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EXHIBIT 99.10
PEPSIAMERICAS, INC. MERGER CONSIDERATION ELECTION
SHARES OF PEPSIAMERICA, INC. COMMON STOCK OWNED BY YOU:
1 The number of shares
2 Taxpayer ID Number:
3 / / Mark this box if you want your Whitman shares to be issued in another
name. (Complete BOX B on the reverse side)
4 / / Mark this box if your PepsiAmericas Common Stock certificates which
you wish to surrender have been lost, destroyed, mutilated or stolen.
Then, complete BOX A below.
5 / / Mark this box if you wish to provide special mailing instructions for
the DRS statements relating to the shares of Whitman Common Stock
and/or checks to which you may be entitled. (Complete BOX C on the
reverse side)
6 / / Mark this box if you wish to make a mixed or partial election and
indicate the number of shares of PepsiAmericas Common Stock in the
space provided next to the chosen election.
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THE FORM OF ELECTION WITH THE ACCOMPANYING CERTIFICATES MUST BE RECEIVED AT
EQUISERVE BY 5:00 P.M. ON DECEMBER 14, 2000.
(PLEASE NOTE: THIS DUE DATE WILL CHANGE IF THE CLOSING OF THE MERGER IS NOT
HELD ON NOVEMBER 30, 2000. PLEASE CALL 1-800-223-2064 TO CONFIRM THIS DUE
DATE IF YOU HAVE ANY QUESTIONS.)
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YOU MUST MARK EITHER BOX 7, 8 OR 9 TO MAKE AN ELECTION.
CHOICE OF ELECTION
7 / / Cash Alternative For _________________ Shares of PepsiAmericas Common
Stock.
8 / / Stock Alternative For _________________ Shares of PepsiAmericas Common
Stock.
9 / / Contingent Payment Alternative For _________________ Shares of
PepsiAmericas Common Stock.
10 / / Purchase up to ____________ Whitman Subscription Shares at a price of
$14.6125 per share. Include a check payable to EquiServe for the
total price of these additional Whitman Shares. The maximum number of
Subscription Shares you may purchase is 0.028 times the number of
shares of PepsiAmericas Common Stock included in your Contingent
Payment Alternative (number 9).
Calculation of Maximum Number of Subscription Shares
___________________________ X 0.028 = ________________________________
Number of Contingent Payment Maximum Number of Subscription
Alternative shares Shares
__________________________ X $14.6125 = $_____________________________
Number of Subscription Payment
Shares desired
If the Subscription Shares are over-subscribed, you will receive your
proportionate share of the Subscription Shares you have requested as
well as a cash refund for the shares you requested but which were not
sold to you.
YOU MUST COMPLETE THE SUBSTITUTE
FORM W-9 ON THE REVERSE SIDE, BOX D.
11 / / ______________________________________________________________________
Signature of Owner (Date)
______________________________________________________________________
Signature of Co-Owner, if any (Date)
__________________________________ _________________________
Daytime Telephone # Evening Telephone #
NO:
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DO NOT DETACH - FOLD ONLY AND INSERT IN THE BROWN-KRAFT ENVELOPE PROVIDED
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BOX A
AFFIDAVIT OF LOST OR DESTROYED CERTIFICATE(S)
AFFIDAVIT IS INVALID IF NOT SIGNED BELOW
Complete this form ONLY if you cannot locate some or all of your PepsiAmericas
Common Stock certificates. Please print clearly.
Taxpayer ID:
<TABLE>
<CAPTION>
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TOTAL SHARES LOST
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Please Fill In Certificate No(s) if Known Number of Shares
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<S> <C>
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Attach separate schedule if needed
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</TABLE>
I certify that I am the lawful owner of the shares described above. These
shares have not been pledged or endorsed and any other person, firm,
corporation, agency or government has asserted any right or title, claim,
equity or other interest in this (these) certificate(s). I have made a
diligent search for the certificate(s), and I have been unable to find it
(them). I agree (for myself, my heirs, assigns and personal representatives),
in consideration of the exchange of the shares represented by the
certificate(s), to completely indemnify, protect and hold harmless each of
GENERAL INSURANCE COMPANY OF AMERICA, PepsiAmericas, Whitman, and EquiServe
Trust Company and their respective affiliates collectively, from and against
any and all losses, costs and damages which they may be subject to, or liable
for, as enumerated in your file. I agree that this form is attached to and
made part of Blanket Bond Number 5926165 underwritten by GENERAL INSURANCE
COMPANY OF AMERICA to protect PepsiAmericas, Whitman, and EquiServe Trust
Company, and their respective affiliates. I agree to surrender the
certificate(s) for its (their) cancellation if I find it (them) at any time.
