Exhibit 99.1
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LOGO: TierOne Corporation
Subscription & Community Stock Order Form
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TierOne Bank
BANK Conversion Center
USE xxx xxxxxx Street
xxxxxxx, xxxxxxxx
--------------------------------- xxxxx (xxx) xxx-xxxx
IMPORTANT-PLEASE NOTE: A
properly completed original
stock order form must be used Expiration Date
to subscribe for common stock. for Stock Order Forms:
Copies of this form are not Xxxxxx, xxxxx xx, 2002
required to be accepted. x:00 p.m., Central
Please read the Stock Daylight
Ownership Guide and Stock Time
Order Form Instructions as you
complete this form.
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(1) Number of Shares (2) Total Payment Due The minimum number of shares that may be subscribed for is 25
------------------------ Subscription ---------------------------- and the maximum number of shares that may be subscribed for in
Price $ the subscription offering is xx,000 shares. See Instructions.
------------------------ X $10.00 = ----------------------------
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(3) Employee/Officer/Director Information (6) Purchaser Account Information
[ ] Check here if you are an employee, officer or director of a. [ ] Check here if you are an Eligible Account Holder with a
TierOne Bank or a member of such person's immediate family deposit account(s) totalling $50.00 or more on
living in the same household. December 31, 2000.
List account(s) below.
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(4) Method of Payment/Check Check Amount
Enclosed is a check, bank draft or ------------------------ b. [ ] Check here if you are a Supplemental Eligible Account
money order made payable to TierOne $ Holder with a deposit account(s) totalling $50.00 or
Bank in the amount indicated in this ------------------------ more on xxxxxxxx xx, 2002.
box. List account(s) below.
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------------------------------------------------------------------ c. [ ] Check here if you are a depositor with a deposit
(5) Method of Payment/Withdrawal account(s) as of xxxxxxx xx, 2002 or a borrower as of
The undersigned authorizes withdrawal from the following June 1, 1995 and continue to be a borrower as of xxxxxxx
account(s) at TierOne Bank. There is no early withdrawal xx, 2002.
penalty for this form of payment. Individual Retirement List account(s) below.
Accounts or Qualified Plans maintained at TierOne Bank cannot ---------------------
be used unless special transfer arrangements are made.
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------------------------------------------------------------------ Account Title Bank
Bank (Names on Accounts) Account Number(s) Use
Amount Number(s) to Withdraw $ Withdrawal Amount(s) Use ---------------------------------------------------------------
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PLEASE NOTE: FAILURE TO LIST ALL YOUR ACCOUNTS MAY RESULT
------------------------------------------------------------------ THE LOSS OF PART OR ALL OF YOUR SUBSCRIPTION RIGHTS. IF
Total Withdrawal Amount $ ADDITIONAL SPACE IS NEEDED, PLEASE UTILIZE THE BACK OF THIS
------------------------------------- STOCK ORDER FORM.
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(7) Stock Registration/Form of Stock Ownership
[ ] Individual [ ] Joint Tenants [ ] Tenants in Common
[ ] Fiduciary (i.e. trust estate) [ ] Company/Corp/Partnership [ ] Uniform Transfers to [ ] IRA or other qualified plan
Minors Act (beneficial owners ss# above)
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(8) Name(s) in which stock is to be registered (please print Adding the names of other persons who are not owners of your
clearly) qualifying accounts will result in your order becoming null and
void.
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Name(s) Social Security # or Tax ID
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Name(s) continued Social Security # or Tax ID
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Street Address County of Residence
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City State Zip Code
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Daytime Evening
(9) Telephone ( ) ( )
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(10) NASD Affiliation (11) Associates/Acting In Concert
[ ] Check here if you are a member of the National Association of [ ] Check here and complete the reverse side of this form, if
Securities Dealers, Inc. ("NASD"), a person affiliated, or you or any associates or persons acting in concert with you
associated, with an NASD member, (continued on reverse side have submitted other orders for shares.
