Exhibit 99.1
Enrollment Form
FIFTH THIRD DIRECT
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ENROLLMENT FORM
PLEASE READ CAREFULLY BEFORE SIGNING
I hereby appoint Fifth Third Bank as my agent under the terms and
conditions of the Fifth Third Direct Investment Plan, as described in the
Prospectus and accompanying this Enrollment Form, to receive any cash
dividends that may become payable to me on any of the shares of Fifth Third
Bancorp Common Stock specified below, and to apply such dividends to the
purchase of shares as provided in the Plan.
Record Holder Status: (please check one)
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[ ] I hereby represent and confirm that I am the registered holder
of shares of common stock of Fifth Third Bancorp.
[ ] I have checked the box below for "Optional Cash Payment" and
have enclosed a check or money order in an amount of at least
$525 ($500 for common stock purchase plus $25 enrollment fee)
to become a registered holder of Fifth Third Bancorp.
I acknowledge receipt of the Fifth Third Direct Plan Prospectus and
agree to the terms and conditions of the Plan stated in that Prospectus.
I understand that I may change my reinvestment options or revoke this
authorization at any time by notifying Fifth Third Bank in writing of my
desire to modify and/or terminate my participation in Fifth Third Direct.
Dividend Reinvestment Options (please check one):
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[ ] Full Reinvestment: I hereby authorize Fifth Third Bancorp to
pay to Fifth Third Bank, as agent for my account, all cash
dividends due to me on shares of Fifth Third Bancorp Common
Stock for which I am the registered holder. I want to reinvest
dividends on all shares registered in my name for the purchase
of full or fractional shares of Fifth Third Bancorp Common
Stock in accordance with the terms of the Plan.
[ ] Partial Reinvestment: I hereby authorize Fifth Third Bancorp to
pay to Fifth Third Bank, as agent for my account, all cash
dividends due to me on (pick one) [ ] shares of Fifth Third
Bancorp Common Stock; or [ ] _______ % of Fifth Third Bancorp
Common Stock for which I am the registered holder. I want to
reinvest dividends on the indicated number of shares or
percentage of shares as so indicated in my name for the
purchase of full or fractional shares of Fifth Third Bancorp
Common Stock in accordance with the terms of the Plan.
[ ] No Reinvestment: I do not want to reinvest any cash dividends
paid on shares of Fifth Third Bancorp Common Stock registered
in my name.
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Cash Purchase Options (please check all that apply):
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[ ] Optional Cash Payment: I enclose herewith a check or money
order payable to Fifth Third Direct in the sum of
$_______________ (minimum $525) and hereby authorize Fifth
Third Bank, as agent, to invest the entire proceeds (less any
applicable fees) from that check or money order in full or
fractional shares of Fifth Third Bancorp Common Stock in
accordance with the terms of the Plan.
[ ] Optional Automatic Investment: I hereby authorize Fifth Third
Bank, as agent, to debit my checking or savings account
$_______ on a monthly basis as set forth in the completed
automatic debit enrollment form (enclosed) and invest such
designated amount (less any applicable fees) in full or
fractional shares of Fifth Third Bancorp Common Stock in
accordance with the terms of the Plan.
I understand that the purchase of Common Stock will be made subject
to the terms and conditions of the Plan, and that I may terminate this
authorization at any time by notifying Fifth Third Bank in writing.
Enrollment Signatures
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Return this Enrollment Form only if you wish to participate in Fifth
Third Direct. This Enrollment Form, when signed, should be mailed to: Fifth
Third Direct c/o Fifth Third Bank, 38 Fountain Square Plaza MD 10AT66,
Cincinnati, Ohio 45263.
All owners of shares held in joint registration must sign this
Enrollment Form.
