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PICCADILLY CAFETERIAS, INC. DIVIDEND REINVESTMENT AND STOCK PURCHASE PLAN ENROLLMENT FORM
NOTE: This not a Proxy
EquiServe Trust Company, N.A. Please mark [X] the appropriate box to enroll or change
P.O. Box 8218 your current plan option. PLEASE NOTE THAT DIVIDENDS ON
Boston, MA 02266-8218 ALL SHARES HELD IN THE PLAN WILL AUTOMATICALLY BE
REINVESTED. DO NOT RETURN THIS CARD UNLESS YOU HAVE
SELECTED ONE OF THE FOLLOWING OPTIONS:
[] FULL DIVIDEND REINVESTMENT: I wish to reinvest the
cash dividends on all shares registered in my name
and on all shares credited to my account under the
Plan. I may also make optional cash payments of a
minimum of $100 per payment up to a maximum of
$5,000 per quarter
[] PARTIAL DIVIDEND REINVESTMENT: I wish to reinvest
____________________________________ the cash dividends on _______ shares registered in
Name(s) of Owner(s) my name and to receive cash dividends on the
____________________________________ remaining shares registered in my name for this
account. I may also make optional cash payments.
____________________________________ [] OPTIONAL CASH ONLY. I wish to make optional cash
Street payments to the Plan. I will receive a dividend
____________________________________ check for all shares registered in my name. Please
City State Zip Code make check or money order payable to EquiServe
Trust Company, N.A
__________________________ __/__/__ If you have an address change, please mark the box to []
Signature(s) of Registered Date the right and indicate the change on the reverse side
Owners(s)-all registered of this form.
owners MUST sign
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^ DETACH CARD HERE ^
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PLEASE READ CAREFULLY BEFORE SIGNING. TEAR ALONG PERFORATION AND
RETURN THE TOP PORTION TO EQUISERVE IN THE ENVELOPE PROVIDED.
KEEP THE BOTTOM PORTION FOR YOUR REFERENCE
INVESTMENT OPTIONS FOR
PICCADILLY CAFETERIAS, INC. DIVIDEND REINVESTMENT AND STOCK PURCHASE PLAN
FULL DIVIDEND REINVESTMENT The cash dividends on all Piccadilly Cafeterias,
Inc. shares registered in your name and the cash dividends on all shares
credited to your account under the Plan will be invested to purchase additional
shares. You may also invest by making optional cash payments of a minimum of
$100 per payment up to a maximum of $5,000 per quarter.
PARTIAL DIVIDEND REINVESTMENT The cash dividends on less than all Piccadilly
Cafeterias, Inc. shares registered in your name may be reinvested in the Plan.
For example, if you have 300 shares registered in your name and want to
reinvest cash dividends on 100 shares, check the "Partial Dividend
Reinvestment" box and write 100 on the blank line. (The cash dividends you
wish to reinvest must be on full shares.) You will receive dividends on the
remaining 200 shares. Please note, the dividends on all shares held in the
Plan will automatically be reinvested to purchase additional shares. You may
also invest by making optional cash payments of a minimum of $100 per payment
up to a maximum of $5,000 per quarter.
OPTIONAL CASH ONLY You may make optional cash payments of a minimum of $100
per payment up to a maximum of $5,000 per quarter without reinvesting dividends
on the shares registered in your name. Any shares purchased through optional
cash payments will be credited to your account under the Plan. Dividends on
all Piccadilly Cafeterias, Inc. shares credited to your account under the Plan
will automatically be reinvested to purchase additional shares. Optional cash
payments must be received by the Agent by the dates provided in the Plan
Prospectus.
QUESTIONS If you have any questions, please write to Piccadilly Cafeterias,
Inc. at EquiServe Trust Company, N.A., P.O. Box 8218, Boston, MA 02266-8218 or
call toll-free: 1-800-633-4236.
Your participation in the Plan is subject to the terms set forth in the
accompanying Prospectus. You may terminate participation in the Plan at any
time by written notice to EquiServe Trust Company, N.A., Dividend Reinvestment
Plan. P.O. Box 8218, Boston, MA 02266-8218.
DO NOT RETURN THIS FORM UNLESS YOU INTEND TO PARTICIPATE IN THE PLAN SINCE THIS
FORM AUTHORIZES EQUISERVE TRUST COMPANY, N.A TO ENROLL YOUR ACCOUNT IN THE
PLAN. IF THIS FORM IS SIGNED BUT NO BOX CHECKED, YOU WILL BE ENROLLED IN THE
PLAN UNDER THE FULL DIVIDEND REINVESTMENT OPTION.
Return to:
EquiServe Trust Company, N.A.
P. O. Box 8218
Boston, MA 02266-8218
