Print this page from
your browser and complete this enrollment card to join the Dividend Reinvestment and Cash
Repurchase Plan.
Blue Chip Value Fund, Inc.
Dividend Reinvestment and Cash Purchase Plan Enrollment Card |
To participate in Blue Chip Value Fund, Inc.'s Dividend Reinvestment and Cash Purchase
Plan, print this page from your browser, complete and sign this enrollment form and return
it to Mellon Investor Services, Inc., P.O. Box 3338, So. Hackensack, NJ 07606.This will authorize Blue Chip Value Fund, Inc. to forward to
Mellon Investor Services, Inc., as your agent, all of the dividends you receive on
common stock to be invested with any voluntary cash contributions you make from a minimum
of $50 or up to $10,000 per month, to purchase additional shares of common stock. All
investments and any voluntary cash contributions are made subject to the terms and
conditions of th Plan as set forth in the accompanying brochure.
This authorization and appointment are given by you with
the understanding that you may terminate them at any time by so notifying
Mellon Investor Services, Inc., in writing, or by completing and returning the form attached to
your plan statement. |
|
If you would like to have your voluntary cash contributions deducted automatcially from
your checking account, enroll in the Plan and complete the Automatic Monthly
Contributions information.To deposit your
shares for safekeeping, check the appropriate box on the reverse side and return this card
and your stock certificate(s) via registered mail, return receipt requested.
Questions regarding Blue Chip Value Fund, Inc.'s Dividend
Reinvestment and Cash Repurchase Plan should be directed to Mellon
Investor Shareholder
Services at 800-288-9541.
Please read carefully. This is not a Proxy. Return
the form only if you wish to participate in the plan. |
|
Please enroll me in the Blue Chip Value Fund, Inc. Dividend Reinvestment and Cash Purchase
Plan as follows:
(please check all that apply)
| O |
I wish to enroll in the Plan. I DO NOT wish
to make an additional cash investment at this time. (You have the option of making cash
investments at any time in the future.) To be eligible for this option, you must
hold at least fifty (50) shares. |
| O |
I wish to enroll in the Plan and make a cash
investment of $_____________ ($50 Minimum, $10,000 Maximum), make check payable to Blue
Chip Value Fund/CMSS. To be eligible for this option, you must hold at least fify
(50) shares. |
| O |
Safekeeping. Deposit the enclosed
____________ shares of stock for safekeeping. |
| O |
Please send information to establish or
rollover an IRA account. |
To enroll in the plan by transferring common stock held by
a broker, please contact your broker or Mellon Investor Services for instructions. |
O |
Automatic Monthly Contributions. Withdraw $____________ (a minimum of $50 or up to $10,000
per month) from my checking account below on a monthly basis to purchase additional Shares
of Common Stock. (You must complete this section and return form with a personal voided
check. Your financial institution can provide you with the following required
information). |
| Financial Institution Name: |
_______________________ |
| Branch Address: |
_______________________ |
| City, State, ZIP: |
_______________________ |
| Account Number: |
_______________________ |
AUTHORIZATION:
Signature____________________________Date__________
Signature____________________________Date__________
All joint owners must sign exactly as names appear on
reverse side.
Print, sign and mail this Enrollment Card to:
Mellon Investor Services Inc.
P.O. Box 3338
So. Hackensack, NJ 07606 |
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