FIRST CAPITAL BANCORP, INC. - FORM S-1/A - EX-99.6 - EXHIBIT 99.6 - February 9, 2012

Attached files

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EX-5.1 - EXHIBIT 5.1 - FIRST CAPITAL BANCORP, INC.d284451dex51.htm
EX-1.4 - EXHIBIT 1.4 - FIRST CAPITAL BANCORP, INC.d284451dex14.htm
EX-1.3 - EXHIBIT 1.3 - FIRST CAPITAL BANCORP, INC.d284451dex13.htm
EX-1.2 - EXHIBIT 1.2 - FIRST CAPITAL BANCORP, INC.d284451dex12.htm
EX-1.1 - EXHIBIT 1.1 - FIRST CAPITAL BANCORP, INC.d284451dex11.htm
EX-99.3 - EXHIBIT 99.3 - FIRST CAPITAL BANCORP, INC.d284451dex993.htm
EX-99.8 - EXHIBIT 99.8 - FIRST CAPITAL BANCORP, INC.d284451dex998.htm
EX-99.9 - EXHIBIT 99.9 - FIRST CAPITAL BANCORP, INC.d284451dex999.htm
EX-99.7 - EXHIBIT 99.7 - FIRST CAPITAL BANCORP, INC.d284451dex997.htm
EX-99.5 - EXHIBIT 99.5 - FIRST CAPITAL BANCORP, INC.d284451dex995.htm
EX-99.1 - EXHIBIT 99.1 - FIRST CAPITAL BANCORP, INC.d284451dex991.htm
EX-99.4 - EXHIBIT 99.4 - FIRST CAPITAL BANCORP, INC.d284451dex994.htm
EX-23.1 - EXHIBIT 23.1 - FIRST CAPITAL BANCORP, INC.d284451dex231.htm
EX-99.10 - EXHIBIT 99.10 - FIRST CAPITAL BANCORP, INC.d284451dex9910.htm
S-1/A - AMENDMENT NO. 1 TO FORM S-1 - FIRST CAPITAL BANCORP, INC.d284451ds1a.htm
EX-99.2 - EXHIBIT 99.2 - FIRST CAPITAL BANCORP, INC.d284451dex992.htm

EXHIBIT 99.6

FIRST CAPITAL BANCORP, INC.

BENEFICIAL OWNER ELECTION FORM

The undersigned acknowledge(s) receipt of your letter and the enclosed materials relating to the grant of non-transferable rights to purchase Units (consisting of one share of common stock, par value $4.00 per share, and a warrant to purchase one-half (1/2) of one share of common stock), of First Capital Bancorp, Inc. (the “Company”).

I (we) hereby instruct you as follows:

(CHECK THE APPLICABLE BOXES AND PROVIDE ALL REQUIRED INFORMATION)

Box 1. q Please DO NOT EXERCISE RIGHTS for Units.

Box 2. q Please EXERCISE RIGHTS for shares of Units as set forth below:

A. Number of Units Being Purchased:                                                                                                                       

B. Total Exercise Price Payment Required:                                                                                                       

Basic Subscription Right

I exercise                                                                  rights

    x            3.00 =        

(no. of your rights)

    (ratio)         (no. of Units)

Therefore, I apply for                                                      

    X                $2.00 =        

(no. of Units)

    (subscription price)       (amount enclosed)

Over-Subscription Privilege

If you fully exercise your Basic Subscription Right, and wish to subscribe for additional Units up to the total number of unsubscribed Units, you may exercise your Over-Subscription Privilege. The Over-Subscription Privilege is subject to a right of first refusal in favor of the standby purchaser in the rights offering. If sufficient Units are available, the Company will seek to honor the over-subscription requests in full. If, however, over-subscription requests exceed the number of unsubscribed Units, the Company will allocate the unsubscribed Units among subscribers exercising their Over-Subscription Privilege by multiplying the number of Units requested by each subscriber through the exercise of their Over-Subscription Privilege by a fraction that equals (x) the number of Units available to be purchased through Over-Subscription Privileges divided by (y) the total number of Units requested by all subscribers through the exercise of their Over-Subscription Privileges.

Accordingly, my maximum Over-Subscription Privilege is:

 

8,913,513

                                                       Units

(total offered units)

      (total no. of Units subscribed for above)       (maximum unsubscribed Units)

Therefore, I apply for:

 

    x                     $2.00                                         
(no. of your over-subscription Units subscribed for)   (subscription price)   (additional amount enclosed)
Total Payment Required =   $                      

Box 3. q Payment in the following amount is enclosed.

$                     

(The total of the above Box 3 must equal the Total Payment Required.)

I (we) on my (our) own behalf, or on behalf of any person(s) on whose behalf, or under whose directions, I am (we are) signing this form:

 

  •  

irrevocably elect to purchase the number of Units indicated above upon the terms and conditions specified in the prospectus; and

 

  •  

agree that if I (we) fail to pay for the Units I (we) have elected to purchase, the exercise will be invalid.

 

Name of beneficial owner(s):    
 

 

Signature of Beneficial Owner(s):    
 

If you arc signing in your capacity as a trustee, executor, administrator, guardian, attorney-in-fact, agent, officer of a corporation or another acting in a fiduciary or representative capacity, please provide the following information:

 

Name:    

 

Capacity:

    

 

Address (including Zip Code):    
 

 

Telephone Number:    

FIRST CAPITAL BANCORP, INC. Reports