of this form)
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(12) Acknowledgment BANK USE
To be effective, this stock order form and accompanying certification form must be properly completed and physically -------------
received by TierOne Bank no later than x:00 p.m., Central Daylight Time, on Xxxxxx, xxxxx xx, 2002, unless extended;
otherwise this stock order form and all subscription rights will be void. The undersigned agrees that after receipt
by TierOne Bank, this stock order form may not be modified, withdrawn or canceled without the Bank's consent and if
authorization to withdraw from deposit accounts at TierOne Bank has been given as payment for shares; the amount
authorized for withdrawal shall not otherwise be available for withdrawal by the undersigned. Under penalty of
perjury, I hereby certify that the Social Security or Tax ID Number and the information provided on this stock order -------------
form is true, correct and complete, that I am not subject to back-up withholding, and that I am purchasing shares
solely for my own account and that there is no agreement or understanding regarding the sale or transfer of such
shares, or my right to subscribe for shares. It is understood that this stock order form will be accepted in
accordance with, and subject to, the terms and conditions of the plan of conversion of the Bank described in the
accompanying prospectus. The undersigned hereby acknowledges receipt of the prospectus at least 48 hours prior to
delivery of this stock order form to the Bank.
Federal regulations prohibit any person from transferring, or entering into any agreement, directly or indirectly, to
transfer the legal or beneficial ownership of subscription rights or the underlying securities to the account of
another. TierOne Bank and TierOne Corporation will pursue any and all legal and equitable remedies in the event they -------------
become aware of the transfer of subscription rights and will not honor orders known by them to involve such transfer. BANK USE
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Signature Date Signature Date
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THE CERTIFICATION FORM ON THE REVERSE SIDE MUST BE SIGNED
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Item (6) Purchaser Account Information - a, b & c continued: Item (10) NASD continued:
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Bank a member of the immediate family of any such person to whose
Account Title (Names on Accounts) Account Number(s) Use support such person contributes, directly or indirectly, or the
------------------------------------------------------------------ holder of an account in which an NASD member or person
associated with an NASD member has a beneficial interest. To
------------------------------------------------------------------ comply with conditions under which an exemption from the NASD's
Interpretation With Respect to Free-Riding and Withholding is
------------------------------------------------------------------ available, you agree, if you have checked the NASD Affiliation
box, (i) not to sell, transfer or hypothecate the stock for a
------------------------------------------------------------------ period of three months following issuance, and (ii) to report
this subscription in writing to the applicable NASD member
------------------------------------------------------------------ within one day of payment therefor.
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Item (11) Associates continued: List below all other orders submitted by you or Associates (as defined) or by persons acting in
concert with you.
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Number of Number of
Name(s) listed on other stock order forms Shares Ordered Name(s) listed on other stock order forms continued Shares Ordered
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"Associate" is defined as: (i) any corporation or organization (other than TierOne Corporation, TierOne Bank or any majority-owned
subsidiary thereof) of which such person is an officer, trustee or partner or is, directly or indirectly, the beneficial owner of
10% or more of any class of equity securities of the corporation or organization; (ii) any trust or other estate in which such
person has a substantial beneficial interest or as to which such person serves as trustee or in a similar fiduciary capacity
(exclusive of any of any tax-qualified employee stock benefit plan); (iii) any person who is related by blood or marriage to such
person, and (i) lives in the same home as such person; or (ii) is a director or senior officer of TierOne Bank or any affiliate
thereof; and (iv) any person Acting in Concert with any of the persons or entities specified in clauses (i) through (iii) above;
provided, however, that any Tax-Qualified or Non-Tax-Qualified Employee Stock Benefit Plan shall not be deemed to be an Associate of
any director, or officer of TierOne Corporation or TierOne Bank, to the extent provided in the plan. When used to refer to a person
other than an officer or director of TierOne Bank, or TierOne Corporation. TierOne Bank in its sole discretion may determine the
persons that are Associates of other persons. Directors of TierOne Corporation and TierOne Bank shall not be deemed to be Associates
solely as a result of their membership on any such board or boards.
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YOU MUST SIGN THE FOLLOWING CERTIFICATION IN ORDER TO PURCHASE STOCK
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CERTIFICATION FORM
I ACKNOWLEDGE THAT THIS SECURITY IS NOT A DEPOSIT OR ACCOUNT AND IS NOT FEDERALLY INSURED OR GUARANTEED BY THE FEDERAL DEPOSIT
INSURANCE CORPORATION, AND IS NOT INSURED OR GUARANTEED BY TIERONE CORPORATION, TIERONE BANK, THE FEDERAL GOVERNMENT OR BY ANY
GOVERNMENT AGENCY. THE ENTIRE AMOUNT OF AN INVESTOR'S PRINCIPAL IS SUBJECT TO LOSS.
