EX-99.5 8 d130240dex995.htm EX-99.5 EX-99.5

EXHIBIT 99.5

 

  STOCK ORDER FORM    

For Internal Use Only

 

              
 

LOGO

 

SEND OVERNIGHT PACKAGES TO:

Stock Information Center

c/o Keefe, Bruyette & Woods

18 Columbia Turnpike, Suite 100

Florham Park, NJ 07932

Call us toll-free,

at 1-(844) 265-9680

 

   

BATCH #                              ORDER #                           CATEGORY #                          

 

REC’D                                                              O                              C                          

 

 
 

ORDER DEADLINE & DELIVERY: A Stock Order Form, properly completed and with full payment, must be received (not postmarked) before 2:00 p.m., Eastern Time, on June 15, 2021. Subscription rights will become void after the deadline. Stock Order Forms can be delivered by using the enclosed Stock Order Reply Envelope or by paying for overnight delivery to the Stock Information Center address on this form. You may also hand-deliver to Blue Foundry Bank’s office located at 217 Rock Road, Glen Rock, New Jersey. Hand delivered stock order forms will only be accepted at this location. You may not hand deliver this form to any other Blue Foundry Bank office. Do not mail Stock Order Forms to any of Blue Foundry Bank’s offices. Faxes or copies of this form are not required to be accepted.

 

 

    PLEASE PRINT CLEARLY AND COMPLETE ALL APPLICABLE SHADED AREAS. READ THE ENCLOSED STOCK ORDER FORM INSTRUCTIONS (BLUE SHEET) AS YOU COMPLETE THIS FORM.
    (1) NUMBER OF SHARES   PRICE PER SHARE   (2) TOTAL PAYMENT DUE         

(4) METHOD OF PAYMENT – DEPOSIT ACCOUNT WITHDRAWAL

The undersigned authorizes withdrawal from the Blue Foundry Bank deposit account(s) listed below. There will be no early withdrawal penalty applicable for funds authorized on this form. Funds designated for withdrawal must be in the listed account(s) at the time this form is received. IRA and other retirement accounts held at Blue Foundry Bank and accounts with check-writing privileges may NOT be listed for direct withdrawal below.

 

   
          x $10.00 =   $                               .00           
   

Minimum Number of Shares: 25 ($250). Maximum Number of Shares: 40,000 ($400,000).

See Stock Order Form Instructions for more information regarding maximum number of shares.

          
          

 

For Internal Use

Only

  

 

Blue Foundry Bank

Deposit Account Number

 

 

Withdrawal

Amount(s)

   
    (3) METHOD OF PAYMENT – CHECK OR MONEY ORDER           
                           

$                         .00   

   
    Enclosed is a personal check, bank check or money order payable directly to Blue Foundry Bancorp, in the amount of:   $                               .00                  

$                         .00   

   
   

Cash, wire transfers and third party checks will not be accepted for this purchase. Checks and money orders will be cashed upon receipt. Blue Foundry Bank line of credit checks may not be remitted as payment.

                 

$                         .00   

   
                       
                     

Total Withdrawal Amount  

 

$                         .00   

   
                            

ATTACH A SEPARATE PAGE IF ADDITIONAL SPACE IS NEEDED.

       
(5) PURCHASER INFORMATION     ACCOUNT INFORMATION – SUBSCRIPTION OFFERING    

Subscription Offering. Check the one box that applies, as of the earliest eligibility date, to the purchaser(s) listed in Section 9:

 

a.  LOGO   Depositors of Blue Foundry Bank with aggregate balances of at least $50 at the close of business on December 31, 2019.

 

b.  LOGO   Depositors of Blue Foundry Bank with aggregate balances of at least $50 at the close of business on March 31, 2021.

 

c.  LOGO   Depositors of Blue Foundry Bank at the close of business on May 5, 2021.

 

CommunityOffering. If (a), (b) or (c) above do not apply to the purchaser(s) listed in Section 9, check the first box that applies to this order:

 

d.  LOGO   You are a resident of Bergen, Morris, Passaic, Essex or Hudson County, New Jersey.

