EXHIBIT 99.12
FORM OF ENROLLMENT/CHANGE FORM
JUNO ONLINE SERVICES, INC.
1999 EMPLOYEE STOCK PURCHASE PLAN ("ESPP")
ENROLLMENT/CHANGE FORM
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SECTION 1: Action Complete Sections:
- ---------- -------------------------------- ---------------------------
ACTIONS |_| New Enrollment 2, 3, 6, 7 and sign
attached Stock Purchase
Agreement
|_| Payroll Deduction Change 2, 4, 7
|_| Terminate Payroll Deductions 2, 5, 7
|_| Leave of Absence 2, 6, 7
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SECTION 2: Name
- ---------- -------------------------------------------------------------
PERSONNEL Last First MI Dept.
DATA
Home Address
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Street
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City State Zip Code
Social Security #|_|_|_| - |_|_| - |_|_|_|_|
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SECTION 3: Effective with the Purchase
- ---------- Interval Beginning: Payroll Deduction Amount: ____%
of cash earnings*
NEW |_| February 1, _______
ENROLLMENT |_| August 1, _______ * Must be a multiple of 1% up to
|_| Initial Offering Period a maximum of 15% of cash
earnings
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SECTION 4: Effective with the I authorize the
- ---------- Pay Period Beginning: ___________________ following new level of
PAYROLL Month, Day and Year payroll deduction: __%
DEDUCTION of cash earnings
CHANGE
* Must be a multiple
of 1% up to a maximum
of 15% of cash
earnings
NOTE: You may reduce your rate of payroll deductions once per
---- 6-month purchase interval to become effective as soon as
possible following the filing of the change form. You
may also increase your rate of payroll deductions to
become effective as of the start date of the next
6-month interval (February 1 or August 1).
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SECTION 5: Effective with the Your election to
- ---------- Pay Period Beginning: ___________________ terminate your payroll
TERMINATE Month, Day and Year deductions for the
PAYROLL balance of the
DEDUCTIONS offering period cannot
be changed, and you
may not rejoin the
offering period at a
later date. You will
not be able to resume
participation in the
ESPP until the start
of the next offering
period.
In connection with my voluntary termination of payroll deductions,
I elect the following action regarding my ESPP payroll deductions
to date in the current purchase interval:
|_| Purchase shares of Juno Online Services, Inc. on next
scheduled purchase date
OR
|_| Refund ESPP payroll deductions collected
NOTE: If your employment terminates for any reason or your
---- eligibility status changes (<20 hrs/wk or <5 months/yr),
you will immediately cease to participate in the ESPP,
and your ESPP payroll deductions collected in that
purchase interval will automatically be refunded to you.
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SECTION 6: In connection with my leave of absence, I elect the following
- ---------- action with respect to my ESPP payroll deductions to date:
LEAVE OF
ABSENCE |_| Purchase shares of Juno Online Services, Inc. on next
scheduled purchase date
OR
|_| Refund ESPP payroll deductions collected
NOTE: If you take an unpaid leave of absence, your payroll
deductions will immediately cease. If you return to
active status within 90 days after the start of your
leave, your payroll deductions will at that time
automatically resume at the rate in effect for you when
your leave began.
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SECTION 7:
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AUTHORIZATION
_________________________________ ______________________________________
Date Signature of Employee