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GENERAL PROXY
The undersigned of ______________, being a
stockholder of
______________________ Inc., does hereby constitute
and
appoint
as the lawful attorney, agent and proxy of the
undersigned
the
following named person:__________________ for a
period of
______________ from the date hereof, to represent
the
undersigned
at any and all stockholders meetings of
____________________
Inc., and at any adjournment thereof, within
____________
from the
date hereof, to act for and in the name, place and
stead of
the
undersigned on all matters and things which may be
presented for
action or consideration at such meetings, giving and
granting
unto said attorney and proxy as full power in all
respects
as the
undersigned could exercise if present in person.
The undersigned hereby ratifies all that his
attorney
and
proxy may or shall lawfully do in voting at any such
meetings, or
at any adjournment or adjournments thereof, within
the
period of
time specified, in respect of all matters, proposals
and
questions that may properly come before the
stockholders
for
consideration and action.
Dated:
________________________________
__________________________
Witness
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