BE IT KNOWN, that I,
________________, the undersigned Shareholder of
_______________, a _____________ corporation, hereby constitute and appoint
___________________ as my true and lawful attorney and agent for me and
in my name, place and stead, to vote as my proxy at the Meeting of the
Shareholders of the said corporation, to be held on _______________ or any
adjournment thereof, for the transaction of any business which may legally come
before the meeting, and for me and in my name, to act as fully as I could do
if personally present; and I herewith revoke any other proxy heretofore given.
WITNESS my hand and seal this ______ day of _______, 200(X)
_____________________________ ___________________________
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