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THE OFFER AND WITHDRAWAL RIGHTS WILL EXPIRE ONE MINUTE FOLLOWING 11:59 P.M., EASTERN TIME, ON SEPTEMBER 15, 2025, UNLESS THE OFFER IS EXTENDED OR EARLIER TERMINATED.
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If delivering Shares by mail:
Equiniti Trust Company, LLC
Operations Center Attn: Reorganization Department P.O. Box 525 Ridgefield Park, New Jersey 07660 |
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If delivering Shares by hand, express mail, courier or any other expedited mail service:
Equiniti Trust Company, LLC
55 Challenger Road Suite # 200 Ridgefield Park, New Jersey 07660 Attn: Reorganization Department |
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DESCRIPTION OF SHARES TENDERED
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Name(s) and Address(es) of Registered
Stockholder(s) (If blank, please fill in name(s) and address) |
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Shares Tendered* (attach additional list if necessary)
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Book Entry Shares Tendered
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| | | | | | Total Shares | | |
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*
Unless otherwise indicated, it will be assumed that all Shares described in the chart above are being tendered.
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Account Number: Transaction Code Number:
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SPECIAL PAYMENT INSTRUCTIONS
(See Instructions 1, 4, 5, and 7) |
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| | To be completed ONLY if the check for the Offer Price in consideration of Shares validly tendered and accepted for payment is to be issued in the name of someone other than the undersigned or if Shares validly tendered by book-entry transfer which are not accepted for payment are to be returned by credit to an account maintained at DTC other than that designated above. | | |
| | Issue: | | |
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Check and/or
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Shares to:
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Name
(Please Print)
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Address
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(Include Zip Code)
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(Tax Identification or Social Security Number) (Please additionally complete IRS Form W-9 (attached) or the applicable IRS Form W-8, available at irs.gov)
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SPECIAL DELIVERY INSTRUCTIONS
(See Instructions 1, 4, 5, and 7) |
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| | To be completed ONLY if the check for the Offer Price in consideration of Shares validly tendered and accepted for payment is to be sent to someone other than the undersigned or to the undersigned at an address other than that shown in the box titled “Description of Shares Tendered” above. | | |
| | Deliver: | | |
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Check and/or
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Shares to:
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Please check here if address change is permanent.
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Name
(Please Print)
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Address
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(Include Zip Code)
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| Name: | | |
(Please Print)
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| Capacity (Full Title): | | |
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| Address: | | |
(Include Zip Code)
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| Area Code and Telephone Number: | | |
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| Tax Identification or Social Security No: | | |
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| Name of Firm: | | |
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| Address: | | |
(Include Zip Code)
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| Authorized Signature: | | |
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| Name: | | |
(Please Print)
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| Area Code and Telephone Number: | | |
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| Dated: | | |
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If delivering Shares by mail:
Equiniti Trust Company, LLC
Operations Center Attn: Reorganization Department P.O. Box 525 Ridgefield Park, New Jersey 07660 |
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If delivering Shares by hand, express mail, courier or any other expedited mail service:
Equiniti Trust Company, LLC
55 Challenger Road Suite # 200 Ridgefield Park, New Jersey 07660 Attn: Reorganization Department |
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