of your
stock.
On the first NAME line, print the first name, middle
initial, and last name of the custodian, with the
abbreviation CUST after the name
Print the first name, middle initial, and last name of the
minor on the second NAME line. Only one custodian and one
minor may be designated.
Please indicate the minor's social security number in the
signature block.
________________________________________________________________________________
OTHER: Generally, fiduciary relationships (such as
Conservatorship, Legal Trust, Guardianship, etc.) are
established under a form of trust agreement or are
pursuant to a court order. Without a legal document
establishing a fiduciary relationship, your stock may not
be registered in a fiduciary capacity.
Instructions: On the first NAME line, print the first
name, middle initial, and last name of the fiduciary if
the fiduciary is an individual. If the fiduciary is a
corporation, list the corporate title on the first NAME
line. Following the name, print the fiduciary title such
as conservator, personal representative, etc.
On the second NAME line, print either the name of the
maker, donor or testator OR the name of the beneficiary.
Following the name, indicate the date and type of legal
document establishing the fiduciary relationship
(agreement, court order, etc.) (Use the space marked OTHER
if necessary). Please contact us if you have any
questions.
EXAMPLE OF A FIDUCIARY REGISTRATION:
John D. Smith Trustee for Tom A. Smith Under Agreement
Dated 06/09/74.
PLEASE NOTE THAT TOTTEN TRUST AND PAYABLE ON DEATH
OWNERSHIPS MAY NOT BE USED IN REGISTERING STOCK.
For example, stock cannot be registered as John Doe
Trustee for Jane Doe or John Doe Payable on Death to Jane
Doe.
________________________________________________________________________________
NASD AFFILIATION: Please refer to the NASD AFFILIATION statement on the face
of this form. If applicable, initial where indicated and
check the box. the National Association of Securities
Dealers, Inc. Interpretation With Respect to Free-Riding
and Withholding (the Interpretation) restricts the sale of
a hot issue (securities that trade at a premium in the
aftermarket) to NASD members, persons associated with NASD
members (i.e., an owner, director, officer, partner,
employee or agent of a NASD member) and certain members of
their families. Such persons are required to indicate that
they will comply with certain conditions required for an
exemption from the restrictions.
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