DATE: _______________
____________________________________ ____________________________________
Shareholder Signature State or country (if other than
The United States) of residence
____________________________________ ____________________________________
Joint Shareholder Signature State or country (if other than
(if jointly held) the United States) of residence
if jointly held
Tax I.D. No.(s) ______________________ ____________________________________
Daytime Phone (___) __________________
THE ENCLOSED SUBSTITUTE FORM W-9 MUST BE COMPLETED AND
RETURNED WITH THIS FORM
THIS IS NOT A PROXY
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<PAGE> II-10
SUBSTITUTE Part 1 - PLEASE PROVIDE TIN ______________
Form W-9 YOUR TIN AND CERTIFY Social Security Number
BY SIGNING AND DATING Or
Department of the Treasury BELOW Employer Identification
Internal Revenue Service Number
Payer's Request for Taxpayer ____________________
Identification Number (TIN) NAME (Please Print)
and Certification ____________________
ADDRESS
_______________________
CITY STATE ZIP CODE
Part 2 - Please check those that apply, if any:
[ ] I am subject to withholding under the
provisions of the Internal Revenue Code of
1986 because (a) I have been notified that
you are subject to backup withholding as a
result of failure to report all interest or
dividends or (b) the Internal Revenue
Service has notified you that you are
subject to backup withholding.
[ ] I am awaiting a TIN.
Part 3 - CERTIFICATION - UNDER THE PENALTIES OF PERJURY, I CERTIFY THAT (1)
The number shown on this form is my correct taxpayer identification number
(or a TIN has not been issued to me but I have mailed or delivered an
application to receive a TIN or intend to do so in the near future), (2) I
am not subject to backup withholding either because I have not been
notified by the Internal Revenue Service (the "IRS") that I am subject to
backup withholding as a result of a failure to report all interest or
dividends or the IRS has notified me that I am no longer subject to backup
withholding, and (3) all other information provided on this form is true,
correct and complete.
SIGNATURE _______________________________________ DATE ___________, 2000
You must cross out item (2) above if you have been notified by the IRS that
you are currently subject to backup withholding because of under reporting
interest or dividends on your tax return and checked the first box in Part
2 above.
NOTE: FAILURE TO COMPLETE AND RETURN THIS FORM MAY RESULT IN BACKUP
WITHHOLDING OF 31% OF ANY PAYMENTS MADE TO YOU. YOU MUST COMPLETE THE
FOLLOWING CERTIFICATE IF YOU CHECKED THE BOX IN PART 2 OF THE SUBSTITUTE
FORM W- 9 INDICATING THATYOU ARE AWAITING A TIN.
CERTIFICATE OF AWAITING TAXPAYER IDENTIFICATION NUMBER
I certify under penalties of perjury that a taxpayer identification number
has not been issued to me and either (a) I have mailed or delivered an
application to receive a taxpayer identification number to the appropriate
Internal Revenue Service Center or Social Security Administration Office or
(b) I intend to mail or deliver an application in the near future. I
understand that if I do not provide a taxpayer identification number by the
time of payment, 31% of all payments of the Purchase Price made to me
thereafter will be withheld until I provide a number.
SIGNATURE _______________________________________ DATE ___________, 2000
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Dividend Direct Deposit Authorization
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Please indicate the account
number and the financial [ ] Checking account number: ______________
institution to which you would
like your dividends deposited. [ ] Financial Institution: ____________
Please enclose a pre-coded deposit
ticket or blank, voided check to [ ] Savings account number: _______________
help us identify your account.
[ ] Financial Institution: ____________
[ ] Other: ________________________________
[ ] Financial Institution: ____________
Please print name(s) as shown on shareholder records:
_______________________________________________________________________________
First Middle Initial Last
_______________________________________________________________________________
First Middle Initial Last
Address _______________________________________________________________________
City __________________ State _____ Zip ________________
Telephone Number (___)_______________ (___)_______________
Home Work
Social Security Number: ___________________________
Signature(s)* __________________________________
__________________________________
* All persons shown on shareholder records are required to sign for
Dividend Direct Deposit
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