 

e.  LOGO   You are placing an order in the Community Offering, but (d) above does not apply.

 

If you checked box (a), (b) or (c) under ‘‘Subscription Offering,’’ please provide the following information as of the eligibility date under which purchaser(s) listed in Section 9 below qualify in the Subscription Offering:

 

   

Account Title

(Name(s) on Account)

  

Blue Foundry Bank

Deposit Account Number

          
          
   

 

NOTE: NOT LISTING ALL ELIGIBLE ACCOUNTS, OR PROVIDING INCORRECT OR INCOMPLETE INFORMATION, COULD RESULT IN THE LOSS OF ALL OR PART OF ANY SHARE ALLOCATION. ATTACH A SEPARATE PAGE IF ADDITIONAL SPACE IS NEEDED.

 

(6) MANAGEMENT Check if you are a Blue Foundry, MHC, Blue Foundry Bancorp-NJ or Blue Foundry Bank:    

LOGO     Director     LOGO     Officer     LOGO     Employee     LOGO     Immediate family member, as defined in the Stock Order Form Instructions

 

   
    (7) MAXIMUM PURCHASER IDENTIFICATION    
   
   

 

LOGO    Check here if you, individually or together with others (see Section 8), are subscribing in the Subscription Offering for the maximum purchase allowed and are interested in purchasing more shares if the maximum purchase limitation(s) is/are increased. If you do not check the box, you will not be contacted and resolicited in the event the maximum purchase limitations are increased.

   
   
    (8) ASSOCIATES/ACTING IN CONCERT    
   

LOGO    Check here if you, or any associate or persons acting in concert with you, have submitted other orders for shares in the Subscription Offering. If you check the box, list below all other orders submitted by you or your associates or by persons acting in concert with you. (This Section 8, including definitions used herein, is continued on reverse side of this form)

   
   

    Name(s) listed in Section 9 on other Stock Order Forms

  Number of shares      

Name(s) listed in Section 9 on other Stock Order Forms

  Number of shares    
           
                       
           
                       
                         
   

(9) STOCK REGISTRATION The name(s) and address that you provide below will be reflected on your stock ownership statement, and will be used for other communications related to this order. Please PRINT clearly and use full first and last name(s), not initials. If purchasing in the Subscription Offering, you may not add the name(s) of persons/entities who do not have subscription rights or who qualify only in a lower purchase priority than yours. See Stock Order Form Instructions for further guidance.

 

   
     
    LOGO   Individual   LOGO   Tenants in Common  

LOGO   Uniform Transfers to Minors Act (for reporting SSN, use minor’s)

            FOR TRUSTEE/BROKER USE ONLY:    
     
    LOGO   Joint Tenants   LOGO   Corporation   LOGO   Partnership   LOGO   Trust – Under Agreement Dated                                     LOGO   Other                                    LOGO   IRA (SSN of Beneficial Owner)             -            -                 
   

  First Name, Middle Initial, Last Name

 

Reporting SSN/Tax ID No.

   
       
   

  First Name, Middle Initial, Last Name

 

SSN/Tax ID No.

   
       
   

  Street

 

Daytime Phone #

   
             
   

  City

 

State

 

Zip

 

County (Important)

 

Evening Phone #

   
                         
    (10) ACKNOWLEDGMENT AND SIGNATURE(S)    
   

I acknowledge that, to be effective, this form, properly completed, together with full payment, must be received before 2:00 p.m., Eastern Time, on June 15, 2021, otherwise this form and all subscription rights will be void. (continued on reverse side of this form)

   
   

—   ORDER NOT VALID UNLESS SIGNED   —

   
   
   

ONE SIGNATURE REQUIRED, UNLESS SECTION 4 OF THIS FORM INCLUDES ACCOUNTS REQUIRING MORE THAN ONE SIGNATURE TO AUTHORIZE

WITHDRAWAL. IF SIGNING AS A CUSTODIAN, TRUSTEE, CORPORATE OFFICER, ETC., PLEASE INCLUDE YOUR FULL TITLE.

