Exhibit 99.6
Peoples
Bancorp, Inc
(Logo)
STOCK CENTER
134 Franklin Corner Road
Lawrenceville, NJ 08648
1-888-844-7205
(Proposed Holding Company for
Trenton Savings Bank FSB)
STOCK ORDER FORM & CERTIFICATION FORM Note: Please read the Stock Order Form
Guide and Instructions included in the packet of information before completion.
DEADLINE The Subscription Offering expires at 12:00 Noon, New Jersey time,___,
1998. Your Original Stock Order Form and Certification Form, properly executed
and with the correct payment, must be received at the Stock Center or a branch
of Trenton Savings Bank FSB by this deadline, or it will be considered void. No
photocopied or faxed Order Forms will be accepted.
NUMBER OF SHARES / AMOUNT OF PAYMENT
(1) NUMBER OF SHARES OF PEOPLES
BANCORP, INC. CURRENTLY OWNED (2) Number of Shares Price per Share (3) Total Amount Due
X $10.00 = $
(Minimum 25)
The minimum number of shares for which you may subscribe is 25. For persons who
do not currently own shares of Peoples Bancorp, Inc., the maximum purchase
limitations are as follows: (i) the maximum number of shares that any person (or
persons on a single account) may purchase in the Offering is ___ shares of
Common Stock, and (ii) the maximum number of shares that any person together
with any associate or group of persons acting in concert may purchase in the
Offering is ___ shares of Common Stock. For persons who currently own shares of
Peoples Bancorp, Inc., the share and share purchase limitations are reduced by
the product of the final Exchange Ratio and the number of shares of Peoples
Bancorp, Inc. currently owned by the person or persons submitting this Order
Form (as indicated in Item 1). The total number of shares to be sold is based on
a valuation that is subject to review prior to filling individual stock orders.
METHOD OF PAYMENT
(4) Enclosed is a check, bank draft or money order payable to PEOPLES BANCORP,
INC. for $____________________ (or cash, if presented in person).
(5) I authorize TRENTON SAVINGS BANK FSB make the withdrawals from my Harbor
Federal account(s) shown below, and understand that the amounts will not
otherwise be available for withdrawal:
PURCHASER INFORMATION
(6) Check here if you are a DIRECTOR, OFFICER or EMPLOYEE of Trenton Savings
Bank FSB or a member of such person's immediate family.
Check here if you were a depositor with at least $50.00 on deposit at the
Eligibility Record Date (August 31, 1996) and/or the Suplemental
Eligibility Record Date (December 31, 1997) and/or a depositor or borrrower
on the Voting Record Date (February 6, 1997). List all the names on the
account(s) and all the account numbers(s) of those accounts you had at
these dates to ensure proper identification of your purchase rights.
Confirm account(s) by initialing here________________.
ACCOUNT NUMBER(S) AMOUNT(S)
$
Total Withdrawal $
THERE IS NO PENALTY FOR EARLY WITHDRAWALS USED FOR THIS PAYMENT. TO WITHDRAW
FROM AN ACCOUNT WITH CHECKING PRIVILEGES, PLEASE WRITE A CHECK.
ACCOUNT TITLE (NAMES ON ACCOUNTS) ACCOUNT NUMBER
If additional space is needed, please use the back side of this form.
(7) STOCK REGISTRATION Form of stock ownership
\ \ Individual \ \ Uniform Transfer to Minors \ \ Partnership
\ \ Joint Tenants (WROS) \ \ Uniform Gift to Minors \ \ Individual Retirement Account
\ \ Tenants in Common \ \ Corporation \ \ Fiduciary/Trust (Under Agreement Dated ____________)
(8) Name Social Security or Tax I.D.
Name Daytime Telephone
Street Address Evening Telephone
City State Zip Code County of Residence
(9) NASD AFFILIATION (This section 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 FreeRiding 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 the issuance, and (ii) to report this subscription
in writing to the applicable NASD member within one day of the payment therefor.
(10) 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.
ACKNOWLEDGMENT By signing below, I acknowledge receipt of the Prospectus dated ,
1998 and the provisions therein and understand that I may not change or revoke
my order once it is received by Peoples Bancorp, Inc. I also certify that this
stock order is for my account only and there is no agreement or understanding
regarding any further sale or transfer of these shares. Federal 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
person. Trenton Savings Bank FSB 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 underreporting interest or dividends on your tax return.
