Ben Franklin Financial, Inc.
Stock Center -- 6 South Dryden -- Arlington Heights, IL 60004
(847) 000-0000
Stock Order Form Instructions
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Items 1 and 2 -- Fill in the number of shares that you wish to purchase and the
total payment due. The amount due is determined by multiplying the number of
shares by the subscription price of $10.00 per share. The minimum purchase is 25
shares. 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 20,000 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 80,000 shares of Common Stock. No
person, by himself or herself, or with an Associate or group of persons acting
in concert, may subscribe for or purchase more than 20,000 shares of Common
Stock in the Public and/or Direct Community Offering.
Ben Franklin Financial, Inc. and Ben Franklin Bank of Illinois have reserved the
right to reject any order received in the Subscription Offering and Community
Offering, in whole or in part.
Item 3 -- Payment for shares may be made in cash (only if delivered by you in
person) or by check, bank draft, or money order payable to Ben Franklin
Financial, Inc. DO NOT MAIL CASH. If you choose to make a cash payment, take
your Stock Order Form, signed Certification Form, and payment in person to a
branch of Ben Franklin Bank of Illinois. Your funds will earn interest at the
Ben Franklin Bank of Illinois' passbook rate until the stock is issued.
Item 4 -- To pay by withdrawal from a savings account or certificate of deposit
of Ben Franklin Bank of Illinois, insert the account number(s) and the amount(s)
you wish to withdraw from each account. If more than one signature is required
to withdraw, each person must sign in the Signature box on the bottom of the
front of the Stock Order Form. To withdraw from an account with checking
privileges, please write a check. No early withdrawal penalty will be charged on
funds used to purchase our stock. A hold will be placed on the account(s) for
the amount(s) you indicate. Payments will remain in certificate account(s) until
the stock offering closes and will continue to earn interest at the certificate
account rate until then. However, if a partial withdrawal reduces the balance of
a certificate account to less than the applicable minimum, the remaining balance
will earn interest at the passbook rate.
Item 5 -- Please check this box if you were a depositor with $50.00 or more on
the Eligibility Record Date (January 31, 1997) and/or the Supplemental
Eligibility Record Date (March 31, 1998) and/or a depositor on the Voting Record
Date (April 30, 1998) and list all the names on the account(s) and all account
number(s) of those accounts you had at these dates to ensure proper
identification of your purchase rights.
Items 6 and 7 -- The stock transfer industry has developed a uniform system of
shareholder registrations that we will use in the issuance of Ben Franklin
Financial, Inc. common stock. Print the name(s) in which you want the stock
registered and the mailing address of the registration. Include the first name,
middle initial, and last name of the shareholder. Avoid the use of two initials.
Please omit words that do not affect ownership rights, such as "Mrs.", "Mr.",
"Drs.", "special account", etc. Subscription rights are not transferable. If you
are a qualified member, to protect your priority over other purchasers as
described in the Prospectus, you must take ownership as your account
relationship is established. If you, as a qualified member, include a
non-qualified member on your order, your priority will be lowered or eliminated.
Enter the Social Security or Tax I.D. number of one registered owner. This
registered owner must be listed on the first "Name" line. Be sure to include
your telephone number, because we will need to contact you if we cannot execute
your order as given. Review the Stock Ownership Guide on the back of this page
and refer to the instructions for Uniform Gift to Minors/Uniform Transfer to
Minors and Fiduciaries.
Items 8 and 9 -- See instructions on the form.
Item 10 -- Be sure all required persons sign.
Be sure to read and sign the Certification Form on the back of the Stock Order
Form.
4111-Ben Franklin Stock Order Form Instructions (Emerald Services)
Stock Ownership Guide
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Individual -- The stock is to be registered in an individual's name only. You
may not list beneficiaries for this ownership.
Joint Tenants -- Joint tenants with rights of survivorship (WROS) identifies two
or more owners. When stock is held by joint tenants with rights of survivorship,
ownership automatically passes to the surviving joint tenant(s) upon the death
of any joint tenant. You may not list beneficiaries for this ownership.
Tenants in Common -- Tenants in common may also identify two or more owners.
When stock is held by tenants in common, upon the death of one co-tenant,
ownership of the stock will be held by the surviving co-tenant(s) and by the
heirs of the deceased co-tenant. All parties must agree to the transfer or sale
of shares held by tenants in common. You may not list beneficiaries for this
ownership.
Individual Retirement Account -- Individual retirement account ("IRA") holders
may make stock purchases from their deposits through a pre-arranged
"trustee-to-trustee" transfer. Stock may only be held in a self-directed IRA.
Ben Franklin Bank does not offer a self-directed IRA. Please contact the Stock
Center if you have any questions about your IRA account or to obtain a list of
brokers who will open a self-directed IRA, or check with your broker. There will
be no early withdrawal or IRS penalties incurred by properly executed
transactions.
Uniform Gift to Minors/Uniform Transfer to Minors -- For residents of many
states, stock may be held in the name of a custodian for the benefit of a minor
under the Uniform Transfer to Minors Act. For residents in other states, stock
may be held in a similar type of ownership under the Uniform Gift 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: 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.
Corporation/Partnership
Corporations/Partnerships may purchase stock. Please provide the
Corporation/Partnership's legal name and Tax I.D. To have depositor rights, the
Corporation/Partnership must have an account in the legal name. Please contact
the Stock Center to verify depositor rights and purchase limitations.
Fiduciary/Trust
Generally, fiduciary relationships (such as Trusts, Estates, Guardianships,
etc.) are established under a form of trust agreement or 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 trustee, executor,
personal representative, etc.
On the second "Name" line, print either the name of the maker, donor or estator
OR the name of the beneficiary. Following the name, indicate the type of legal
document establishing the fiduciary relationship (agreement, court order, etc.).
In the blank after "Under Agreement Dated", fill the date of the document
governing the relationship. The date of the document need not be provided for a
trust created by a will.
An example of fiduciary ownership of stock in the case of a trust is: John D.
Smith, Trustee for Thomas A. Smith Under Agreement Dated 06/09/87.
4111 -- Ben Franklin Stock Order Form Instructions (Emerald Services)