EXHIBIT 99.9
XXXXX'X RESTAURANTS, INC.
1999 EMPLOYEE STOCK PURCHASE PLAN ("ESPP")
ENROLLMENT/CHANGE FORM
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SECTION 1:
------------------ ACTION COMPLETE SECTIONS:
/ / New Enrollment 2, 3, 7 AND sign attached Stock Purchase
ACTIONS / / Payroll Deduction Change Agreement
/ / Terminate Payroll Deductions 2, 4, 7
/ / Leave of Absence 2, 5, 7
2, 6, 7
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SECTION 2:
------------------ Name
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Last First MI Dept.
PERSONNEL DATA
Home Address
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Street
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City State Zip Code
--- --- ---- ---- --- ---- --- ---- ---
Social - -
Security #
--- --- ---- ---- --- ---- --- ---- ---
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SECTION 3: Effective with the Purchase Payroll Deduction Amount: _________ % of cash
------------------ Interval Beginning: earnings*
NEW ENROLLMENT / / First Business Day of February, _______
* Must be a multiple of 1% up to a maximum of
/ / First Business Day of August, _________ 10% of cash earnings
/ / Initial Offering Period
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SECTION 4: Effective with the I authorize the following new level of
------------------ Pay Period payroll deduction: ______________% of cash
Beginning: earnings*
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Month, Day and Year
PAYROLL DEDUCTION
CHANGE
* Must be a multiple of 1% up to a maximum
of 10% of cash earnings
NOTE: You may reduce your rate of payroll deductions
once per 6-month purchase interval to become
effective as soon as possible following the
filing of the change form. You may also increase
your rate of payroll deductions to become
effective as of the start date of the next
6-month interval (first business day of February
or August).
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SECTION 5: Effective with the Your election to terminate your payroll
------------------ Pay Period deductions for the balance of the offering
Beginning: period cannot be changed, and you may not
-------------------------------------------- rejoin the offering period at a later date.
Month, Day and Year You will not be able to resume participation
in the ESPP until the start of the next
offering period.
TERMINATE PAYROLL
DEDUCTIONS
In connection with my voluntary termination of payroll
deductions, I elect the following action regarding my ESPP
payroll deductions to date in the current purchase
interval:
/ / Purchase shares of Rubio's Restaurants, Inc. at the end of the purchase interval
OR
/ / Refund ESPP payroll deductions collected
NOTE: If your employment terminates for any reason or
your eligibility status changes (< 20 hrs/week or
< 5 months/year), you will immediately cease to
participate in the ESPP, and your ESPP payroll
deductions collected in that purchase interval
will automatically be refunded to you.
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SECTION 6: In connection with my leave of absence, I elect the
------------------ following action with respect to my ESPP payroll
deductions to date in the current purchase interval:
/ / Purchase shares of Rubio's Restaurants, Inc. at the end of the purchase interval
LEAVE OF ABSENCE
OR
/ / Refund ESPP payroll deductions collected
NOTE: If you take an unpaid leave of absence, your
payroll deductions will immediately cease.
If you return to active status within 90
days after the start of your leave, your
payroll deductions will at that time
automatically resume at the rate in effect
for you when your leave began.
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SECTION 7:
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AUTHORIZATION I hereby authorize the specific action or actions indicated above.
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Date Signature of Employee
