EX-99.1 4 dex991.htm ENROLLMENT FORM Enrollment Form

Exhibit 99.1

 

  Shareholder Direct   Co. # 28807

STOCK PURCHASE AND DIVIDEND REINVESTMENT PLAN

FOR SHARES OF

FIFTH THIRD BANCORP

ENROLLMENT APPLICATION

 

LOGO       Please enroll this account as follows:
   

Check onebox only  (x).

   

If you do not check any box, then FULL DIVIDEND REINVESTMENT will be assumed.

 

  ¨   FULL DIVIDEND REINVESTMENT
   

Reinvest all dividends for this account.

 

  ¨   PARTIAL DIVIDEND REINVESTMENT
   

Reinvest dividends on                      shares held by me in certificate form and on all shares held by you as Agent and pay dividends in cash on all remaining shares held by me in certificate form.

 

  ¨  

CASH PAYMENTS ONLY (NO DIVIDEND REINVESTMENT)

All dividends will be paid in cash.

I (We) hereby appoint American Stock Transfer & Trust Company as my (our ) Agent under the terms and conditions of the Plan, as described in the Brochure of the Plan which accompanied this form, to receive cash payments and apply them to the purchase of shares of FIFTH THIRD BANCORP Common Stock as indicated below.

NO INTEREST WILL BE PAID ON THE FUNDS HELD PENDING INVESTMENT.

ACCOUNT INFORMATION

 

1.

SINGLE/JOINT:  Joint account will be presumed to be joint tenants with right of survivorship unless restricted by applicable state law or otherwise indicated. The Social Security Number of the first-named tenant is required.

 

2.

CUSTODIAL:  A minor is the beneficial owner of the account with an adult custodian managing the account until the minor becomes of age, as specified in the Uniform Gift to Minors Act in the minor’s state of residence. The minor’s Social Security Number is required.

 

3. TRUST:  Account is established in accordance with the provisions of a trust agreement.

This form, when completed and signed, should be mailed with your check in the blue envelope provided. Please affix postage to ensure proper processing. If you do not have the envelope, mail your check and the form to:

 

   FIFTH THIRD BANCORP
  

c/o American Stock Transfer & Trust Company

P.O. Box 922, Wall Street Station, New York, New York 10269-0560

Attn: Shareholder Direct Plan

If your name is preprinted above, it is for mailing purposes only. Please complete one of the boxes below for the exact account registration.

 

                                            ACCOUNT LEGAL REGISTRATION (CHOOSE ONE):                                   

 

SOCIAL SECURITY OR TAXPAYER IDENTIFICATION NUMBER                                                     

I hereby warrant, under penalty of perjury, that the number provided above is correct.

 

¨    SINGLE/JOINT ACCOUNT   ¨    CUSTODIAL ACCOUNT   ¨    TRUST ACCOUNT
     

                                                                     

 

                                                                     

 

                                                                     

Name   Custodian’s Name   Trustee Name
     

                                                                     

 

                                                                     

 

                                                                     

Joint Owner (if any)   Minor’s Name   Trust Name or Beneficiary
     

                                                                     

 

                                                                     

 

                                                                     

Joint Owner (if any)

 

 

Minor’s State of Residence

 

 

Date of Trust

 

 

ACCOUNT ADDRESS                                                                                                                                                                                     
    STREET                                              CITY    STATE    ZIP CODE
SIGNATURE(s)                                                                                                                                                                                                 
All Joint Owners Must Sign

 

    

MINIMUM INITIAL INVESTMENT IS $250 FOR NEW INVESTORS

MINIMUM INVESTMENT IS $50 FOR STOCKHOLDERS OF RECORD

AND CURRENT PLAN PARTICIPANTS

MAXIMUM INVESTMENT IS $10,000 PER MONTH

 

ATTACHED IS A CHECK FOR     $  

        
        
      

 

FIFTH THIRD BANCORP Enroll. App. 08-27-08                FOR AUTOMATIC MONTHLY DEDUCTIONS, SEE REVERSE       


COMPLETE THIS PART ONLY IF YOU WANT AUTOMATIC MONTHLY DEDUCTIONS

 

I (We) hereby authorize American Stock Transfer & Trust Company to make monthly automatic transfers of funds from the checking or savings account in the amount stated below. This monthly deduction will be used to purchase shares of FIFTH THIRD BANCORP Common Stock for deposit into my (our) FIFTH THIRD BANCORP account.

     

1. Indicate the Type of Account: Checking or Savings.

 

2. Print the complete Bank Account Number.

 

3. Print the name on Bank Account as it appears on your bank statement.

 

4. Print the complete name of your financial institution, including the branch name and address.

 

5. Print the ABA Number (Bank Number) from your check or savings deposit slip.

 

 

Signature(s)

 

 

                                                                                                  

 

                                                                                                  

     

6. Amount of automatic monthly deduction: Indicate the monthly amount authorized to be transferred from your account. The minimum is $25 per month and the maximum is $10,000 per month from your checking or savings account to purchase FIFTH THIRD BANCORP Common Stock.

 

       

Please enclose a copy of a VOIDED check or savings deposit slip to verify banking information.

  Daytime   

Date                                     

 

Phone Number                                               

  

 

FILL IN THE INFORMATION BELOW FOR STOCK

PURCHASES USING AUTOMATIC MONTHLY DEDUCTIONS.

Please Print All items

1.

 

  Type of Account  ¨     Checking   ¨    Savings

 

 

                                     
2.                                                                                                                    
  Bank Account Number

 

                                             
3.                                                                                                                                        
  Name of Bank Account

 

                                               
4.                                                                                                                                        
  Financial Institution

 

                                                   
                                                                                                                                       
  Branch Name

 

                                                   
                                                                                                                                       
  Branch Street Address

 

                                                   
                                                                                                                                       
  Branch City, State and Zip Code

 

                                             
5.                                                     6.   $                                                                                            
  ABA Number                     Amount of automatic deduction              

PLEASE CONFIRM ITEMS 2 AND 5 WITH YOUR BANK

PRIOR TO SUBMITTING THIS APPLICATION.

 

                                                       
                                   
Name on               JOHN A. DOE                                                            20              
Bank Account             MARY B. DOE                                                         
          123 YOUR STREET                                                         
          ANYWHERE, U.S.A. 12345                                             63-858     
                   670     
                      PAY TO THE           
                      ORDER OF                                                                    $         
   

Financial

Institution and

Branch

information

                                     DOLLARS     
              First National Bank              
            of Anywhere              
          123 Main Street              
          Anywhere, U.S.A. 12345              
   
          FOR                                                                                             SAMPLE (NON-NEGOTIABLE)    
           

LOGO

 

        
                               
                                 
          ABA Number       Bank Account Number            

FIFTH THIRD BANK Enroll. App. 08-27-08