SAMPLE PROXY CARD

 

 

 

 

 

 

 

 

 

 

 




Sample Company A
789 Corporate Drive
Headquarters, USA 56789This is the company name and address.

 

 

 

 

 

 

 

2010 Annual Meeting Admission Ticket
Tuesday, April 27, 2010
Grand Hotel Ballroom
Headquarters, USA 56788This is the date and location of the meeting.

Upon arrival, please present this admission ticket and photo identification and any other required documents.You can also use this proxy card to physically attend the meeting.

 

Mr. and Mrs. Investor

1234 Main Street

Anywhere, USA 12345

 

 

 

 

 

 

 Electronic Voting Instructions

You can vote by Internet or telephone.
Available 24 hours a day, 7 days a week

Instead of mailing your proxy, you may choose to vote on the Internet or by telephone. Validation details including Control Number are located on this form.

Please vote immediately. Your vote is important.

This describes the different methods you can vote. In many situations, you will have three options:

  • To vote by mail, use the business reply envelope that came with the proxy materials you received in the mail. Indicate your vote by filling out the Proxy Card.
  • To vote by phone, use the number provided on the Proxy Card. You will be prompted to vote using the Control Number.
  • To vote over the Internet, go to the website provided on the Proxy Card and use your Control Number to vote.

 

 

 

 

 

 

 

 

 

 

 

LOGO

 

Vote by Internet

  • Log on to the Internet and go to designated Web site.
  • Follow the steps outlined on this secured Web site.

 

 

 

 

 

 

 

  

 

  

 

 

 

 

 

 

 

 

  

 

  

 

 

 

 

 

Using a black ink pen, mark your votes with an X as shown in this example. Please do not write outside the designated areas.
 X 

 

 

 

 

LOGO

 

Vote by telephone

  • Call toll-free designated number from a touch-tone telephone. There is NO CHARGE for this call.
  • Follow the instructions provided by the recorded message.

 

 

 

 

 

 

 

  

 

  

 

    Annual Meeting Proxy Card

1234567890This is the Control Number you will use to identify yourself as a shareholder if you vote by proxy online or over the telephone.

 

 

 

 

 

 

 

 

 A. 

  

Voting Items

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

              The Board of Directors recommend voting FOR items 1 and 2

 

 

1. Election of Directors

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ForHere is where you vote for directors.  In addition to "for," you may have other options such as "against," "abstain," or "withhold."  See "What are the mechanics of voting either in person or by proxy?" for more information about what these options mean. In addition, there is a section in your proxy statement, often toward the front under a heading like "Votes Required to Adopt a Proposal," that will explain how your votes are counted.

 

AgainstHere is where you vote for directors.  In addition to "for," you may have other options such as "against," "abstain," or "withhold."  See "What are the mechanics of voting either in person or by proxy?" for more information about what these options mean. In addition, there is a section in your proxy statement, often toward the front under a heading like "Votes Required to Adopt a Proposal," that will explain how your votes are counted.

 

AbstainHere is where you vote for directors.  In addition to "for," you may have other options such as "against," "abstain," or "withhold."  See "What are the mechanics of voting either in person or by proxy?" for more information about what these options mean. In addition, there is a section in your proxy statement, often toward the front under a heading like "Votes Required to Adopt a Proposal," that will explain how your votes are counted.

    

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

01)  Rich Doe

 
   

 
   

 
   

    

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

02)  Kathy Smith

 
   

 
   

 
   

    

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

03)  Owen Jones

 
   

 
   

 
   

    

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

04)  Betty Roe

 
   

 
   

 
   

    

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

    

 

 

ForHere is where you vote for proposals other than director elections. Your options are typically "for," "against," and "abstain."   See "What are the mechanics of voting either in person or by proxy?" for more information about what these options mean. In addition, there is a section in your proxy statement, often toward the front under a heading like "Votes Required to Adopt a Proposal," that will explain how your votes are counted.

 

AgainstHere is where you vote for proposals other than director elections. Your options are typically "for," "against," and "abstain."   See "What are the mechanics of voting either in person or by proxy?" for more information about what these options mean. In addition, there is a section in your proxy statement, often toward the front under a heading like "Votes Required to Adopt a Proposal," that will explain how your votes are counted.

 

AbstainHere is where you vote for proposals other than director elections. Your options are typically "for," "against," and "abstain."   See "What are the mechanics of voting either in person or by proxy?" for more information about what these options mean. In addition, there is a section in your proxy statement, often toward the front under a heading like "Votes Required to Adopt a Proposal," that will explain how your votes are counted.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. Proposal to ratify the selection of XYZ Accounting Firm as Independent Registered Public Accounting Firm for year 2010.

 
   

 
   

 
   

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.  Management Proposal 1 You may have the chance to vote on proposals from both Management and Shareholders. Often, the Board of Directors will indicate on the proxy card whether they are "for" or "against" these proposals.

 
   

 
   

 
   

 

 

 

 

 

 

    

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.  Shareholder Proposal 1 You may have the chance to vote on proposals from both Management and Shareholders. Often, the Board of Directors will indicate on the proxy card whether they are "for" or "against" these proposals.

 
   

 
   

 
   

 

 

 

 

 

 

    

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 B. 

  

Non-Voting ItemsNon-voting matters may include technical and administrative issues. 

 

 

 

 

 

 

 

 

 

 
   

 

  Annual Report Mailing    

  Mark box with an X to

 

Change of Address — Please print your new address below.

 

 

 

Comments — Please print your comments below.

 

 

  discontinue annual report

  mailing for this account.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 C. 

  

Authorized Signatures If you vote by mail, you need to sign your card for it to be valid and counted. — This section must be completed for your vote to be counted. Date and Sign Below.

 

 

Please sign exactly as name(s) appears. Joint owners should each sign. When signing as attorney, executor, administrator, corporate officer, trustee, guardian, or custodian, please give full title.

 

 

 

 

 

 

 

 

 

 

Date (mm/dd/yyyy) — Please print date below.

 

 

 

Signature 1 — Please keep signature within the box.

 

 

 

Signature 2 — Please keep signature within the box.



                  

 

 

 

 

 

 

 

 

If voting by mail, you must complete Sections A & C and mail in the provided envelope.

(On the back of this proxy card, there may be instructions relating to broker voting. Those instructions may include language similar to that found in NYSE rules.)