EX-99 5 exhibit99_2.txt EXHIBIT 99.2 TRANSACTION REQUEST EXHIBIT 99.2 (Front)
TRANSACTION REQUEST PEOPLES BANCORP INC. ACCOUNT # 9999999999 OPTIONAL CASH INVESTMENT ELECTION Mail to: Shareowner Services Peoples Bancorp Inc. PBN1 [ ] Enclosed is a check made payable to Dividend Reinvestment and Stock Purchase Plan Shareowner Services P.O. Box 64856 for: $ _____________________________ St. Paul, MN 55164-0856 Minimum $100.00 / Maximum $10,000.00 per month [ ] Please change my address as indicated. Shareowner Services must receive your payment by SHAREHOLDER NAME 5 p.m. CT on (DATE) in order to invest it on the next ADDRESS 1 purchase date. ADDRESS 2 Shareowner Services will process your purchase instructions according to your Plan prospectus upon receipt of your properly completed request which includes ACCOUNT NUMBER or SSN and PLAN NAME. We will not be liable for any claim arising out of failure to purchase common shares on a certain date or at a specific price. Requests submitted on this form will only affect your Dividend Reinvestment and Stock Purchase Plan ("Plan") common shares, not common shares held in direct registration. (Bar-coded account number) (Bar-coded issue number) ------------------------------------------------------------------------------------------------------------------------------------ (Back) TRANSACTION REQUEST (continued) [ ] 1. Sell ________________________Plan shares as soon Company Name: ___________________________________ as practicable. 2. Direct Deposit [ ] Checking or [ ] Savings Shareowner 10 Digit Account Number ______________________________ ______________________________________ ______________________ ABA/Routing Number Bank Account Number (include voided check or deposit slip) ALL REGISTERED OWNERS MUST SIGN [ ] 3. Deposit ____________________ shares from the enclosed X _______________________________________________ certificate (s). X _______________________________________________ [ ] 4. Discontinue ACH [ ] 5. Change ACH Amount $ _________________ _________________________________________________ 6. Terminate From Plan (choose only one) Print Shareowner Names(s) [ ] Issue full shares & sell fractional share. [ ] Sell all Plan shares. (___)______________________ _________________ [ ] Issue __________ Plan shares and sell remaining shares. Daytime Phone Number Date