Common use of FORM OF ELECTION TO PURCHASE Clause in Contracts

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To AMERCO: The undersigned hereby irrevocably elects to exercise ____________ Rights represented by this Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certificates for such shares be issued in the name of: Name:_____________________ Address:__________________ _____________________ Social security or taxpayer identification number:__________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Name:_____________________ Address:__________________ _____________________ Social security or taxpayer identification number:__________________ Dated:__________________ (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate) Signature Guaranteed:

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise Exercise the Right Rights Certificate.) To AMERCOTo: Internet Security Systems, Inc. The undersigned hereby irrevocably elects to exercise ____________ Rights represented by this Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certificates for such shares be issued in the name of: Name:_____________________ Address:__________________ _____________________ Social Rights represented by this Rights Certificate to purchase the Junior Preferred Shares issuable upon the exercise of such Rights and requests that certificates for such share(s) be issued in the name: Please insert social security or taxpayer identification number:__________________ other identifying number -------------------------------------------- (Please print name and address) -------------------------------------------- If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Name:_____________________ Address:__________________ _____________________ Social Please insert social security or taxpayer identification number:__________________ other identifying number -------------------------------------------- (Please print name and address) -------------------------------------------- Dated:__________________ : , --------------- -------- ---------------------------------- Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Rights Certificate) Signature Guaranteed:)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To AMERCOReinsurance Group of America, Incorporated: The undersigned hereby irrevocably elects to exercise ____________ Rights represented by this Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certificates for such shares be issued in the name of: Name:_____________________ Address:__________________ _____________________ Social security or taxpayer identification number:__________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Name:_____________________ Address:__________________ _____________________ Social security or taxpayer identification number:__________________ Dated:__________________ _____________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate) Signature Guaranteed:: Signatures must be guaranteed by a member or a participant in the Securities Transfer Agent Medallion Program, the New York Stock Exchange Medallion Signature Program or the Stock Exchange Medallion Program.

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To AMERCO: GRC International, Inc. The undersigned hereby irrevocably elects to exercise ____________ Rights represented by this Right Certificate to purchase the shares of Preferred Common Stock issuable upon the exercise of such Rights and requests that certificates certifies for such shares be issued in the name of: Name:_____________________ Address:__________________ _____________________ Social Please insert social security or taxpayer identification number:__________________ other identifying number ------------------------------------ (Please print name and address) ------------------------------------ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Name:_____________________ Address:__________________ _____________________ Social Please insert social security or taxpayer identification number:__________________ other identifying number ------------------------------------ (Please print name and address) ------------------------------------ Dated:__________________ : ------------------------------ ------------------------------------ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate) Signature Guaranteed: Certificate ----------- The undersigned hereby certifies by checking the appropriate boxes that:

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To AMERCOHearUSA, Inc.: The undersigned hereby irrevocably elects to exercise _______________ Rights represented by this Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certificates for such shares be issued in the name of: Name:_____________________ Address:__________________ _____________________ Social security or taxpayer identification number:__________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Name:_____________________ Address:__________________ _____________________ Social security or taxpayer identification number:__________________ Dated:__________________ ______________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate) Signature Guaranteed:: Signatures must be guaranteed by a member or a participant in the Securities Transfer Agent Medallion Program, the New York Stock Exchange Medallion Signature Program or the Stock Exchange Medallion Program.

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To AMERCOArch Coal, Inc.: The undersigned hereby irrevocably elects to exercise ____________ Rights represented by this Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certificates for such shares be issued in the name of: Name:_____________________ Address:__________________ _____________________ Social security or taxpayer identification number:___________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Name:_____________________ Address:__________________ _____________________ Social security or taxpayer identification number:__________________ Dated:__________________ __________________________________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate) Signature Guaranteed:: Signatures must be guaranteed by a member or a participant in the Securities Transfer Agent Medallion Program, the New York Stock Exchange Medallion Signature Program or the Stock Exchange Medallion Program.