   
                
   

Signature (title, if applicable)

 

Date

    

Signature (title, if applicable)

   Date    
                           

(over)  

 


STOCK ORDER FORM – SIDE 2

(8) ASSOCIATES/ACTING IN CONCERT (continued from front of Stock Order Form)

Associate – The term “associate” of a person means:

 

  (1)

any corporation or organization (other than Blue Foundry Bank, Blue Foundry Bancorp, Blue Foundry Bancorp-NJ or Blue Foundry, MHC or a majority-owned subsidiary of any of those entities) of which the person is a senior officer, partner or, directly or indirectly, 10% beneficial shareholder;

  (2)

any trust or other estate in which the person has a substantial beneficial interest or serves as a trustee or in a similar fiduciary capacity; provided, however, it does not include any employee stock benefit plan in which the person has a substantial beneficial interest or serves as trustee or in a similar fiduciary capacity; and

  (3)

any person who is related by blood or marriage to such person and who either lives in the same home as such person or who is a director or officer of Blue Foundry, MHC, Blue Foundry Bancorp-NJ or Blue Foundry Bank.

Acting in concert – The term “acting in concert” means:

 

  (1)

knowing participation in a joint activity or interdependent conscious parallel action towards a common goal whether or not pursuant to an express agreement; or

  (2)

a combination or pooling of voting or other interests in the securities of an issuer for a common purpose pursuant to any contract, understanding, relationship, agreement or other arrangement, whether written or otherwise.

A person or company that acts in concert with another person or company (“other party”) will also be deemed to be acting in concert with any person or company who is also acting in concert with that other party, except that any tax-qualified employee stock benefit plan will not be deemed to be acting in concert with its trustee or a person who serves in a similar capacity solely for determining whether common stock held by the trustee and common stock held by the employee stock benefit plan will be aggregated.

We have the sole discretion to determine whether prospective purchasers are “associates” or “acting in concert.” Persons having the same address, persons exercising subscription rights through a single qualifying deposit account held jointly and persons exercising subscription rights through qualifying deposit accounts registered at the same address, will be deemed to be acting in concert unless we determine otherwise. The board of directors are not treated as associates of each other solely because of their membership on the board of directors.

Please see the Prospectus section entitled “The Conversion and Stock Offering – Additional Limitations on Common Stock Purchases” for more information on purchase imitations.

 



(10) ACKNOWLEDGMENT AND SIGNATURE(S) (continued from front of Stock Order Form)

I acknowledge that, after receipt by Blue Foundry Bancorp, this Stock Order Form may not be modified or canceled without Blue Foundry Bancorp consent, and that if withdrawal from a deposit account has been authorized, the authorized amount will not otherwise be available for withdrawal. Under penalty of perjury, I certify that (1) the Social Security or Tax ID information and all other information provided hereon are true, correct and complete, (2) I am purchasing shares solely for my own account and that there is no agreement or understanding regarding the sale or transfer of such shares, or my right to subscribe for shares, and (3) I am not subject to backup withholding tax [cross out (3) if you have been notified by the IRS that you are subject to backup withholding]. I acknowledge that my order does not conflict with the overall purchase limitation of $400,000 in all categories of the offering combined, for any person or entity, together with any associates or persons acting in concert with such person or entity,as set forth in the plan of conversion, and the Prospectus dated             , 2021.

Subscription rights pertain to those eligible to subscribe in the Subscription Offering. Subscription rights are only exercisable by completing and submitting a Stock Order Form, with full payment for the shares subscribed for. Federal regulations prohibit any person from transferring or entering into any agreement directly or indirectly to transfer the legal or beneficial ownership of subscription rights, or the underlying securities, to the account of another.

I ACKNOWLEDGE THAT THE SHARES OF COMMON STOCK ARE NOT DEPOSITS OR ACCOUNTS AND ARE NOT INSURED OR GUARANTEED BY THE FEDERAL DEPOSIT INSURANCE CORPORATION OR ANY OTHER GOVERNMENT AGENCY.

If anyone asserts that the shares of common stock are federally insured or guaranteed, or are as safe as an insured deposit, I should call the Board of Governors of the Federal Reserve System at (202) 452-3000.

