North Arkansas Bancshares, Inc.
Stock Order Form
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EXPIRATION DATE
NEWPORT FEDERAL for Stock Order
SAVINGS BANK Forms:
200 OLIVIA DRIVE , 1997
NEWPORT, ARKANSAS 12:00 Noon,
72112 (870) 523- Central Time
3340
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IMPORTANT--PLEASE NOTE: A properly completed original stock order form must
be used to subscribe for common stock. Faxes or copies of this form are not
required to be accepted. Please read the Stock Ownership Guide and Stock
Order Form Instructions as you complete this Form.
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(1) NUMBER OF SHARES SUBSCRIPTION PRICE (2) TOTAL PAYMENT DUE
[ ] X $10.00 = [ ]
The minimum number of shares that may be subscribed for is 25 shares. The
maximum number of shares that may be purchased by any person in the
Subscription Offering is 10,000 shares. The maximum number of shares that
may be purchased in the conversion by any person together with associates or
groups acting in concert is 15,000 shares. Management has the authority to
increase or decrease these limits.
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[_] (3) EMPLOYEE/OFFICER/DIRECTOR INFORMATION
Check here if you are a director, officer or employee of Salida Building and
Loan Association or a member of such person's immediate family.
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[_] (4) METHOD OF PAYMENT/CHECK Check Amount
Enclosed is a check, bank draft or money [ ]
order made payable to Salida Building and
Loan Association in the amount of:
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[_] (5) METHOD OF PAYMENT/WITHDRAWAL
The undersigned authorizes withdrawal from the following account(s) at
Salida Building and Loan Association. There is no penalty for early
withdrawal used for this payment.
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Account Number(s) Withdrawal Amount(s)
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Total Withdrawal Amount
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(6) PURCHASER INFORMATION
a. [_] Eligible Account Holder --Check here if you were a depositor of at
least $50.00 at Salida Building and Loan Association on December 31,
1995. Enter information below for all deposit accounts that you had
at Salida Building and Loan Association on December 31, 1995.
b. [_] Supplemental Eligible Account Holder--Check here if you were a
depositor of at least $50.00 at Salida Building and Loan Association
on September 30, 1997 but are not an Eligible Account Holder. Enter
information below for all deposit accounts that you had at Salida
Building and Loan Association on September 30, 1997.
c. [_] Other Member -- Check here if you held a deposit or loan at Salida
Building and Loan Association as of , 1997 but are not an Eligible
Account Holder or Supplemental Eligible Account Holder.
d. [_] Local Community Resident -- Check here if you are a permanent
resident of Chaffee, Lake, Fremont or Saguache County, Colorado.
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Account Title (Names on Accounts) Account Number(s)
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PLEASE NOTE: FAILURE TO LIST YOUR ACCOUNTS MAY RESULT IN LOSS OF PART OR
ALL OF YOUR SUBSCRIPTION RIGHTS. IF ADDITIONAL SPACE IS NEEDED, PLEASE
UTILIZE THE BACK OF THIS STOCK ORDER FORM.
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(7) STOCK REGISTRATION/FORM OF STOCK OWNERSHIP
[_] Individual [_] Joint Tenants
[_] Tenants in Common
[_] Fiduciary (i.e. trust, estate, etc.) [_] Corporation or Partnership
[_] Uniform Gifts to Minors Act [_] Other
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(8) NAME(S) IN WHICH STOCK IS TO BE REGISTERED (PLEASE PRINT CLEARLY)
Name(s) continued Social Security # or Tax ID
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Social Security # or Tax ID
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Street Address City State Zip Code
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(9) TELEPHONE INFORMATION Daytime Evening County of Residence
( ) ( )
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[_] (10) NASD AFFILIATION
Check here if you are a member of the National Association of Securities
Dealers, Inc. ("NASD"), a person associated with an NASD member, a member of
the immediate family of any such person to whose support such person
contributes, directly or indirectly, or the holder of an account in which an
NASD member or person associated with an NASD member has a beneficial
interest. To comply with conditions under which an exemption from the NASD's
Interpretation With Respect to Free-Riding and Withholding is available, you
agree, if you have checked the NASD Affiliation box, (i) not to sell,
transfer or hypothecate the stock for a period of 90 days following
issuance, and (ii) to report this subscription in writing to the applicable
NASD member within one day of payment therefor.
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[_] (11) ASSOCIATE--ACTING IN CONCERT
Check here, and complete the reverse side of this Form, if you or any
associates (as defined on the reverse side of this Form) or persons acting
in concert with you have submitted other orders for shares in the
Subscription and/or Community Offerings.
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(12) ACKNOWLEDGMENT
To be effective, this fully completed Stock Order Form must be actually
received by Salida Building and Loan Association, no later than 12:00 p.m.
Noon, Mountain Time, on __________, 1997, unless extended; otherwise this
Stock Order Form and all subscription rights will be void. Completed Stock
Order Forms, together with the required payment or withdrawal
authorization, may be delivered to Salida Building and Loan Association or
may be mailed to the Post Office Box indicated on the enclosed business
reply envelope. All rights exercisable hereunder are not transferable and
shares purchased upon exercise of such rights must be purchased for the
account of the person exercising such rights.