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires The signature to exercise the Right Certificateforegoing Assignment and Certificate must correspond to the name as written upon the face of this Rights Certificate in every particular, without alteration or enlargement or any change whatsoever. To: PEERLESS MFG. CO.) To AMERCO: The undersigned hereby irrevocably elects to exercise ____________ Rights represented by this Right Rights Certificate to purchase the shares of Preferred Common Stock issuable upon the exercise of the Rights (or such Rights other securities of the Company or of any other person that may be issuable upon the exercise of the Rights) and requests that certificates for such shares be issued in the name ofof and delivered to: Name:_____________________ Address:__________________ _____________________ Social Please insert social security or taxpayer identification other identifying number:__________________ : --------------- Please print name and address: ------------------------------------------- ------------------------------------------------------------------------- If such number of Rights shall are not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall will be registered in the name of and delivered to: Name:_____________________ Address:__________________ _____________________ Social Please insert social security or taxpayer identification other identifying number:__________________ : --------------- Please print name and address: ------------------------------------------- ------------------------------------------------------------------------- Dated:__________________ (: ---------------------- --------------------------------- Signature must conform in all respects to name of holder as specified on the face of this Right Certificate) Signature Guaranteed:

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Warrant Certificate.) To AMERCO: The undersigned hereby irrevocably elects to exercise ____________ Rights represented by this Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certificates for such shares be issued in the name of: Name:TO _____________________ Address:__________________ _____________________ Social : The undersigned hereby irrevocably elects to exercise Warrants represented by this Warrant Certificate to purchase the shares of Common Stock issuable upon the exercise of such Warrants and requests that certificates for such shares be issued in the name of: Please insert social security or taxpayer identification number:__________________ other identifying number ----------------------------- ----------------------------------------------------------------- (Please print name and address) If such number of Rights Warrants shall not be all the Rights Warrants evidenced by this Right Warrant Certificate, a new Right Warrant Certificate for the balance remaining of such Rights Warrants shall be registered in the name of and delivered to: Name:_____________________ Address:__________________ _____________________ Social Please insert social security or taxpayer identification number:__________________ other identifying number ------------------------------ ----------------------------------------------------------------- (Please print name and address) Dated:_________________, 19___ --------------------------------------- (Signature must conform in all respects to name of holder as specified on the face of this Right Warrant Certificate) Signature Guaranteed:)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To AMERCOMobile Mini, Inc.: The undersigned hereby irrevocably elects to exercise exercise_________________ Rights represented by this Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certificates for such shares be issued in the name of: Name:_____________________ : ------------------------------- Address:__________________ _____________________ : ---------------------------- ----------------------------- Social security or taxpayer identification number:__________________ : ----------------------------- If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Name:_____________________ : ------------------------------- Address:__________________ _____________________ : ---------------------------- ----------------------------- Social security or taxpayer identification number:__________________ : ----------------------------- Dated:__________________ : ------------------ ----------------------------------- Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate) Signature Guaranteed:: Signatures must be guaranteed by a member or a participant in the Securities Transfer Agent Medallion Program, the New York Stock Exchange Medallion Signature Program or the Stock Exchange Medallion Program.

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise Exercise the Right Certificate.) To AMERCOTo: John X. Xxxxxxx Xxxpany The undersigned hereby irrevocably elects to exercise _____________________ Rights represented by this Right Certificate to purchase the shares of Preferred Common Stock issuable upon the exercise of such Rights and requests that certificates for such shares share(s) be issued in the name: ----------------------------------------------------------------------- (Please print name of: Name:_____________________ Address:__________________ _____________________ Social and address) ----------------------------------------------------------------------- (Please insert social security or taxpayer identification other identifying number:__________________ ) If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Name:_____________________ Address:__________________ _____________________ Social ---------------------------------------------------------------------- (Please print name and address) ---------------------------------------------------------------------- (Please insert social security or taxpayer identification other identifying number:__________________ ) Dated:__________________ : , ------------------- ---- ------------------------------------------- Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate) Signature Guaranteed:)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To AMERCO[NAME OF COMPANY]: The undersigned hereby irrevocably elects to exercise _____________ Rights represented by this Right Certificate to purchase the shares of Preferred Stock Common Shares issuable upon the exercise of such Rights and requests that certificates for such shares be issued in the name of: Name:: _________________________________ Address:: __________________ _____________________ Social security Security or taxpayer identification number:: ______________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Name:: ______________________________ Address:_____________________________ Social Security or taxpayer identification number: _____________________________ Social security or taxpayer identification number:Dated: __________________ Dated:__________________ (Signature must conform in all respects respect to name of holder as specified on the face of this Right Certificate) Signature Guaranteed:

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To AMERCOthe Company and the Rights Agent: The undersigned hereby irrevocably elects to exercise _____________________ Rights represented by this Right Certificate and to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certificates for such shares be issued in the name of: Name:Please insert social security or other identifying number: _____________________ Address:__________________ ________________________________________________________________________________ Social security or taxpayer identification number:(Please print name and address) ________________________________________________________________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Name:Please insert social security or other identifying number: _____________________ Address:__________________ ________________________________________________________________________________ Social security or taxpayer identification number:(Please print name and address) ________________________________________________________________________________ Dated:: _________________ ___________________________________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate) Signature Guaranteed:)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To AMERCOWorldCom, Inc.: The undersigned hereby irrevocably elects to exercise _____________________ Rights represented by this Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certificates for such shares be issued in the name of: Name:: ____________________________________________ Address:: ____________________________________________ ____________________________________________ Social security or taxpayer identification number:: _______________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Name:: ____________________________________________ Address:: ____________________________________________ ____________________________________________ Social security or taxpayer identification number:: _______________________________ Dated:: ________________ ____________________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate) Signature Guaranteed:

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To AMERCOFURNITURE BRANDS INTERNATIONAL, INC.: The undersigned hereby irrevocably elects to exercise ____________ Rights represented by this Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certificates for such shares be issued in the name of: Name:_____________________ Address:__________________ _____________________ Social security or taxpayer identification number:__________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Name:_____________________ Address:__________________ _____________________ Social security or taxpayer identification number:__________________ Dated:__________________ ___________________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate) Signature Guaranteed:

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To AMERCO: GRC International, Inc. The undersigned hereby irrevocably elects to exercise ____________ ------- Rights represented by this Right Certificate to purchase the shares of Preferred Common Stock issuable upon the exercise of such Rights and requests that certificates certifies for such shares be issued in the name of: Name:_____________________ Address:__________________ _____________________ Social Please insert social security or taxpayer identification number:__________________ other identifying number ------------------------------------- (Please print name and address) ------------------------------------- If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Name:_____________________ Address:__________________ _____________________ Social Please insert social security or taxpayer identification number:__________________ other identifying number ------------------------------------- (Please print name and address) ------------------------------------- Dated:__________________ : ------------------------------- ------------------------------------- Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate) Signature Guaranteed:)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise the Right Certificate.) To AMERCOTo: The Enstar Group, Inc. The undersigned hereby irrevocably elects to exercise _________________ Rights represented by this Right Certificate to purchase the shares of Preferred Common Stock issuable upon the exercise of such Rights and requests that certificates for such shares share(s) be issued in the name ofname: Name:___________________________________________________________ Address:(Please print name and address) __________________ __________________________________________ Social (Please insert social security or taxpayer identification other identifying number:__________________ ) If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Name:Please insert social security or other identifying number ____________________________________________ Address:(Please print name and address) Dated: ________________, 19__ _____________________ Social security or taxpayer identification number:________________________ Dated:__________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate) Signature Guaranteed:

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To AMERCO: Allmerica Financial Corporation The undersigned hereby irrevocably elects to exercise ____________ Rights represented by this Right Rights Certificate to purchase the number of shares of Preferred Common Stock (or other securities) issuable upon the exercise of such Rights and requests that certificates for such shares be issued in the name of: Name:Please insert social security or other identifying number (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Rights Certificate, a new Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Please insert social security or other identifying number (Please print name and address) ________________________________________________________________________________________________________________________________________________ Address:__________________ _____________________ Social security or taxpayer identification number:__________________ If such number of Rights shall not be all the Rights evidenced by this Right CertificateDated: , a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Name:_____________________ Address:__________________ _____________________ Social security or taxpayer identification number:__________________ Dated:__________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Rights Certificate) Signature Guaranteed:** ** Signature must be guaranteed be a member firm of The New York Stock Exchange, Inc. or a commercial bank or trust company having an office or correspondent in New York City. Certificate The undersigned hereby certifies by checking the appropriate boxes that:

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise Exercise the Right Rights Certificate.) To AMERCOTo: Z-Tel Technologies, Inc. The undersigned hereby irrevocably elects to exercise ____________ Rights represented by this Right Rights Certificate to purchase the shares of Junior Preferred Stock Shares issuable upon the exercise of such Rights and requests that certificates for such shares share(s) be issued in the name ofname: Name:_____________________ Address:__________________ _____________________ Social Please insert social security or taxpayer identification number:__________________ other identifying number -------------------------------------------- (Please print name and address) -------------------------------------------- If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Name:Please insert social security or other identifying number -------------------------------------------- (Please print name and address) -------------------------------------------- Dated: _________________, ____ Address:__________________ _____________________ Social security or taxpayer identification number:__________________ Dated:__________________ ---------------------------------- Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Rights Certificate) Signature Guaranteed:)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To AMERCOHEARx Ltd.: The undersigned hereby irrevocably elects to exercise ____________________________ Rights represented by this Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certificates for such shares be issued in the name of: Name:_____________________ : -------------------- Address:__________________ _____________________ : ----------------- ------------------- Social security or taxpayer identification number:__________________ : ------------------------- If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Name:_____________________ : -------------------- Address:__________________ _____________________ : ----------------- ------------------- Social security or taxpayer identification number:__________________ : ------------------------- Dated:__________________ : --------------------- ------------------------------------ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate) Signature Guaranteed:: Signatures must be guaranteed by a member or a participant in the Securities Transfer Agent Medallion Program, the New York Stock Exchange Medallion Signature Program or the Stock Exchange Medallion Program.

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise Exercise the Right Rights Certificate.) To AMERCOTo: Fritx Xxxpanies, Inc. The undersigned hereby irrevocably elects to exercise ____________ Rights represented by this Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certificates for such shares be issued in the name of: Name:_____________________ Address:__________________ _____________________ Social Rights represented by this Rights Certificate to purchase the Junior Preferred Shares issuable upon the exercise of such Rights and requests that certificates for such share(s) be issued in the name: Please insert social security or taxpayer identification number:__________________ other identifying number -------------------------------------------- (Please print name and address) -------------------------------------------- If such number of Rights shall not be all the Rights evidenced by this Right Rights Certificate, a new Right Rights Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Name:_____________________ Address:__________________ _____________________ Social Please insert social security or taxpayer identification number:__________________ other identifying number -------------------------------------------- (Please print name and address) -------------------------------------------- Dated:__________________ : , -------------- ---- ---------------------------------- Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Rights Certificate) Signature Guaranteed:)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To AMERCODHB INDUSTRIES, INC.: The undersigned hereby irrevocably elects to exercise ____________ _____Rights represented by this Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certificates for such shares be issued in the name of: Name: Address:_____________________ Address:__________________ _____________________________ Social security or taxpayer identification number:______________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Name: Address:_____________________ Address:__________________ _____________________________ Social security or taxpayer identification number:______________________________ Dated:: _______________________________ ______________________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate) Signature Guaranteed:

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To AMERCO: GRC International, Inc. The undersigned hereby irrevocably elects to exercise ____________ Rights represented by this Right Certificate to purchase the shares of Preferred Common Stock issuable upon the exercise of such Rights and requests that certificates certifies for such shares be issued in the name of: Name:Please insert social security or other identifying number (Please print name and address) _____________________ Address:__________________ _____________________ Social security or taxpayer identification number:__________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Name:Please insert social security Or other identifying number (Please print name and address) _______________________________________ AddressDated:_________________________________ _____________________ Social security or taxpayer identification number:___________________ Dated:__________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate) Signature Guaranteed:)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To AMERCOSCS TRANSPORTATION, INC.: The undersigned hereby irrevocably elects to exercise ______________ Rights represented by this Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certificates for such shares be issued in the name of: Name:_____________________ : --------------------------- Address:__________________ _____________________ : --------------------------- --------------------------- Social security or taxpayer identification number:__________________ : ------------------------------------ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Name:_____________________ : --------------------------- Address:__________________ _____________________ : --------------------------- --------------------------- Social security or taxpayer identification number:__________________ : ------------------------------------ Dated:__________________ : ---------------- Signature ---------------------------------- (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate) Signature Guaranteed:

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To AMERCOESCO Electronics Corporation: The undersigned hereby irrevocably elects to exercise ____________ Rights represented by this Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certificates for such shares be issued in the name of: Name:_____________________ : --------------------- Address:__________________ _____________________ : ------------------ --------------------- Social security or taxpayer identification number:__________________ : -------------------- If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Name:_____________________ : ---------------------- Address:__________________ _____________________ : ------------------- ---------------------- Social security or taxpayer identification number:__________________ : --------------------- Dated:__________________ : ------------------- -------------------------------------------------- Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate) Signature Guaranteed:

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To AMERCOXxxxxx Industries, Inc.: The undersigned hereby irrevocably elects to exercise ____________ Rights represented by this Right Certificate to purchase the shares of Preferred Common Stock issuable upon the exercise of such Rights and requests that certificates for such shares be issued in the name of: Name:_____________________ Address:__________________ _____________________ Social security or taxpayer identification number:___________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Name:_____________________ Address:__________________ _____________________ Social security or taxpayer identification number:___________________ Dated:__________________ (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate) Signature Guaranteed:: Signatures must be guaranteed by a member or a participant in the Securities Transfer Agent Medallion Program, the New York Stock Exchange Medallion Signature Program or the Stock Exchange Medallion Program.

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To AMERCOTo: NEW BEVEXXX XXXDINGS, INC. The undersigned hereby irrevocably elects to exercise ________________ Rights represented by this Right Certificate to purchase the shares of Preferred Stock Common Shares issuable upon the exercise of such Rights and requests that certificates for such shares be issued in the name of: Name:_____________________ Address:__________________ _____________________ Social Please insert social security or taxpayer identification number:__________________ other identifying number -------------------------------------------------------------------------------- (Please print name and address) -------------------------------------------------------------------------------- If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Name:_____________________ Address:__________________ _____________________ Social Please insert social security or taxpayer identification number:__________________ other identifying number -------------------------------------------------------------------------------- (Please print name and address) -------------------------------------------------------------------------------- Dated:__________________ (: ------------------ ----------------------------------- Signature must conform in all respects to name of holder as specified on the face of this Right Certificate) Signature Guaranteed: --------------------------- 42 The undersigned hereby certifies by checking the appropriate boxes that:

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To AMERCOVISTACARE, INC.: The undersigned hereby irrevocably elects to exercise ____________ _____Rights represented by this Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certificates for such shares be issued in the name of: Name:: ____________________________ Address:: _________________________ _____________________________ Social security or taxpayer identification number:: __________________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Name:: ____________________________ Address:: _________________________ _____________________________ Social security or taxpayer identification number:: __________________________ Dated:: ___________ _______________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate) Signature Guaranteed:

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To AMERCONew NiSource Inc.: The undersigned hereby irrevocably elects to exercise ______________________ Rights represented by this Right Certificate to purchase the shares of Preferred Stock or other securities or property issuable upon the exercise of such Rights and requests that certificates for such shares be issued in the name of: Name:_____________________ Address:__________________ _____________________ Social Please insert social security or taxpayer identification number:__________________ other identifying number -------------------------------------------------------------------------------- If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Name:Please insert social security or other identifying number -------------------------------------------------------------------------------- Dated: ___________________, 20__ Address:__________________ _____________________ Social security or taxpayer identification number:__________________ Dated:__________________ ------------------------------------ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate) Signature Guaranteed:)

FORM OF ELECTION TO PURCHASE. (To be executed if registered holder desires to exercise Exercise the Right Certificate.) To AMERCOTo: Resource Bancshares Mortgage Group, Inc. The undersigned hereby irrevocably elects to exercise ____________________ Rights represented by this Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certificates for such shares share(s) be issued in the name ofname: Name:_____________________ Address:__________________ _____________________ Social Please insert social security or taxpayer identification number:__________________ other identifying number -------------------------------------------- If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Name:Please insert social security or other identifying number -------------------------------------------- Dated: _________________, ____ Address:__________________ _____________________ Social security or taxpayer identification number:__________________ Dated:__________________ ---------------------------------- Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate) Signature Guaranteed:)