I further certify that, before subscribing for shares of the common stock of Blue Foundry Bancorp, I received the Prospectus dated             , 2021, and I have read the terms and conditions described in the Prospectus, including disclosure concerning the nature of the security being offered and the risks involved in the investment, described by Blue Foundry Bancorp in the “Risk Factors” section, beginning on page 18. Risks include, but are not limited to the following:

Risks Related to COVID-19

 

1.

The COVID-19 pandemic has had and may continue to have an adverse impact on our business, results of operations and prospects.

Risks Related to Economic Conditions

 

2.

A worsening of economic conditions in our market area could reduce demand for our products and services and/or result in increases in our level of non-performing loans, which could adversely affect our operations, financial condition and earnings.

 

3.

The geographic concentration of our loan portfolio and lending activities makes us vulnerable to a downturn in our local market area.

Risks Related to Growth

 

4.

Our business strategy includes growth, and our financial condition and results of operations could be negatively affected if we fail to grow or fail to manage our growth effectively.

 

5.

Building market share through de novo branching may cause our expenses to increase faster than revenues.

 

6.

New lines of business or new products and services may subject us to additional risks.

Risks Related to Interest Rate Risk

 

7.

Future changes in interest rates may reduce our profits.

Risks Related to Lending Activities

 

8.

Because we intend to increase our commercial real estate and commercial loan originations, our lending risk will increase.

 

9.

If our allowance for loan losses is not sufficient to cover actual loan losses, our earnings and capital could decrease.

 

10.

If our non-performing assets increase, our earnings will be adversely affected.

Risks Related to Competition

 

11.

Strong competition within our market area may limit our growth and profitability.

Risks Related to Operations and Security

 

12.

We face significant operational risks because the nature of the financial services business involves a high volume of transactions.

 

13.

Cyber-attacks or other security breaches could adversely affect our operations, net income or reputation.

 

14.

Risks associated with system failures, interruptions, or breaches of security could negatively affect our earnings.

 

15.

We depend on our management team, many of whom are new to Blue Foundry Bank, to implement our business strategy and execute successful operations and we could be harmed by the loss of their services.

 

16.

Our cost of operations is high relative to our revenues.

 

17.

The cost of additional finance and accounting systems, procedures and controls in order to satisfy our new public company reporting requirements will increase our expenses.

 

18.

We are a community bank and our ability to maintain our reputation is critical to the success of our business and the failure to do so may materially adversely affect our performance.

 

19.

Our risk management framework may not be effective in mitigating risk and reducing the potential for significant losses.

Risks Related to Regulatory Matters

 

20.

Changes in laws and regulations and the cost of regulatory compliance with new laws and regulations may adversely affect our operations and/or increase our costs of operations.

 

21.

We are subject to stringent capital requirements, which may adversely impact our return on equity, require us to raise additional capital, or restrict us from paying dividends or repurchasing shares.

 

22.

Non-compliance with the USA PATRIOT Act, Bank Secrecy Act, or other laws and regulations could result in fines or sanctions.

 

23.

Changes in management’s estimates and assumptions may have a material impact on our consolidated financial statements and our financial condition or operating results.

Risks Related to the Stock Offering

 

24.

The future price of the shares of common stock may be less than the $10.00 purchase price per share in the stock offering.

 

25.

Our failure to effectively deploy the net proceeds may have an adverse effect on our financial performance.

 

26.

Our return on equity will be low following the stock offering. This could negatively affect the trading price of our shares of common stock.

 

27.

Our stock-based benefit plans will increase our expenses and reduce our income.

 

28.

The implementation of stock-based benefit plans may dilute your ownership interest.

 

29.

The cost of a withdrawal from our multiple-employer defined benefit pension plan may be greater than estimated.

 

30.

Various factors may make takeover attempts more difficult to achieve.

 

31.

There may be a limited trading market in our shares of common stock, which would hinder your ability to sell our common stock and may lower the market price of our common stock.

 

32.

Our stock value may be negatively affected by applicable regulations that restrict stock repurchases.

