PAYMENT ELECTION. In accordance with the terms of the Pinnacle West Capital Corporation 2007 Long-Term Incentive Plan and pursuant to Section 4(b) of the Award Agreement, I hereby elect to receive payment for the Restricted Stock Units and Dividend Equivalents that vest on the dates set forth below in the following form (place an “X” in the “Stock” column or in the “50% Cash/50% Stock” column for each of the years and types of Awards set forth below): Restricted Stock Units and Dividend Equivalents 50% Cash/ Vesting Date Stock 50% Stock 02/20/2012 o o 02/20/2013 o o 02/20/2014 o o 02/20/2015 o o
PAYMENT ELECTION. The Annuity Amount may be paid in annual, semi-annual, or quarterly installments. If the Annuity is funded with cash or assets having a fair market value of $25,000 or more, the donor may elect monthly annuity payments. More frequent installment payments will result in a slightly lower charitable income tax deduction. I elect Annual Semi-annual Quarterly Monthly Annuity Payments
PAYMENT ELECTION. The undersigned Holder hereby elects to purchase shares of Common Stock of SVI Solutions, Inc. (the "Warrant Stock"), pursuant to the terms of the attached Warrant, and tenders herewith payment of the purchase price for such shares in full.
PAYMENT ELECTION. Payment to Self – A check subject to mandatory federal and applicable state withholding tax will be mailed to your address on the previous page. Direct Rollover to an Eligible Plan – Check only one box below and complete Rollover Information Section Below: Government 457(b) 401(a)/401(k) 403(b) Direct Rollover to a Traditional XXX Direct Rollover to a Xxxx XXX (subject to ordinary income tax) Rollover Information: Company or Trustee’s Name (to whom the check should be made payable) Company or Trustee’s Mailing Address 1 Company or Trustee’s Mailing Address 2 Company or Trustee’s City State Zip Code Account Number Company or Trustee’s Phone Number PART 5: SIGNATURE, CONSENT, AND SUBSTITUTE IRS FORM W-9 UNDER PENALTIES OF PERJURY UNDER THE LAWS OF THE UNITED STATES OF AMERICA, I CERTIFY THAT ALL OF THE INFORMATION PROVIDED ON THIS FORMER PARTICIPANT CLAIM FORM IS TRUE, CORRECT AND COMPLETE AND THAT I SIGNED THIS FORMER PARTICIPANT CLAIM FORM.
PAYMENT ELECTION. Direct Rollover to an Eligible Plan – Check only one box below and complete the Rollover Information Section below: Government 457(b) Direct Rollover to a Traditional IRA 401(a)/401(k) Direct Rollover to a Xxxx XXX (subject to ordinary income tax) 403(b) Rollover Information: Company or Trustee’s Name (to whom the check should be made payable) PART 5: SIGNATURE, CONSENT, AND SUBSTITUTE IRS FORM W-9 UNDER PENALTIES OF PERJURY UNDER THE LAWS OF THE UNITED STATES OF AMERICA, I CERTIFY THAT ALL OF THE INFORMATION PROVIDED ON THIS FORMER PARTICIPANT ROLLOVER FORM IS TRUE, CORRECT, AND COMPLETE AND THAT I SIGNED THIS FORMER PARTICIPANT ROLLOVER FORM.
PAYMENT ELECTION. In accordance with the terms of the Pinnacle West Capital Corporation 2007 Long-Term Incentive Plan and pursuant to Section 4(b) of the Award Agreement, I hereby elect to receive payment for the Restricted Stock Units that vest on the dates set forth below in the following form (place an “X” in the “Cash” column or in the “Stock” column for each of the years set forth below): Vesting Date Cash Stock ¨ ¨ ¨ ¨ ¨ ¨ ¨ ¨ Note: If you elected to receive payment in the form of Stock for any vested Restricted Stock Units, complete Section 2.
PAYMENT ELECTION. Payment to Self. A check will be mailed to you to the address on the previous page. Direct Rollover to an Eligible Plan: Check only one box below and complete the Rollover Information Section below. Direct Rollover to tax-deferred plan. (Governmental 457(b), 401(a)/ 401(k), 403(b), or traditional XXX Direct Rollover to a Xxxx XXX. (subject to ordinary income tax) Rollover Information: Company or Trustee’s Name (to whom the check should be made payable) Company or Trustee’s Mailing Address 1 Company or Trustee’s Mailing Address 2 Company or Trustee’s City State Zip ( ) Account Number Company or Trustee’s Phone Number
PAYMENT ELECTION. I elect to receive payment of my shares of Stock pursuant to my ____________________ Restricted Stock Unit Agreement: ____ Paid in a lump-sum payment within 30 days following my Separation from Service. ____ Paid in ____ (maximum of 5) equal annual installments commencing within 30 days following my Separation from Service from the Corporation with each subsequent payment to be paid on the anniversary of my Separation from Service.
PAYMENT ELECTION. In accordance with the terms of the Pinnacle West Capital Corporation 2012 Long-Term Incentive Plan and pursuant to Section 4(b) of the Award Agreement, I hereby elect to receive payment for the Restricted Stock Units and Dividend Equivalents that vest on the dates set forth below in the following form (place an “X” in the “100% Stock” column, in the “50% Cash/50% Stock” column or in the “100% Cash” column for each of the years and types of Awards set forth below): Restricted Stock Units and Dividend Equivalents Vesting Date 100% Stock 50% Cash/ 50% Stock 100% Cash __/__/_____ ¨¨¨¨ ¨¨¨¨ ¨¨¨¨ __/__/_____ __/__/_____ __/__/_____
PAYMENT ELECTION. No later than thirty (30) days following the Date of Grant, the Grantee shall make an Initial Election by filing with the Company an initial Payment Election Form, in a form provided by the Company, indicating whether the payment of the Deferred Stock Unit Award, if vested, upon the Grantee’s death or Termination of Board
