PROXY

KNOW ALL MEN BY THESE PRESENTS:

I, ______________________, in my capacity as President of

_______________________, a stockholder of the __________________________, and by
virtue of the powers vested in me by its Board of Directors, hereby make, constitute and
appoint ___________________________ or, in his absence or inability, the Chairman of the
Meeting, as my true and lawful proxy, for me and in my name, place and stead, to attend and
represent __________________ at the Annual Stockholders’ Meeting of the
____________________________ on _____________________, including the adjournment
thereof, and thereat to vote upon all shares of stock owned by __________________ in all
matters and for the transaction of any and all business that may come before the said meeting
as fully and with effects as I could if personally present and voting, and hereby ratifying and
confirming all that my said proxy may do or cause to be done by virtue hereof.

The power and authority herein granted shall only be valid for purposes of attending
the _______________ Annual Stockholders’ Meeting of the ___________________, and
shall be automatically revoked thereafter.

________________________ ______________________
Date (Name and Signature of Stockholder)

WITNESSES:

___________________________ ______________________________
Printed Name & Signature Printed Name & Signature