 

33.

You may not revoke your decision to purchase Blue Foundry Bancorp common stock in the subscription or community offerings after you send us your order.

 

34.

We are an emerging growth company within the meaning of the Securities Act, and because we expect to take advantage of certain exemptions from various reporting requirements applicable to emerging growth companies, our common stock could be less attractive to investors.

 

35.

The distribution of subscription rights could have adverse income tax consequences.

Risks Related to the Charitable Foundation

 

36.

The contribution to the charitable foundation will dilute your ownership interest and adversely affect net income in 2021.

 

37.

Our contribution to the charitable foundation may not be tax deductible, which could reduce our profits.

 

By executing this form, I acknowledge that I am not waiving any rights under federal or state securities laws, including the Securities Act of 1933 and the Securities Exchange Act of 1934.

½ See Front of Stock Order Form




BLUE FOUNDRY BANCORP

STOCK INFORMATION CENTER: 1-(844) 265-9680

STOCK ORDER FORM INSTRUCTIONS

 

Sections (1) and (2) – Number of Shares and Total Payment Due. Indicate the Number of Shares that you wish to subscribe for and the Total Payment Due. Calculate the Total Payment Due by multiplying the Number of Shares by the $10.00 price per share. The minimum purchase is 25 shares ($250). No individual may purchase more than 40,000 shares ($400,000) of common stock. Further, no person or entity, together with associates or persons acting in concert with such person or entity, may purchase more than 40,000 shares ($400,000) of common stock in all categories of the stock offering combined. Please see the Prospectus section entitled “The Conversion and Stock Offering – Additional Limitations on Common Stock Purchases” for more specific information. By signing this form, you are certifying that your order does not conflict with these purchase limitations.

 

 

Section (3) – Method of Payment – Check or Money Order. Payment may be made by including with this form a personal check, bank check or money order made payable directly to Blue Foundry Bancorp. Funds will be deposited upon receipt. The funds remitted by personal check must be available within the account(s) when your Stock Order Form is received. Indicate the amount remitted. Interest will be calculated at 0.05% per annum from the date payment is processed until the stock offering is completed or terminated, at which time the subscriber will be issued a check for interest earned. Please do not remit cash, a Blue Foundry Bank line of credit check, wire transfers or third party checks as payment.

 

 

Section (4) – Method of Payment – Deposit Account Withdrawal. Payment may be made by authorizing a direct withdrawal from your Blue Foundry Bank deposit account(s). Indicate the account number(s) and the amount(s) you wish withdrawn. Attach a separate page, if necessary. Funds designated for withdrawal must be available within the account(s) at the time this Stock Order Form is received. Upon receipt, we will place a hold on the amount(s) designated by you – the funds will be unavailable to you for withdrawal thereafter. The funds will continue to earn interest within the account at the contractual rate. The interest will remain in the accounts when the designated withdrawal is made, at the completion of the offering. There will be no early withdrawal penalty for withdrawal from a Blue Foundry Bank certificate of deposit (CD) account. Note that you may NOT designate accounts with check-writing privileges. Please submit a check instead. If you request direct withdrawal from such accounts, we reserve the right to interpret that as your authorization to treat those funds as if we had received a check for the designated amount, and we will immediately withdraw the amount from your checking account(s). Additionally, you may not designate direct withdrawal from a Blue Foundry Bank IRA or other retirement accounts. For guidance on using retirement funds, whether held at Blue Foundry Bank or elsewhere, please contact the Stock Information Center as soon as possible – preferably at least two weeks before the June 15, 2021 offering deadline. See the Prospectus section entitled “The Conversion and Stock Offering – Procedure for Purchasing Shares in the Subscription and Community Offerings – Using Individual Retirement Account Funds.” Your ability to use retirement account funds to purchase shares cannot be guaranteed and depends on various factors, including timing constraints and the institution where those funds are currently held.