If anyone asserts that this security is federally insured or guaranteed, or is as safe as an insured deposit, I should call the
Office of Thrift Supervision, Regional Director of the Dallas Regional Office at (xxx) xxx-xxxx.
I further certify that, before purchasing the common stock, par value $0.01 per share, of TierOne Corporation (the "Company"), the
proposed holding company for TierOne Bank, I received a prospectus of the Company dated xxxxxxx xx, 2002 relating to such offer of
common stock. The prospectus that I received contains disclosure concerning the nature of the common stock being offered by the
Company and describes in the "Risk Factors" section beginning on page xx, the risks involved in the investment in this common stock,
including but not limited to the following:
1. Our loan portfolio includes more loans with a higher risk of loss.
2. Our purchases of loans outside our primary market area may increase our risks.
3. Our continuing concentration of loans in our primary market area may increase our risks.
4. Our low return on equity may cause our common stock to decline.
5. Our future returns on equity will be adversely affected by the proceeds from the offering.
6. An increase in the offering range would be dilutive.
7. Our stock value may suffer from anti-takeover provisions that may impede potential takeovers.
8. Higher interest rates could hurt our profitability.
9. Our employee stock benefit plans will increase our costs.
10. Our employee stock benefit plans will be dilutive.
11. Our valuation is not indicative of the future value of our common stock.
12. There is no guarantee that an active trading market for your stock will develop, which may hinder your ability to sell your
common stock.
13. The establishment of the TierOne Charitable Foundation will negatively impact our profits for the year ended December 31, 2002.
14. Failure to approve the TierOne Charitable Foundation may materially affect the pro forma market value of TierOne Corporation.
(By Executing this Certification Form the Investor is Not Waiving Any Rights Under the Federal Securities Laws,
Including the Securities Act of 1933 and the Securities Exchange Act of 1934)
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Signature Date Signature Date
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Print Name Print Name
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THIS CERTIFICATION MUST BE SIGNED IN ORDER TO PURCHASE STOCK
[Logo] TierOne Corporation
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Stock Ownership Guide
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Individual
Include the first name, middle initial and last name of the shareholder. Avoid the use of two initials. Please omit words that do
not affect ownership rights, such as "Mrs.", "Mr.", "Dr.", "special account", "single person", etc.
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Joint Tenants
Joint tenants with right of survivorship may be specified to identify two or more owners. When stock is held by joint tenants with
right of survivorship, ownership is intended to pass automatically to the surviving joint tenant(s) upon the death of any joint
tenant. All parties must agree to the transfer or sale of shares held by joint tenants.
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Tenants in Common
Tenants in common may also be specified to identify two or more owners. When stock is held by tenants in common, upon the death of
one co-tenant, ownership of the stock will be held by the surviving co-tenant(s) and by the heirs of the deceased co-tenant. All
parties must agree to the transfer or sale of shares held by tenants in common.
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Uniform Transfers to Minors Act ("UTMA")
Stock may be held in the name of a custodian for a minor under the Uniform Transfers to Minors Act of each state. There may be only
one custodian and one minor designated on a stock certificate. The standard abbreviation for Custodian is "CUST", while the Uniform
Transfers to Minors Act is "UTMA". Standard U.S. Postal Service state abbreviations should be used to describe the appropriate
state. For example, stock held by Xxxx Xxx as custodian for Xxxxx Xxx under the Nebraska Uniform Transfers to Minors Act will be
abbreviated Xxxx Xxx, CUST Xxxxx Xxx UTMA NE (use minor's social security number).
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Fiduciaries
Information provided with respect to stock to be held in a fiduciary capacity must contain the following:
o The name(s) of the fiduciary. If an individual, list the first name, middle initial and last name. If a corporation,
list the full corporate title (name). If an individual and a corporation, list the corporation's title before the
individual.
o The fiduciary capacity, such as administrator, executor, personal representative, conservator, trustee, committee, etc.
o A description of the document governing the fiduciary relationship, such as a trust agreement or court order.
Documentation establishing a fiduciary relationship may be required to register your stock in a fiduciary capacity.
o The date of the document governing the relationship, except that the date of a trust created by a will need not be
included in the description.
o The name of the maker, donor or testator and the name of the beneficiary.
An example of fiduciary ownership of stock in the case of a trust is: Xxxx Xxx, Trustee Under Agreement Dated 10-1-87 for Xxxxx Xxx.