(11) SIGNATURE
THIS FORM MUST BE DATED AND SIGNED IN THE SPACE PROVIDED (ALONG WITH YOUR
DATED AND SIGNED CERTIFICATION FORM ON THE REVERSE SIDE). When purchasing as a
custodian, corporate officer, etc., include your full title. An additional
signature is required only when payment is by withdrawal from an account that
requires more than one signature to withdraw funds.
SIGNATURE Title (if applicable) Date
SIGNATURE Title (if applicable) Date
YOUR ORDER WILL BE FILLED IN ACCORDANCE WITH THE PROVISIONS OF THE PROSPECTUS.
THIS ORDER IS NOT VALID IF NOT SIGNED. If you need help completing this Form,
you may call the Stock Information Center at 1-(888) 844-7205.
THE SHARES OF COMMON STOCK OFFERED HEREBY ARE NOT SAVINGS ACCOUNTS AND ARE NOT
INSURED BY THE FEDERAL DEPOSIT INSURANCE CORPORATION, THE SAVINGS ASSOCIATION
INSURANCE FUND OR ANY OTHER CORPORATION, FUND, OR GOVERNMENTAL AGENCY.
FOR OFFICE USE ONLY
Date Rec'd ____/____/____ Check # _________________ Amount $ _________________
Category _______ Order # _________ Batch _______ Initials ____
BE SURE TO COMPLETE AND SIGN THE CERTIFICATION FORM ON THE REVERSE SIDE.
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Peoples
Bancorp, Inc
(Logo)
ITEM (6) -- (CONTINUED)
ACCOUNT TITLE (NAMES ON ACCOUNTS) ACCOUNT NUMBER(S)
ACCOUNT TITLE (NAMES ON ACCOUNTS) ACCOUNT NUMBER(S)
ITEM (10) -- (CONTINUED)
List below all other orders submitted by you or your Associates (as defined)
or by persons acting in concert with you.
NAMES LISTED ON OTHER NUMBER OF SHARES ORDERED
STOCK ORDER FORMS
The term "associate," when used to indicate a relationship with any person, is
defined to mean (i) a corporation or organization (other than the Mutual Holding
Company or Bancorp, a majority-owned subsidiary of Bancorp or the Bank) 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 or in a similar fiduciary capacity,
provided, however, that such term shall not include any tax qualified employee
stock benefit plan of the Bank 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 spouse, who has
the same home as such person or who is a director or officer of Bancorp or the
Bank or any of the subsidiaries of the foregoing.
CERTIFICATION FORM
(This form must be dated and signed along with your dated and signed
Stock Order Form on the reverse side.)
I ACKNOWLEDGE THAT THE SHARES OF COMMON STOCK, $0.01 PAR VALUE PER SHARE
("COMMON STOCK"), OF PEOPLESBANCORP, INC. ("COmpany"), THE PROPOSED HOLDING
COMPANY FOR TRENTON SAVINGS BANK FSB ("THEBANK"), ARE NOT FEDERALLY INSURED AND
ARE NOT GUARANTEED BY THE COmpany, THE BANK OR 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's Northeast Regional Director, Robert Albanese at (201)
413-1000.
I further certify that, before purchasing the shares of Common Stock of the
Company, I received a copy of the Prospectus dated _____ , 1998 which discloses
the nature of the shares of Common Stock being offered thereby and describes the
following risks involved in an investment in the Common Stock under the heading
"Risk Factors" beginning on page 19 of the Prospectus:
1. Low Return of equity Following the Conversion ......................(Page )
2. Uncertaintly as to Future Growth Opportunities and Ability to Successfully
Deploy Offering Proceds ............................................(Page )
3. Independent Valuation of the Company and its Impact on the Trading Price of
Common Stocks ......................................................(Page )
4. Absence of Securities Gains ........................................(Page )
5. Possible Increase in Offering Range and Number of Shares Issued ....(Page )
6. Potential Effects of Charges in Interest Rates and the Current Interest
Rate Environment ...................................................(Page )
7. Risks Related to Increasing Portfolio of Higher Yielding Loans .....(Page )
8. Certain Anti-Takeover Provisions ...................................(Page )
9. Possible Dilutive Effect of Issujoance of Additional Shares ........(Page )
10. Higher Compensation Expenses in Future Periods .....................(Page )
11. Regulatory Oversight and Legislation ...............................(Page )
12. Capability of the Bank's Data Processing Hardware to Accommodate the Year
2000 ...............................................................(Page )
Signature Date Signature Date
Name (Please Print) Name (Please Print)
(NOTE: ALL PARTIES NAMED AS REGISTERED OWNERS IN ITEM 8 ON THE REVERSE SIDE MUST
SIGN CERTIFICATION FORM)
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