 

 

Section (5) – Purchaser Information. Please check the one box that applies to the purchaser(s) listed in Section 9 of this form. Purchase priorities in the Subscription Offering are based on eligibility dates. Boxes (a), (b) and (c) refer to the Subscription Offering. If you checked box (a), (b) or (c), list all Blue Foundry Bank deposit account numbers that the purchaser(s) had ownership of as of the applicable eligibility date. Include all forms of account ownership (e.g. individual, joint, IRA, etc.). If purchasing shares for a minor, list only the minor’s eligible accounts. If purchasing shares for a corporation or partnership, list only that entity’s eligible accounts. Attach a separate page, if necessary. Failure to complete this section, or providing incorrect or incomplete information, could result in a loss of part or all of your share allocation in the event of an oversubscription. Boxes (d) and (e) refer to the Community Offering. Orders placed in the Subscription Offering will take priority over orders placed in the Community Offering. See the Prospectus section entitled “The Conversion and Stock Offering” for further details about the Subscription and Community Offerings.

 

 

Section (6) – Management. Check the box if you are a Blue Foundry, MHC, Blue Foundry Bancorp-NJ or Blue Foundry Bank director, officer or employee, or a member of their immediate family.

 

 

Section (7) – Maximum Purchaser Identification. Check the box, if applicable. Failure to check the box will result in you not receiving notification in the event the maximum purchase limit(s) is/are increased. If you checked the box but have not subscribed for the maximum amount in the Subscription Offering, you will not receive this notification.

 

 

Section (8) – Associates/Acting in Concert. Check the box, if applicable, and provide the requested information. Attach a separate page if necessary.

 

 

Section (9) – Stock Registration. Clearly PRINT the name(s) in which you want the shares registered and the mailing address for all correspondence related to your order, including a stock ownership statement. Each Stock Order Form will generate one stock ownership statement, subject to the stock allocation provisions described in the Prospectus. IMPORTANT: Subscription rights are non-transferable. If placing an order in the Subscription Offering, you may not add the names of persons/entities who do not have subscription rights or who qualify only in a lower purchase priority than yours. A Social Security or Tax ID Number must be provided. The first number listed will be identified with the stock for tax reporting purposes. Listing at least one phone number is important in the event we need to contact you about this form. NOTE FOR FINRA (Formerly NASD) MEMBERS: If you are a member of the Financial Industry Regulatory Authority (“FINRA”), formerly the National Association of Securities Dealers (“NASD”), or a person affiliated or associated with a FINRA member, you may have additional reporting requirements. Please report this subscription in writing to the applicable department of the FINRA member firm within one day of payment thereof.


BLUE FOUNDRY BANCORP

STOCK INFORMATION CENTER: 1-(844) 265-9680

STOCK ORDER FORM INSTRUCTIONS (CONTINUED)

 

 

Form of Stock Ownership. For reasons of clarity and standardization, the stock transfer industry has developed uniform stockholder registrations for issuance of stock ownership statements. Beneficiaries may not be named on stock registrations. If you have any questions about wills, estates, beneficiaries, etc., please consult your legal advisor. When registering stock, do not use two initials – use the full first name, middle initial and last name. Omit words that do not affect ownership such as “Dr.” or “Mrs.” Check the one box that applies.

Owning Stock IndividuallyUsed when shares are registered in the name of only one owner. To qualify in the Subscription Offering, the individual named in Section 9 of the Stock Order Form must have been an eligible depositor at Blue Foundry Bank at the close of business on December 31, 2019, March 31, 2021 or May 5, 2021.

Owning Stock JointlyUsed when shares are registered in the name of two or more owners. To qualify in the Subscription Offering, the persons named in Section 9 of the Stock Order Form must have been an eligible depositor at Blue Foundry Bank at the close of business on December 31, 2019, March 31, 2021 or May 5, 2021.

Joint TenantsJoint Tenancy (with Right of Survivorship) may be specified to identify two or more owners where ownership is intended to pass automatically to the surviving tenant(s). All owners must agree to the sale of shares.

Tenants in CommonMay be specified to identify two or more owners where, upon the death of one co-tenant, ownership of the stock will be held by the surviving co-tenant(s) and by the heirs of the deceased co-tenant. All owners must agree to the sale of shares.

