EX-99.2 5 dex992.htm FORM OF ENROLLMENT FORM Form of Enrollment Form

Exhibit 99.2

Dividend Reinvestment and Stock Purchase Plan Authorization Form

 

LOGO

 

                        c/o Registrar and Transfer Co.

                        Attn: Dividend Reinvestment Dept.

                        P.O. Box 664

                        Cranford, NJ 07016-9896

  To participate in the Consumers Bancorp, Inc. Dividend Reinvestment and Stock Purchase Plan, complete and sign the reverse side of this enrollment form and return it in the enclosed envelope.
  Name 1
   
  Name 2
   
  Street Address
   
  City/State/Zip Code
   
  Daytime Telephone Number
  (                     )
  Social Security Number
                      –         –


NOTE: Return this form only if you wish to participate in the Plan. Please enroll me in the Consumers Bancorp, Inc. Dividend Reinvestment and Stock Purchase Plan.

This will authorize Consumers Bancorp, Inc. to forward to the Plan Agent all or a portion of the dividends you receive on Consumers Bancorp, Inc. common stock to be invested, together with any voluntary cash contributions you make (from $100.00 to $5,000.00 per quarter) to purchase additional shares of Consumers Bancorp, Inc. common stock. All investments and any voluntary cash contributions are made subject to the terms and conditions of the Plan as set forth in the accompanying plan document.

This authorization and appointment are given by you with the understanding that you may terminate them at any time by notifying the Plan Agent.

 

q Full Dividend Reinvestment — Please apply the dividends on all shares of Consumers Bancorp, Inc. common stock that I currently own as well as all future shares that I acquire.

 

q Partial Dividend Reinvestment — Please remit to me the dividends on                      shares. I understand that the dividends on my remaining Consumers Bancorp, Inc. shares, as well as all future Consumers Bancorp, Inc. shares that I acquire will be reinvested under the Plan.

 

q Optional Cash Payments Only — Permit me to purchase additional shares without reinvesting dividends on common stock registered in my name.

 

q Automatic Quarterly Contributions — Withdraw $                     (min. $100 and max. $5,000) from my checking or savings account below on a quarterly basis to purchase additional shares of Consumers Bancorp, Inc. common stock. My account will be debited on the 10th or next business day of the months of March, June, September and December.

(To enroll, you must complete this section and return it along with a voided check for checking accounts or a preprinted deposit slip for savings accounts. Deductions will occur each quarter five days before the Investment Date or if such date is not a business day, the preceding business day. Your financial institution can provide you with the following required information.)

Type of Account:                             q Checking                             q Savings

Financial Institution RT/ABA Number: ________________________

Checking/Savings Account Number: __________________________

 

q Safekeeping — Deposit the enclosed                      shares of Consumers Bancorp, Inc. stock for safekeeping. (To deposit your shares for safekeeping, check this box and return this form and your stock certificates via registered mail, return receipt requested, and properly insured.)

Mail completed form to:

Registrar and Transfer company

P.O. Box 664

Cranford, NJ 07016-9896

Attention: Dividend Reinvestment Department

Please sign exactly as name(s) appear on the stock certificate(s). If shares are held jointly, all holders must sign.

Signature________________ Date___________ Signature (if necessary)___________________ Date___________