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Exhibit 99.2
COLUMBIA FINANCIAL OF
KENTUCKY, INC.
Proposed Holding Company for Columbia Federal Savings Bank
Stock Information Center
2497 Dixie Highway
Ft. Mitchell, Kentucky 41017-3085
(606) XXX-XXXX
STOCK ORDER FORM
________________________________________________________________________________
DEADLINE The Subscription Offering ends at X:XX P.M., Eastern time, on March XX,
1998. Your Stock Order and Certification Form, properly executed and with the
correct payment, must be received at the address on the top of this form or at
any other office of Columbia Federal Savings Bank by this deadline, or it will
be considered void.
________________________________________________________________________________
The minimum number of shares that may be subscribed
(1) Number of Shares Price Per Share (2) Total Amount Due for is 25. The maximum individual subscription is
------------------- ----------------------- 15,000 shares. No person, together with associates
| | x $10.00 = | | and persons acting in concert with such person may
------------------- ----------------------- purchase more than 30,000 of the shares sold in
the Conversion. There are additional purchase
limitations for associates and groups acting in
concert as defined in the Prospectus.
_______________________________________________________________________________
METHOD OF PAYMENT
(3) / /Enclosed is a check, bank draft or money order payable to Columbia
Financial of Kentucky, Inc., for $_________________ (or cash if
presented in person).
(4)/ / I authorize Columbia Federal Savings Bank to make withdrawals from my
Columbia Federal Savings Bank certificate or savings account(s) shown
below, understand that there will be no penalty for early withdrawal
and understand that the amounts will not otherwise be available for
withdrawal:
ACCOUNT NUMBER(S) AMOUNT(S)
________________________________________________________________________________
|
________________________________________________________|_______________________
|
________________________________________________________|_______________________
|
________________________________________________________|_______________________
|
________________________________________________________|_______________________
|
TOTAL WITHDRAWAL |_______________________
________________________________________________________________________________
(5)/ / Check here if you are a director, officer or employee of Columbia Federal
Savings Bank or a member of such person's immediate family.
________________________________________________________________________________
(6)/ / ASSOCIATE - ACTING IN CONCERT
Check here, and complete the reverse side of this form, if you or any
associate (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
Offering and/or Direct Community Offering.
________________________________________________________________________________
(7) PURCHASER INFORMATION
a./ / Eligible Account Holder Check here if you were a depositor with $50.00 or
more on deposit with Columbia Federal Savings Bank as of 09/30/96. Enter
information below for all deposit accounts that you had at Columbia
Federal Savings Bank on 09/30/96.
b./ / Supplemental Eligible Account Holder - Check here if you were a depositor
with $50.00 or more on deposit with Columbia Federal Savings Bank as of
12/31/97 but are not an Eligible Account Holder. Enter information below
for all deposit accounts that you had at Columbia Federal Savings Bank on
12/31/97.
c./ / Other Member - Check here if you were a depositor of Columbia Federal
Savings Bank as of XX/XX/XX, or a borrower of Columbia Federal Savings
Bank as of XX/XX/XX whose loan was in existence on 12/16/95, but are
not an Eligible Account Holder or a Supplemental Eligible Account
Holder. Enter information below for all deposit and loan accounts that you
had at Columbia Federal Savings Bank on XX/XX/XX.
d./ / Local Community - Check here if you are a permanent resident of either
Boone County or Kenton County, Kentucky.
ACCOUNT TITLE (NAMES ON ACCOUNTS) AMOUNT NUMBER
________________________________________________________________________________
|
___________________________________________|____________________________________
|
___________________________________________|____________________________________
|
___________________________________________|____________________________________
(additional space on back of form)
________________________________________________________________________________
(8) STOCK REGISTRATION
/ / Individual / / Uniform Transfer to Minors / / Partnership
/ / Joint Tenants / / Uniform Gift to Minors / / Individual Retirement Account
/ / Tenants in Common / / Corporation / / Fiduciary/Trust (Under Agreement Dated _________)
___________________________________________________________________________________________________________________________________
|
|
Name |Social Security or Tax I.D.
___________________________________________________________________________________________|_______________________________________
|
|
Name |Social Security or Tax I.D.
___________________________________________________________________________________________|_______________________________________
|
Street |Daytime
Address |Telephone
___________________________________________________________________________________________|_______________________________________
|
Zip |Evening
City State Code County |Telephone
___________________________________________________________________________________________|_______________________________________
________________________________________________________________________________
/ / NASD AFFILIATION (This section only applies to those individuals who meet
the delineated criteria)
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 three months following the issuance and (ii) to report this
subscription in writing to the applicable NASD member within one day of the
payment therefor.
________________________________________________________________________________
ACKNOWLEDGMENT By signing below, I acknowledge receipt of the Prospectus dated
XXXXX XX, 199X and understand I may not change or revoke my order once it is
received by Columbia Financial of Kentucky, Inc. I also certify that this stock
order is for my account and there is no agreement or understanding regarding any
further sale or transfer of these shares. Applicable regulations prohibit any
persons 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 person. Columbia Federal
Savings Bank will pursue any and all legal and equitable remedies in the event
it becomes aware of the transfer of subscription rights and will not honor
orders known by it to involve such transfer. Under penalties of perjury, I
further certify that: (1) the social security number or taxpayer identification
number given above is correct; and (2) I am not subject to backup withholding.