Owning Stock as Custodian for a MinorShares may be held in the name of a custodian for a minor under the Uniform Transfer to Minors Act. To qualify in the Subscription Offering, the minor (not the custodian) named in Section 9 of the Stock Order Form must have been an eligible depositor at Blue Foundry Bank at the close of business on December 31, 2019, March 31, 2021 or May 5, 2021. The standard abbreviation for custodian is “CUST.” The Uniform Transfer to Minors Act is “UTMA.” Include the state abbreviation. For example, stock held by John Smith as custodian for Susan Smith under the NJ Uniform Transfer to Minors Act, should be registered as John Smith CUST Susan Smith UTMA-NJ (list only the minor’s social security number).

Owning Stock By a Corporation/PartnershipOn the first name line indicate the name of the corporation or partnership and indicate the entity’s Tax ID Number for reporting purposes. To qualify in the Subscription Offering, the corporation or partnership named in Section 9 of the Stock Order Form must have been an eligible depositor at Blue Foundry Bank at the close of business on December 31, 2019, March 31, 2021 or May 5, 2021.

Owning Stock in a Trust/Fiduciary CapacityIndicate the name of the fiduciary and the capacity under which the fiduciary is acting (for example, “Executor”), or name of the trust, the trustees and the date of the trust. Indicate the Tax ID Number to be used for reporting purposes. To qualify in the Subscription Offering, the entity named in Section 9 of the Stock Order Form must have been an eligible depositor at Blue Foundry Bank at the close of business on December 31, 2019, March 31, 2021 or May 5, 2021.

Owning Stock in a Self-Directed IRA (for trustee/broker use only) – Registration should reflect the custodian or trustee firm’s registration requirements. For example, on the first name line, indicate the name of the brokerage firm, followed by CUST or TRUSTEE. On the second name line, indicate the name of the beneficial owner (for example, “FBO JOHN SMITH IRA”). You can indicate an account number or other underlying information and the custodian or trustee firm’s address and department to which all correspondence should be mailed related to this order, including a stock ownership statement. Indicate the TAX ID Number under which the IRA account should be reported for tax purposes. To qualify in the Subscription Offering, the beneficial owner named in Section 9 of this form must have been an eligible depositor at Blue Foundry Bank at the close of business on December 31, 2019, March 31, 2021 or May 5, 2021.

 

 

Section (10) – Acknowledgment and Signature(s). Sign and date the Stock Order Form where indicated. Before you sign, please carefully review the information you provided and read the acknowledgment. Verify that you have printed clearly and completed all applicable shaded areas on the Stock Order Form. Only one signature is required, unless any account listed in Section 4 requires more than one signature to authorize a withdrawal.

Please review the Prospectus carefully before making an investment decision. Deliver your completed original Stock Order Form, with full payment or deposit account withdrawal authorization, so that it is received (not postmarked) before 2:00 p.m., Eastern Time, on June 15, 2021. You may submit your original Stock Order Form by paying for overnight delivery to the address listed on the Stock Order Form or by mail using the Stock Order Reply Envelope provided. You may also hand-deliver stock order forms to Blue Foundry Bank’s office located at 217 Rock Road, Glen Rock, New Jersey, which is open between 9:00 a.m. and 5:00 p.m., Monday, Tuesday, Wednesday and Friday, 9:00 a.m. and 6:00 p.m. on Thursday and 9:00 a.m. and 1:00 p.m. on Saturday. Hand delivered stock order forms will only be accepted at this location. Do not hand deliver this form to any other Blue Foundry Bank offices. Please do not mail Stock Order Forms to any of Blue Foundry Bank’s offices. We are not required to accept Stock Order Forms that are found to be deficient or incorrect, or that do not include proper payment or the required signature. Faxes or copies of this form are not required to be accepted.

OVERNIGHT DELIVERY can be made to the Stock Information Center address provided on the front of the Stock Order Form.

QUESTIONS? Call our Stock Information Center, toll-free, at 1-(844) 265-9680 , between 10:00 a.m. and 4:00 p.m., Eastern Time, Monday through Friday. The Stock Information Center is closed on bank holidays.