Proxy Voting Form Template

PROXY FORM

Company Name: Company Name

Meeting Type: Annual Meeting Special Meeting

Meeting Date: Date

Meeting Time: Time

Meeting Location: Address / Virtual Platform

APPOINTMENT OF PROXY

The undersigned shareholder of Company Name hereby appoints:

PRIMARY PROXY:

Name: Proxy Name

Address: Proxy Address

OR, if unavailable, ALTERNATE PROXY:

Name: Alternate Name

Address: Alternate Address

as the lawful attorney and proxy of the undersigned, with full power of substitution, to represent and vote all shares of Common/Preferred Stock that the undersigned is entitled to vote at the Annual/Special Meeting of Shareholders to be held on Date at Time at Location, and at any adjournment or postponement thereof.

SHAREHOLDER INFORMATION

Shareholder Name: _______________________

Number of Shares Held: _________ shares of Class Stock

Account/Certificate Number: _______________________

VOTING INSTRUCTIONS

THIS PROXY WILL BE VOTED AS DIRECTED. IF NO DIRECTION IS GIVEN, THIS PROXY WILL BE VOTED FOR/AGAINST/AS PROXY DETERMINES ALL PROPOSALS.

### PROPOSAL 1: ELECTION OF DIRECTORS

To elect Number directors to serve until the next annual meeting and until their successors are elected.

Nominees:

• Director Name 1
• Director Name 2
• Director Name 3
• Director Name 4

INSTRUCTION:

FOR all nominees listed WITHHOLD AUTHORITY to vote for all nominees

FOR all nominees EXCEPT the following: ___________________

### PROPOSAL 2: Description - e.g., Ratification of Independent Auditors

To ratify the appointment of Auditor Firm Name as the independent registered public accounting firm for the fiscal year ending Date.

FOR AGAINST ABSTAIN

### PROPOSAL 3: Description - e.g., Approval of Stock Option Plan

To approve the Year Stock Option Plan authorizing issuance of up to Number shares.

FOR AGAINST ABSTAIN

### PROPOSAL 4: Description - e.g., Amendment to Articles of Incorporation

To approve amendment to Articles of Incorporation to describe amendment.

FOR AGAINST ABSTAIN

### PROPOSAL 5: Description - if applicable

Description of proposal

FOR AGAINST ABSTAIN

### OTHER BUSINESS

In their discretion, the proxies are authorized to vote upon such other business as may properly come before the meeting or any adjournment thereof.

Grant discretionary authority to proxies AGAINST any other business ABSTAIN on other business

SPECIAL INSTRUCTIONS

Additional Instructions or Comments:

_____________________________________________

_____________________________________________

_____________________________________________

REVOCATION AND REPLACEMENT

This proxy is revocable and may be revoked at any time before it is exercised by:

1. Delivering written notice of revocation to the Company Secretary 2. Submitting a later-dated proxy 3. Attending the meeting and voting in person

This proxy revokes all prior proxies given by the undersigned.

AUTHORITY

The proxy holders named above, or their substitutes, are hereby authorized and directed to vote or act with respect to all shares of stock which the undersigned would be entitled to vote or act upon, with all powers the undersigned would possess if personally present.

ACKNOWLEDGMENT

The undersigned acknowledges receipt of: Notice of Meeting Proxy Statement dated Date Year Annual Report

Other materials: ___________________

SIGNATURE

PLEASE SIGN EXACTLY AS NAME APPEARS ABOVE

If shares are held jointly, each holder should sign. When signing as attorney, executor, administrator, trustee, guardian, or corporate officer, please give full title.

Signature: _______________________

Print Name: _______________________

Date: _______________________

Second Shareholder (if joint ownership):

Signature: _______________________

Print Name: _______________________

Date: _______________________

IF SIGNING ON BEHALF OF A CORPORATION OR OTHER ENTITY:

Entity Name: _______________________

State of Organization: _______________________

Authorized Signature: _______________________

Print Name: _______________________

Title: _______________________

Date: _______________________

CORPORATE SEAL - if applicable

INSTRUCTIONS FOR RETURNING PROXY

DEADLINE: This proxy must be received by Time on Date

Return Methods:

Mail:

Company Name Attention: Corporate Secretary Address City, State ZIP

Email: Email Address

Fax: Fax Number

In Person: Deliver to Company's principal office at Address

Online: URL if electronic submission available

IMPORTANT NOTICE

• If you plan to attend the meeting and vote in person, you do not need to return this proxy
• Returning this proxy does not prevent you from attending the meeting and voting in person
• Your vote is important - please complete and return promptly
• If you have questions, contact: Contact Name at Phone or Email

FOR COMPANY USE ONLY:

Received Date: ___________

Received By: ___________

Recorded: Yes

System Entry Date: ___________