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EXHIBIT 99(a)
WELLINGTON HALL, LIMITED
STOCK ORDER FORM
Pursuant to the accompanying Prospectus dated __________________, 1997,
Wellington Hall, Limited (the "Company"), a corporation incorporated under the
laws of the State of North Carolina, is offering to the holders of its
outstanding Common Stock of record on __________, ___ 1997 (the "Shareholders")
the nontransferable right to subscribe (a "Right") for one additional share of
Common Stock, no par value, for each share of Common Stock held on the record
date at a price of $.50 per share. In addition, each Shareholder may subscribe
for shares in addition to those that his Rights entitle him to purchase, and if
the Shareholders in the aggregate do not subscribe for the maximum number of
shares to which they are entitled in the Rights Offering, such remaining shares
will be sold to Shareholders who have subscribed therefor (the "Subscription
Offering"), subject to proration if the offering is oversubscribed as explained
in the Prospectus. Any shares that are not sold in the Rights Offering and
Subscription Offering may be sold to persons who are not directors, officers or
Shareholders of the Company (the "Public Offering").
It is understood that this Stock Order Form is subject to the
provisions contained in the Prospectus and that Stock Order Forms will be
accepted, rejected or accepted for fewer than the number of shares ordered in
accordance with the terms of the Offerings set forth in the Prospectus. No Stock
Order Form will be accepted unless accompanied by full payment for all shares
ordered. To the extent any Stock Order Form is rejected or accepted for fewer
than the number of shares ordered, a refund of the payment attributable thereto
will be made without reduction or interest.
Unless extended by the Company, the Rights Offering and the
Subscription Offering end at 5:00 p.m. Eastern Standard Time on ___________ __,
1997 and the Public Offering ends at 5:00 p.m. Eastern Standard Time on
_________ __, 1997. Your Stock Order Form, properly executed and with correct
payment in United States dollars or check or money order payable to the order of
Lexington State Bank must be mailed or delivered in the manner indicated below
and received by Lexington State Bank, as subscription agent for the Company,
prior to the applicable deadline, or it will be considered void.
Lexington State Bank
By Mail: By Hand Delivery:
Trust Department Trust Department
Post Office Box 867 38 West First Avenue
Lexington, North Carolina 27293-0867 Lexington, North Carolina 27292
The undersigned acknowledges (i) receipt from the Company prior to the
completion of this Stock Order Form of a Prospectus dated February ___, 1997 and
of the terms therein and (ii) that after delivery to Lexington State Bank, this
order may not be modified or revoked, and certifies that (iii) that this stock
order is for the account of the undersigned only.
PLEASE COMPLETE AND SIGN THIS STOCK ORDER FORM
AND COMPLETE THE STOCK REGISTRATION INFORMATION FORM ON THE REVERSE SIDE.
The undersigned hereby orders and agrees to purchase the
number of shares of Common Stock of Wellington Hall, Limited shown
below at a price of $.50 per share:
No. of Shares Ordered
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x $.50 Purchase Price per Share
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$ Total Purchase Price Enclosed
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This is the ________ day of ____________________, 1997.
Signatures:
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Purchaser
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2
Joint Owner (if any)
STOCK REGISTRATION INFORMATION FORM
The purpose of the following information is to ensure the accurate
registration of your stock ownership in Wellington Hall, Limited.
Please print the name(s) in which your stock is to be registered and
the mailing address for the stock certificate, understanding that Rights are not
transferrable. Please check one of the boxes below to show the legal form of
ownership. If purchased for a trust, include the date of the trust agreement and
the title of the trust.
(PLEASE PRINT)
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NAME
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SOCIAL SECURITY NO./TAXPAYER I.D. NO.
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ADDITIONAL NAME IF JOINT OWNER
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SOCIAL SECURITY NO./TAXPAYER I.D. NO. OF JOINT OWNER
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MAILING ADDRESS
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CITY STATE ZIP CODE
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DAYTIME PHONE
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EVENING PHONE
Number of shares to be registered in above name(s):__________________
Legal form of ownership:
/ / Individual / / Tenants in Common
/ / Joint Tenants with Right of Survivorship / / Other __________
FOR OFFICE USE ONLY
No. of Rights Exercised
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No. of Shares Requested in Subscription Offering
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No. of Shares Requested in Public Offering
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No. of Shares Accepted
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Paid with Order $
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Refund (if any) $
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