EX-99.3

E 5 U E M D M F A

Exhibit 99.3



Computershare Trust Company, N.A. PO Box 505000
Louisville, KY 40233-5000 Within USA, US territories & Canada 866 249 2610 Outside USA, US territories & Canada 201 680 6578 www.computershare.com/investor

Name

Address

City, State, Zip


		Holder Account Number

		— — — — — — — — — — — — — —


Use a black pen. Print in CAPITAL letters inside the grey areas as shown in this example.

This form is to be used for recurring debits only.

Do not use for one time purchases.

Direct Stock Purchase Plan - Direct Debit Authorization - Monthly

Funds will be withdrawn on the 25th day of the month or on the next business day.

LOGO

Dollar Amount:

This plan allows for a minimum amount of $50 with a maximum of $10,000 per month. If applicable, an enrollment fee will be deducted from the initial investment.

Financial Institution Information

Please select one.

Individual

Joint

Other

Please select one.

Checking

Account

Savings

Account


Financial institution account number		Financial institution routing number

Note: DO NOT USE A CREDIT CARD. If you do not know your account number or the routing number, please see the reverse side of this form or check with your financial institution. Account numbers must be in numeric format.
Name(s) in which the above account is held

LOGO

Note: If you are not currently enrolled in this company’s Plan, by signing this form, you agree to the following: (1) to enroll in the Plan for full dividend reinvestment so that all of your dividends will be used to purchase additional shares (if available); (2) to be bound by the terms and conditions of the prospectus or brochure that governs the Plan; (3) that you have read and fully understand the terms and conditions of the prospectus or brochure; and (4) that you further agree that your participation in the Plan will continue until you notify Computershare in writing or by other available means that you desire to terminate participation in the Plan. Upon providing such notification, you acknowledge that withdrawal from the Plan will be subject to the terms and conditions of the prospectus or brochure that governs the Plan.

I/We hereby authorize Computershare to make monthly automatic transfers of funds from the above account in the amount shown. This deduction will be used to purchase shares to be deposited into my/our account.

All owners of the financial institution account must sign below.


Signature 1 - Please keep signature within the box.	Signature 2 - Please keep signature within the box.	Date (mm/dd/yyyy)

Daytime Telephone Number

Please return completed form to:

Computershare

PO Box 505000

Louisville, KY 40233-5000