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CORPORATE PROXY
________ (the "Corporation")
________ ("Stockholder"), the undersigned, having an address at the following:
________
hereby designates the following individual as true and lawful proxy ("Proxy") for the Stockholder with the full power of substitution to represent Stockholder and vote all of Stockholder's shares with respect to the Corporation: ________.
Such Proxy shall be valid at the meeting on the following date: ________. This meeting is the annual meeting of the Corporation.
By this designation of Proxy, the Stockholder hereby revokes any and all prior proxy designations which may have been made with respect to the Stockholder's shares.
The Proxy may vote at the Proxy's sole and exclusive discretion, except with regard to the following:
________
EXECUTION:
Name of Stockholder: ________
_____________________________
Signature
_____________________________
Date
(notary page follows)
State of Alabama
County of: ______________________________
__________________________________________________________________
Notary Signature, Printed Name, and Notary/Bar Roll Number
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