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To AMERCOThe Goodyear Tire & Rubber Company: The undersigned hereby irrevocably elects to exercise ____________ ---------------- Rights represented by this Right Certificate to purchase the shares of Preferred the Common Stock issuable upon the exercise of such Rights and requests that certificates for such shares be issued in the name of: Name:_____________________ Address:__________________ _____________________ Social Please insert social security or taxpayer identification number:__________________ other identifying number ------------------------------------------------------------------------------- If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Name:_____________________ Address:__________________ _____________________ Social Please insert social security or taxpayer identification number:__________________ other identifying number ------------------------------------------------------------------------------- Dated:__________________ : , 19 ---------------- ---- ----------------------------------- Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate) Signature Guaranteed:

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To AMERCONew Ralcorp Holdings, Inc.: The undersigned hereby irrevocably elects to exercise ____________ Rights represented by this Right Certificate to purchase the shares of Preferred Common Stock issuable upon the exercise of such Rights and requests that certificates for such shares be issued in the name of: Name:_: ____________________ Address:___________________ _____________________ Social security or taxpayer identification number:___________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Name:_: ____________________ Address:_: _________________ _____________________ Social security or taxpayer identification number:___________________ Dated:___________ , 19 _________________________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate) Signature Guaranteed:: Signatures must be guaranteed by a member firm of a registered national securities exchange, a member of the National Association of Securities Dealers, Inc., or a commercial bank or trust company having an office or correspondent in the United States.

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To AMERCOFURNITURE BRANDS INTERNATIONAL, INC.: The undersigned hereby irrevocably elects to exercise ______________ Rights represented by this Right Certificate to purchase the shares of Preferred Stock issuable upon the exercise of such Rights and requests that certificates for such shares be issued in the name of: Name:_____________________ Address:__________________ _____________________ Social security or taxpayer identification number:__________________ If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Name:_____________________ Address:__________________ _____________________ Social security or taxpayer identification number:__________________ Dated:__________________ ______________________________________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate) Signature Guaranteed:: Signatures must be guaranteed by a member or a participant in the Securities Transfer Agent Medallion Program, the New York Stock Exchange Medallion Signature Program or the Stock Exchange Medallion Program.

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To AMERCOMedco Research, Inc.: The undersigned hereby irrevocably elects to exercise ____________ Rights represented by this Right Certificate to purchase the shares of Preferred Stock Common Shares issuable upon the exercise of such Rights and requests that certificates for such shares be issued in the name of: Name:_____________________ Address:__________________ _____________________ ------------------------------------------------------------------------------- (Please print name and address) ------------------------------------------------------------------------------- Social security Security or taxpayer identification other identifying number:__________________ : If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Name:_____________________ Address:__________________ _____________________ ---------------------------------------------------------------- (Please print name and address) ---------------------------------------------------------------- Social security Security or taxpayer identification other identifying number:__________________ : Dated:__________________ (--------------------------- Signature must conform in all respects to name of holder as specified on the face of this Right Certificate) Signature Guaranteed: Certificate The undersigned hereby certifies by checking the appropriate boxes that:

FORM OF ELECTION TO PURCHASE. (To be executed if holder desires to exercise the Right Certificate.) To AMERCOTO: The undersigned hereby irrevocably elects to exercise ________________________ Rights represented by this Right Certificate to purchase the shares of Preferred the Common Stock issuable upon the exercise of such Rights and requests that certificates for such shares be issued in the name of: Name:_____________________ Address________________________________________________________. Please insert social security or other identifying number:__________________________________ _____________________ Social security or taxpayer identification number:___________________________________________________________ (Please print name and address) If such number of Rights shall not be all the Rights evidenced by this Right Certificate, a new Right Certificate for the balance remaining of such Rights shall be registered in the name of and delivered to: Name:_____________________________________________________________________________ Address:(Please insert social security or other identifying number) __________________ ____________________________________________________________ Social security or taxpayer identification number:(Please print name and address) _____________________________________________________________________________ Dated:___: _______________ Signature (Signature must conform in all respects to name of holder as specified on the face of this Right Certificate) Signature Guaranteed: