Exhibit 99.2
ENROLLMENT FORM-NEW PARTICIPANTS
FIFTH THIRD DIRECT
ENROLLMENT FORM
PLEASE READ CAREFULLY BEFORE SIGNING
Record Holder Status: (please check one and sign below)
[ ] 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 $520 ($500
for common stock purchase plus $20 enrollment fee) to become a
registered holder of Fifth Third Bancorp.
Dividend Reinvestment Options: (please check one and sign below)
[ ] 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
Fifth Third Direct, as may be amended from time to time (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. I
will only invest voluntary cash under the terms and conditions of the
Plan.
Cash Purchase Options: (please check all that apply and sign below)
[ ] Optional Cash Payment: I enclose herewith a check or money order
payable to Fifth Third Direct in the sum of $_______________ (minimum
$520) 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, savings or other account
$_______________ on a monthly basis as set forth in the completed
automatic debit authorization form on reverse side and invest such
designated amount (less any applicable fees and commissions) in full
or fractional shares of Fifth Third Bancorp Common Stock in
accordance with the terms of the Plan. The reverse side must be
completed.
I hereby appoint Fifth Third Bank as my agent under the terms and conditions
of the Fifth Third Direct, 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. I acknowledge receipt of the Fifth Third Direct Prospectus and
agree to the terms and conditions of the Plan stated in that Prospectus, as
same may be amended from time to time.
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. 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
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 Joint Shareholder Signature
(if jointly held)
__________________________________ ___________________________________
State or country (if other than State or country (if other than
the United States) of residence the United States) of residence if
jointly held
Daytime Phone (_____) ____________
SUBSTITUTE Part 1-PLEASE PROVIDE YOUR TIN AND TIN ____________
Form W-9 CERTIFY BY SIGNING AND DATING BELOW Social Security
Number
Department of the _________________________________ Or
Treasury Internal NAME (Please Print) Employer
Revenue Service Identification
_________________________________
NumberPayer's Request ADDRESS
for Taxpayer
Identification _________________________________
Number (TIN) CITY STATE ZIP CODE
and Certification
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 THAT YOU 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
Automatic Debit Authorization
Please indicate the account from which you would like your additional
investments withdrawn. You must enclose a pre-encoded deposit ticket or
blank, voided check to help us identify your account.
[ ] Checking account [ ] Savings account [ ] Other account
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
Signature(s)* ________________________ _______________________________
* All persons shown on shareholder records are required to sign for
Automatic Debit Authorization
Dividend Direct Deposit Authorization Form
Partial Reinvestment Participants Only
Please indicate the account number and the financial institution to which you
would like your dividends deposited. You must enclose a pre-encoded deposit
ticket or blank, voided check to help us identify your account.
[ ] Checking account [ ] Savings account [ ] Other account
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
Signature(s)* ________________________ _______________________________
* All persons shown on shareholder records are required to sign for
Dividend Direct Deposit
