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EXHIBIT 99.3
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CRESCENT BANKING COMPANY
DIVIDEND REINVESTMENT AND STOCK PURCHASE PLAN
TRANSACTION REQUEST FORM
I hereby request, pursuant to the Dividend Reinvestment and Stock Purchase
Plan (the "Plan") of Crescent Banking Company (the "Company") to complete the
transaction(s) that I have described below. I understand that, by completing
and signing this Transaction Request Form, Crescent Bank & Trust Company, as the
administrator of the Plan, will execute the transaction(s) described by me below
in accordance with the provisions of the Plan, which are set forth in the
Prospectus. I hereby certify that I have carefully reviewed and have understood
the provisions of the Prospectus.
Please deposit my shares, which are represented by the enclosed stock
certificate(s), to my Plan account.
Stock Certificate Number(s):
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Number of Shares Represented by such Certificate(s):
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Please purchase additional shares of the Company's common stock, par value
$1.00 per share (the "Common Stock"), for my Plan account. To purchase
such additional shares, I have enclosed a check, in good funds, in the
amount of $______________.
Please withdraw from the Plan __________ of the shares in my Plan account.
Please transfer ______________ of the shares of Common Stock that are
currently held in my Plan account to (please select only one):
the Plan account of ____________________________ (please use the
full legal name of the person to whom you wish to transfer your
shares); or
___________________________ (please use the full legal name of
the person to whom you wish to transfer your shares).
Please provide me with a stock certificate representing ______________ of
the shares of Common Stock held in my Plan account. I understand that the
name on the certificate will be the same as that on my Plan account unless
I provide a different name below:
_________________________________________
(please provide the full legal name of the person in
whose name you would like to have the certificate
issued, if not your own)
I understand that the transactions described above will be made under the
terms and conditions of the Plan as described in the Prospectus, which I have
received, carefully reviewed and understood, and that, following my delivery of
this completed and signed Transaction Request Form, I will be unable to revoke
the transactions described herein.
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Please Print Name(s) Signature(s)
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Date Social Security or Tax I.D. No. Signature(s)
IMPORTANT
Medallion Guarantee: To transfer book-entry Plan shares from your Plan
account, or to issue a certificate in any name other than that shown on your
Plan account, the above signature(s) must correspond with the name(s) exactly as
shown on your Plan account and MUST be Medallion Guaranteed by an authorized
Medallion Guarantee Program. If the above signatures are not Medallion
Guaranteed, the transfer request will be returned without having been effected.
