Employee Stock Option Notice of Intent and Agreement (PDF)

Employee Stock Option Notice of Intent and Agreement

1. Account Owner

Name Fidelity Account Number This phone number may be used if we have questions, but will not Daytime Phone Extension be used to update your account information.

Check this box if you are a control person, affiliate, or an immediate family/household member of a control person or affiliate of the company listed below under SEC Rule 144 (this would include, but is not limited to, a director, 10% shareholder, policy-making officer, and members of the board of directors). 2. Instructions

To Fidelity Brokerage Services LLC and National Financial Services LLC (collectively, “Fidelity”): I hereby request that Fidelity extend credit to me in my account and remit funds payable to:

Name of Company issuing options, the “Issuer”

in the payment of aggregate exercise price (the “Exercise Price”), plus any applicable withholding for taxes, of employee stock options (the “Options”) enabling me to purchase shares of common stock of the Issuer, as set forth herein in the Notice of Intent and Agreement form or other form acceptable to the Issuer. This Notice of Intent and Agreement is valid for only 90 days from when it is dated. I authorize and direct Fidelity to take delivery of the shares and to deposit the shares in my Fidelity account. In connection with the exercise of the Options, I represent that: 1. The Options were granted in connection in determining how, whether, or when to respect to any cash dividends, stock with my employment, I am currently exercise the Options, other than as set splits, spin-offs, shareholder votes or authorized to exercise them, and I have forth herein pursuant to my request. other corporate transactions) will depend received from the Issuer a prospectus 3. I am aware that various federal and state on when the issuer considers the shares covering the sale of the shares to me. laws or regulations may be applicable to issued in connection with my option 2. I understand that the exercise of the my transactions, including, but not limited exercise to be outstanding shares, and that Options and/or the subsequent sale to, Rule 144 under the Securities Act of Fidelity shall not be liable for any claims or of the shares may have significant tax 1933, and Section 16(b) and Rule 10b-5 losses in connection with the foregoing. consequences. I further understand under the Securities Exchange Act of 1934, 5. I agree that I have read and understand that Fidelity and its employees are not and I shall conduct these transactions in the terms and conditions of the Margin authorized to give me tax or investment conformity with all applicable laws and Account Agreement, if applicable, advice, and I have consulted other sources regulations. including the potential for stock buy-in, I deem appropriate in connection with 4. I understand that my rights as a which governs the Fidelity account my transaction. I agree that Fidelity will shareholder (including my rights with specified in Section 1 of this form. not exercise any independent discretion Please check the appropriate box: Do not verify my stock options with the above-listed company. Hold forms on file until I call with instructions. Please call me as soon as you verify my stock options with the above-listed company. I can be reached at: My Phone Number

My Plan Administrator is: Plan Administrator Name Plan Administrator Phone Number

I authorize Fidelity, the Plan Administrator, and/or the Issuer to exchange information regarding the acquisition and disposition of the shares, including, without limitation, notification of the sale of stock acquired as a result of exercise of a stock option and matters relating to income tax withholding. I understand that this extension of credit by Fidelity for option exercise and payment of any required withholding for taxes and certificate issuance fees will result in a debit balance in my account, that Fidelity will charge interest on all credit extended to me, and that all transactions in this account will be subject to the provisions of the Customer Agreement, which governs the Fidelity account specified in Section 1. Form continues on next page.

1.796963.104 Page 1 of 2 017680101 3. Notice of Intent to Exercise

I hereby give my notice of intent to exercise options granted to me, entitling me to purchase shares of common stock on payment in the amount set forth below of the grant price for said shares and satisfaction of all other requirements of the option grant. I understand the completion of this form does not complete my stock option exercise and that I must call Fidelity at 800-544-3929 to complete my exercise.

Tax Withholding Instructions For nonqualified grants I understand that my exercise of options granted to me will give rise to tax withholding obligations at rates specified by my employer. I understand and hereby authorize Fidelity that required tax withholding (together with the grant price) will be paid from my brokerage account, and may result in a debit balance in my account as outlined above. Please contact Fidelity with any questions regarding tax withholding and payment of grant price in connection with your option exercise.

List Option(s):

Number of Shares Grant Price Grant Date MM DD YY Type Number of Shares Grant Price Grant Date MM DD YY Type $ $

PRINT OWNER NAME

OWNER SIGNATURE DATE MM/DD/YYYY

SIGN X X

On this form, “Fidelity” means Fidelity Brokerage Services LLC and its affiliates. Brokerage services are provided by Fidelity Brokerage Services LLC, Member NYSE, SIPC. All trademarks indicated are the property of their respective owners. 455904.5.0 (02/18)

1.796963.104 Page 2 of 2 017680102