EX-99.4 9 isba_2021xs3dxposxex994.htm EX-99.4 Document

Exhibit 99.4
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Stock Purchase Form - I hereby appoint the PLAN ADMINISTRATOR as my agent under the terms and conditions of the Plan, as described in the Prospectus for the Plan, to receive and apply the following to the purchase of shares, without charge, as provided in the Plan:
Optional Cash Investment
¨CHECK OR MONEY ORDER - The amount payable on the enclosed check or money order made payable to Isabella Bank Corporation. Check Amount: _______________ subject to any minimum or maximum amounts set by Isabella Bank Corporation from time to time.
¨AUTOMATIC BANK WITHDRAWAL - $_______________, automatically deducted from the bank account identified below subject to any minimum or maximum amounts sets by Isabella Bank Corporation from time to time.
Type of account: ¨ Checking ¨ Savings. Account #:____________________
¨I do NOT wish to have my shares reinvested.
Date: ___________________________________________________________________________________________
Signature(s): _____________________________________________________________________________________
Signature(s): _____________________________________________________________________________________
Please print names(s)_________________________________________#_____________________________________
and Shareholder ID #
                                  __________________________________________#____________________________________
Social Security Number: ____________________________________________________________________________
Address: _________________________________________________________________________________________
City, State, Zip ____________________________________________________________________________________
Phone Number ____________________________________________________________________________________
E-Mail Address ___________________________________________________________________________________
Please sign and return to Shareholder Services Department
Shareholder Department Use Only
Number of Shares _______________ Price _______________