Exhibit 99.3
AMERIVEST PROPERTIES INC.
DIVIDEND REINVESTMENT PLAN
ENROLLMENT AUTHORIZATION FORM
Account Number:
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RETURN TO:
UMB Bank, n.a.
Securities Transfer Division
P.O. Box 410064
Kansas City, Missouri 64141-0064
I hereby appoint the UMB Bank, n.a. (the "Plan Administrator") as my agent
subject to the Terms and Conditions set forth in the accompanying prospectus or
brochure to invest my dividends received from the Company as indicated by the
option chosen on this form. I further acknowledge and agree that my
participation in the Plan will be subject to the Terms and Conditions of
Participation as set forth in the prospectus or brochure, or as amended by the
Company. Participation in the Plan will continue until I notify the Plan
Administrator in writing of my desire to terminate participation, and is subject
to the terms of participant withdrawal as agreed upon in the Company's
prospectus or brochure.
If you do not sign and return this form, you will continue to receive dividend
checks.
PLEASE REFER TO THE PLAN PROSPECTUS OR BROCHURE BEFORE MAKING A CHOICE.
[ ] FOR FULL REINVESTMENT OF DIVIDENDS: Reinvest the dividends on all of my
shares of Common Stock toward the purchase of additional shares of
Common stock.
[ ] FOR PARTIAL REINVESTMENT OF DIVIDENDS: Reinvest the dividends on
_______ [insert number of shares] of my whole shares of Common Stock,
which are held by me, toward the purchase of additional shares of
Common stock and send me the cash dividends on any remaining shares
held by me.
SIGNATURE OF REGISTERED OWNERS
Signature
Date:
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Daytime Telephone:
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Authorization is not valid unless this form is signed by all registered
shareholders.
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