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Stock Order Form Instructions
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Items 1 and 2 - Number of Shares and Total Payment Due
Fill in the number of shares that you wish to purchase and the total payment due. The amount due is determined by multiplying the
number of shares by the subscription price of $10.00 per share. The minimum purchase in the subscription offering is 25 shares. As
more fully described in the plan of conversion outlined in the prospectus, the maximum purchase in the subscription offering is
$500,000 (50,000 shares), and the maximum purchase in the community offering (if held) by any person, is $500,000 (50,000 shares).
However, no person, together with associates and persons acting in concert with such person, may purchase in the aggregate more than
$1,53700,000 (153,700 shares) of common stock.
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Item 3 - Employee/Officer/Trustee Information
Check this box to indicate whether you are an employee, officer or trustee of TierOne Bank or a member of such person's immediate
family living in the same household.
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Item 4 - Method of Payment by Check
Indicate the total check(s) amount in this box if your method of payment is by check, bank draft or money order. Payment for shares
may be made in cash (only if delivered by you in person to a full service branch office of TierOne Bank) or by check, bank draft or
money order payable to TierOne Bank. Your funds will earn interest at TierOne Bank's passbook rate of interest until the conversion
is completed. (DO NOT MAIL CASH TO PURCHASE STOCK!)
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Item 5 - Method of Payment by Withdrawal
If you pay for your stock by a withdrawal from a deposit account at TierOne Bank, indicate the account number(s) and the amount of
your withdrawal authorization for each account. The total amount withdrawn should equal the amount of your stock purchase. There
will be no penalty assessed for early withdrawals from certificate accounts used for stock purchases. This form of payment may not
be used if your account is an Individual Retirement Account or Qualified Plan.
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Item 6 - Purchaser Information
a. Check this box if you are an Eligible Account Holder with a deposit account(s) totalling $50.00 or more on December 31,
2000.
b. Check this box if you are a Supplemental Eligible Account Holder with a deposit account(s) totalling $50.00 or more on
xxxxxxxx xx, 2002.
c. Check this box if you are a depositor with a deposit account(s) as of xxxxxxx xx, 2002 or a borrower as of June 1, 1995
and continue to be a borrower as of xxxxxxx xx, 2002.
Please list all names and all account numbers on accounts you had at these dates in order to insure proper identification of your
purchase rights.
Note: Failure to list all your accounts or loans may result in the loss of part or all of your subscription rights.
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Items 7, 8 and 9 - Stock Registration/Form of Stock Ownership, Names and Telephone Number
The stock transfer industry has developed a uniform system of shareholder registrations that will be used in the issuance of your
TierOne Corporation common stock. Complete items 7, 8 and 9 as fully and accurately as possible, and be certain to supply your
social security or Tax I.D. number(s) and your daytime and evening telephone number(s). We may need to call you if we cannot execute
your order as given. If you have any questions regarding the registration of your stock, please consult your legal advisor. Stock
ownership must be registered in one of the ways described above under "Stock Ownership Guide".
Adding the names of other persons who are not owners of your qualifying account(s) will result in your order becoming null and void.
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Item 10 - NASD Affiliation
Check this box if you are a member of the NASD or if this item otherwise applies to you.
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Item 11 - Associates Acting in Concert
Check this box if you or any associate (as defined on the reverse side of the stock order form) or person acting in concert with you
has submitted another order for shares and complete the reverse side of the stock order form.
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Item 12 - Acknowledgement
Sign and date the stock order form and certification form where indicated. Before you sign, review the stock order form, including
the acknowledgement, and the certification form. Normally, one signature is required. An additional signature is required only when
payment is to be made by withdrawal from a deposit account that requires multiple signatures to withdraw funds.
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You may mail your completed stock order form and certification form in the envelope that has been provided, or you may deliver your
stock order form and certification form to any full service branch office of TierOne Bank. Your stock order form and certification
form, properly completed, and payment in full (or withdrawal authorization) at the subscription price must be physically received by
TierOne Bank no later than x:00 p.m., Central Daylight Time, on Xxxxxx, xxxxx xx, 2002 or it will become void. If you have any
remaining questions, or if you would like assistance in completing your stock order form and certification form, you may call our
conversion Center at (xxx) xxx-xxxx, Monday through Friday, between the hours of 10:00 a.m. and 4:00 p.m. The conversion center will
be closed for bank holidays.
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