It is understood that this Stock Order Form will be accepted in accordance
with, and subject to, the terms and conditions of the Plan of Conversion of
Salida Building and Loan Association described in the accompanying
Prospectus. If the Plan of Conversion is not approved by the voting members
of Salida Building and Loan Association at a Special Meeting to be held on
____________, 1997, or any adjournment thereof, all orders will be
cancelled and funds received as payment, with accrued interest, will be
returned promptly. The undersigned agrees that after receipt by Salida
Building and Loan Association, this Stock Order Form may not be modified,
withdrawn or cancelled (unless the conversion is not completed within 45
days after the completion of the Subscription Offering) without the
Association's consent, and if authorization to withdraw from deposit
accounts at Salida Building and Loan Association has been given as payment
for shares, the amount authorized for withdrawal shall not otherwise be
available for withdrawal by the undersigned.
Under penalty of perjury, I certify that the Social Security or Tax ID
Number and the other information provided under number 8 of this Stock
Order Form are true, correct and complete that I am purchasing for my own
account and that there is no agreement or understanding regarding the
transfer of my subscription rights or the sale or transfer of these shares.
Applicable Regulations prohibit any person from transferring or entering
into any agreement directly or indirectly to transfer, the legal or
beneficial ownership of conversion subscription rights, or the underlying
securities to the account of another. Salida Building and Loan Association
and High Country Bancorp, Inc. may pursue any and all legal and equitable
remedies in the event they become aware of the transfer of subscription
rights and will not honor orders known by them to involve such transfer.
I acknowledge that the common stock offered is not a savings or deposit
account and is not federally insured or guaranteed.
A VALID STOCK ORDER FORM MUST BE SIGNED AND DATED TWICE: BELOW AND ON THE
ACKNOWLEDGEMENT FORM ON THE REVERSE HEREOF.
SIGNATURE DATE SIGNATURE DATE
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DATE REC'D
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CATEGORY
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ORDER # BATCH
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DEPOSIT
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A SIGNED ACKNOWLEDGEMENT FORM MUST ACCOMPANY ALL STOCK ORDER FORMS (SEE
REVERSE SIDE)
ITEM (6)A, B, C--(CONTINUED)
Account Title (Names on Account Account Title (Names on Account
Accounts) Number(s) Accounts) Number(s)
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ITEM (11)--(CONTINUED)
List below all other orders "Bank" is defined as: (i) any corporation or
submitted by you or your organization (other than Newport Federal
Associates (as defined) or by Savings Bank, North Arkansas Bancshares,
persons acting in concert with Inc., or a majority-owned subsidiary of
you. Newport Federal Savings Bank or North
Arkansas Bancshares, Inc.) of which such
Name(s) listed on Number of person is an officer or partner or is,
other Stock Order Shares directly or indirectly, the beneficial owner
Forms Ordered of 10% or more of any class of equity
- -------------------- ---------- securities; (ii) any trust or other estate
- -------------------- ---------- in which such person has a substantial
- -------------------- ---------- beneficial interest or as to which such
- -------------------- ---------- person serves as a director or in a similar
- -------------------- ---------- fiduciary capacity; provided, however, such
term shall not include North Arkansas
Bancshares, Inc.'s or Newport Federal
Savings Bank's employee benefit plans in
which such person has a substantial
beneficial interest or serves as a director
or in a similar fiduciary capacity; and
(iii) any relative or spouse of such person,
or any relative of such spouse, who either
has the same home as such person or who is a
Director of Newport Federal Savings Bank or
North Arkansas Bancshares, Inc. or any
subsidiaries thereof.
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A VALID STOCK ORDER FORM MUST BE SIGNED AND DATED BELOW AND ON THE FRONT OF
THIS FORM.
ACKNOWLEDGEMENT FORM
I/WE ACKNOWLEDGE THAT THIS SECURITY IS NOT A DEPOSIT OR SAVINGS ACCOUNT AND
IS NOT FEDERALLY INSURED, AND IS NOT GUARANTEED BY NEWPORT FEDERAL SAVINGS
BANK (THE "BANK") OR BY THE FEDERAL GOVERNMENT.
If anyone asserts that this security is federally insured or guaranteed, or
is as safe as an insured deposit, I should call the Office of Thrift
Supervision, Midwest Region Director, Frederick R. Casteel at (972) 281-
2000.
I/We further certify that, before purchasing the common stock, par value
$.01 per share, of North Arkansas's Bancshares, Inc., the proposed holding
company for Newport Federal Savings Bank, I/we received a Prospectus dated
, 1997 (the "Prospectus").
The Prospectus that I/we received contains disclosure concerning the nature
of the security being offered and describes the risks involved in the
investment, including but not limited to:
1. Lack of Active Market for Common Stock (page 1)
2. Below Average Return on Average Equity and Increased
Expenses Immediately After Conversion (page 1)
3. Recent Operating Results (page 1)
4. Large Delinquent Loan (page 2)
5. Nonresidential Lending (page 2)
6. Potential Impact of Changes in Interest Rates
and the Current Interest Rate Environment (page 2)
7. Market Area Limitations (page 3)
8. Dependence on President (page 3)
9. Anti-Takeover Provisions and Statutory Provisions
that Could Discourage HostileAcquisitions of Control (page 3)
10. Possible Voting Control by Directors and Officers (page 4)
11. Possible Dilutive Effect of MRP and Stock Options (page 4)
12. Financial Institution Regulation of the Thrift Industry (page 4)
13. Arkansas Usury Law (page 4)
14. Possible Adverse Tax Consequences of the
Subscription Rights (page 5)
15. Branch Acquisition (page 5)
16. Restrictions on Repurchase of Shares (page 5)
Signature Date Signature Date
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Name (Please Print) Name (Please Print)
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