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PROXY
BE IT KNOWN, that I, (1), the undersigned Shareholder of (2), a (3) corporation, hereby constitute and appoint (4) 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 (5) or any adjournment thereof, for the transaction of any business which may legally
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