NOTARY REQUIRED FOR REPLACEMENT OF CERTIFICATES TOTALING 500 SHARES OR MORE
AFFIDAVIT IS INVALID IF NOT SIGNED BELOW AND/OR A CERTIFIED CHECK OR
MONEY ORDER IS NOT INCLUDED
X Signed by Affiant (stockholder) ______________________________________ on this
(Deponent) (Indemnitor)
(Heirs Individually)
(date) _____________________________________
Month Day Year
State of County of Notary Signature
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Printed Name of Notary
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Sworn to and subscribed to me this My Commission Expires
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(Month/Day/Year) (Month/Day/Year)
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(Notary Seal)
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Replacement Insurance Premium Calculation for lost common stock certificates.
X $0.08 = $
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SHARES LOST INSURANCE PREMIUM PER SHARE TOTAL PREMIUM DUE
Please make your check payable to GENERAL INSURANCE COMPANY OF AMERICA and
enclose it with this Form.
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PLEASE READ THE INSTRUCTIONS TO THE ELECTION AND
TRANSMITTAL FORM BEFORE COMPLETING THIS FORM.
By signing on the reverse side:
- I certify that I have read and understand the Instructions for completing
the Form of Election.
- I certify that all of the representations, warranties and agreements set
forth in paragraph 9, Important Information, in the Instructions for
completing the Form of Election are true and correct with respect to me or
with respect to the beneficial owner of the shares tendered hereby, and
that the tendering stockholder is making these representations and
warranties to Whitman Corporation.
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BOX D SUBSTITUTE FORM W-9
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If the Taxpayer ID Number printed on the reverse
side of this Form is INCORRECT, cross it out and
write in the CORRECT number here.
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CORRECTED EMPLOYER I.D. NUMBER
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Under penalties of perjury, I certify that:
(1) the number printed on the other side of this form or the corrected number
above is my correct Taxpayer ID Number (or I am waiting for a number to be
issued to me), and (2) I am not subject to backup withholding because:
(A) I am exempt from backup withholding, or (B) I have not been notified by the
Internal Revenue Service (IRS) that I am subject to backup withholding as a
result of a failure to report all interest or dividends, or (C) the IRS has
notified me that I am no longer subject to backup withholding (you must cross
out item (2) above if you have been notified by the IRS that you are currently
subject to backup withholding).
/ / EXEMPT PAYEE ATTACH ENCLOSED IRS FORM W-8 CERTIFICATE OF FOREIGN STATUS (IF
APPLICABLE)
X Signature Date:
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BOX B
TO TRANSFER OWNERSHIP
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If you want your Whitman Common Stock Signature GUARANTEE MEDALLION
and/or check to be issued in ANOTHER
NAME, fill in this section with the
information for the new account name.
If you want multiple accounts, list
them on a separate sheet.
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Name (Please Print First, Title of Officer Signing
Middle & Last Name) this Guarantee
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Address (Number and Street) Name of Guarantor - Please Print
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(City, State & Zip Code) Address of Guarantor Firm
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(Tax Identification or
Social Security Number)
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BOX C
SPECIAL MAILING INSTRUCTIONS
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Fill in ONLY if mailing to someone other than the undersigned or to the
undersigned at an address other than that shown on the front of this card. Mail
statement(s) and/or check(s) to:
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Name (Please Print First, Middle & Last Name)
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Address (Number and Street)
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(City, State & Zip Code)
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IF YOU WISH TO MAKE A VALID ELECTION, YOU MUST RETURN YOUR PEPSIAMERICAS COMMON
STOCK CERTIFICATE(S) WITH YOUR COMPLETED FORM OF ELECTION AND ANY OTHER REQUIRED
DOCUMENTS TO ONE OF THE ADDRESSES BELOW BEFORE 5:00 P.M. ON DECEMBER 14, 2000.
(PLEASE NOTE: THIS DUE DATE WILL CHANGE IF THE CLOSING OF THE MERGER IS NOT HELD
ON NOVEMBER 30, 2000. PLEASE CALL 1-800-223-2064 TO CONFIRM THIS DUE DATE IF
YOU HAVE ANY QUESTIONS.)
MAILING ADDRESS
BY MAIL: BY OVERNIGHT COURIER: BY HAND:
EquiServe EquiServe EquiServe
P.O. Box 842011 Attn: Whitman c/o Securities Transfers &
Boston, MA 02284-2011 40 Campanelli Drive Reporting Services, Inc.
Braintree, MA 02184 Attn: Corporate Actions
100 William Street, Galleria
New York, NY 10038
DELIVERY OF THE FORM OF ELECTION OR YOUR PEPSIAMERICAS COMMON STOCK
CERTIFICATES TO AN ADDRESS OTHER THAN AS SET FORTH ABOVE WILL NOT CONSTITUTE
A VALID DELIVERY TO THE EXCHANGE AGENT. RETURN IN THE YELLOW ENVELOPE. DO NOT
USE THE WHITE BALLOT ENVELOPE.
PLEASE CALL 1-800-223-2064 WITH QUESTIONS
