AUTHORIZATION (PROXY) TO VOTE SHARES
Date: [DATE] The undersigned, the record owner of [COMPANY NAME] Corporation's Share Certificate No. [N], representing [N] shares of stock in the [COMPANY NAME] Corporation, authorizes [N] to vote the aforementioned shares at the Corporation's shareholders' meeting to be held at the following time, date and location: Time: [TIME] Date: [DATE] Location: [LOCATION] By virtue of this proxy, [N] shall have the right to vote for the election of directors and on any other business that may be raised properly at the meeting.