You must cross out this item, (2) above, if you have been notified by the
Internal Revenue Service that you are subject to backup withholding because of
under-reporting interest or dividends on your tax return. By signing below, I
also acknowledge that I have not waived any rights under the Securities Act of
1933 and the Securities Exchange Act of 1934.
SIGNATURE THIS FORM MUST BE SIGNED AND DATED TWICE: HERE AND ON THE
CERTIFICATION FORM ON THE REVERSE HEREOF. THIS ORDER IS NOT VALID IF THE STOCK
ORDER FORM AND CERTIFICATION FORM ARE NOT BOTH SIGNED. YOUR ORDER WILL BE FILLED
IN ACCORDANCE WITH THE PROVISIONS OF THE PROSPECTUS. When purchasing as a
custodian, corporate officer, etc., include your full title. An additional
signature is required only if payment is by withdrawal from an account that
requires more than one signature to withdraw funds.
THE SHARES OF COMMON STOCK OFFERED HEREBY ARE NOT SAVINGS ACCOUNTS AND ARE NOT
INSURED OR GUARANTEED BY THE FEDERAL DEPOSIT INSURANCE CORPORATION, THE SAVINGS
ASSOCIATION INSURANCE FUND OR ANY OTHER GOVERNMENTAL AGENCY.
________________________________________________________________________________
Signature Title (if applicable) Date
________________________________________________________________________________
Signature Title (if applicable) Date
________________________________________________________________________________
________________________________________________________________________________
FOR OFFICE Date Rec'd____/____/____ Check # ____________________
USE Amount $________________ Category ___________________
Batch # _________ - _____________Order # Deposit $___________________
________________________________________________________________________________
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COLUMBIA FINANCIAL OF KENTUCKY, INC.
Proposed Holding Company for Columbia Federal Savings Bank
________________________________________________________________________________
ITEM (6) CONTINUED; ASSOCIATE - ACTING IN CONCERT DEFINITION OF ASSOCIATE
The term "associate" of a person is defined to mean (i) any
ASSOCIATE LISTED ON NUMBER OF corporation or other organization (other than Columbia Financial
OTHER STOCK ORDERS SHARES ORDERED of Kentucky, Inc. ("Company"), Columbia Federal Savings Bank
____________________________________________________________ ("Columbia Federal Savings"), or a majority owned subsidiary of
_________________________________|__________________________ Columbia Federal Savings, of which such person is a director,
_________________________________|__________________________ officer or partner or is directly or indirectly the beneficial
_________________________________|__________________________ owner 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 trustee
ITEM (7) CONTINUED; PURCHASER INFORMATION or in a similar fiduciary capacity, provided, however, that such
____________________________________________________________ term shall not include any tax-qualified employee stock benefit
ACCOUNT TITLE (NAMES ON ACCOUNT) ACCOUNT NUMBER plan of the Company or Columbia Federal Savings in which such
____________________________________________________________ person has a substantial beneficial interest or serves as a
_________________________________|__________________________ trustee or in a similar fiduciary capacity; and (iii) any relative
_________________________________|__________________________ or spouse of such person, or any relative of such person, who
_________________________________|__________________________ either has the same home as such person or who is a director or
_________________________________|__________________________ officer of the Company or Columbia Federal Savings or any of their
subsidiaries.
________________________________________________________________________________
CERTIFICATION FORM
(This Certification Must Be Signed
In Addition to the Stock Order Form On Reverse Hereof)
I ACKNOWLEDGE THAT THE SHARES OF COMMON STOCK, NO PAR VALUE PER SHARE, OF
COLUMBIA FINANCIAL OF KENTUCKY, INC.,IS NOT A DEPOSIT OR AN ACCOUNT AND IS NOT
FEDERALLY INSURED, AND IS NOT GUARANTEED BY COLUMBIA FEDERAL SAVINGS BANK OR BY
THE FEDERAL GOVERNMENT.
If anyone asserts that the shares of common stock are federally insured or
guaranteed, or are as safe as an insured deposit, I should call the Office of
Thrift Supervision Central Regional Director, Ronald N. Karr, at (312) 917-5000
.
I further certify that, before purchasing the shares of common stock of Columbia
Financial of Kentucky, Inc., I received a copy of the Prospectus dated XXXXXX
XX, 199X which discloses the nature of the common shares being offered thereby
and describes the following risks involved in an investment in the common shares
under the heading "Risk Factors" on page 1 of the Prospectus:
1. Low Return on Assets and Low Return on Equity
2. Reduction on Return on Equity Due to Proceeds of Offering
3. Competition in Market Area
4. Interest Rate Risk
5. Dilutive Effect and Expense of the ESOP, the Stock Option Plan and the
RRP
6. Limited Market for the Common Shares
7. Legislation and Regulation Which May Adversely Affect Columbia Federal's
Earnings and Operations
8. Anti-Takeover Provisions Which May Discourage Sales of Common Shares for
Premium Prices and Controlling Influence of Management
9. Risk of Delayed Offering
10. Dilutive Effect of Increase in Valuation Range
11. Possible Tax Liability Related to Subscription Rights
____________________________________ _____________________________________
Signature Date Signature Date
____________________________________ _____________________________________
(NOTE: IF STOCK IS TO BE HELD JOINTLY, BOTH PARTIES MUST SIGN)
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