UNITED STATES BANKRUPTCY COURT WESTERN DISTRICT OF NEW YORK In Re A REORGANIZATION CASE UNDER CHAPTER 11 Case No. Debtor CLASS [ ] BALLOT FOR ACCEPTING OR REJECTING PLAN OF REORGANIZATION Filed by on The Court has approved a disclosure statement with respect to the Plan. The Disclosure Statement provides information to assist you in deciding how to vote your ballot. If you do not have a Disclosure Statement, you may obtain a copy from [name, address, telephone number and fax number [name, address, telephone and fax number of proponent's attorney] . Court approval of the disclosure statement does not indicate approval of proponent's attorney] the Plan by the Court. You should review the Disclosure Statement and Plan before you vote You may wish to seek legal advice concerning the Plan and your classification and treatment under the Plan. Your claim or security interest has been placed in Class [ ] under the Plan. If you hold claims or equity interests in more than one class, you will receive a ballot for each class in which you are entitled to vote. If your ballot is not received by the U.S. Bankruptcy Court at the address below on or before the date of the confirmation hearing or continuation thereof, and such deadline is not extended, you vote will not count as either an acceptance or rejection of the Plan. If the Plan is confirmed by the Bankruptcy Court it will be binding on you whether or not you vote. ACCEPTANCE OR REJECTION OF THE PLAN [If voter is the holder of an equity interest:] The undersigned, the holder of Class [ ] equity interest in the debtor consisting of shares or other interests of (describe equity interest) in the debtor, [If voter is the holder of a bond, debenture or other debt security:] The undersigned, the holder of a Class [ ] claim against the Debtor consisting of (state unpaid principal amount) $ of (describe bond, debenture or other security) of the debtor. For purposes of this Ballot, it is not necessary and you should not adjust the principal amount for any accrued or unmatured interest. [If voter is the holder of a secured, priority or unsecured nonpriority claim:] The undersigned, holder of a Class [ ] claim against the Debtor in the unpaid principal amount of . $ [Check One Box Only] $ [ Dated: ] ACCEPTS THE PLAN [ ] REJECTS THE PLAN Return this Ballot to: Clerk, U.S. Bankruptcy Court Print or type name: Signed: (If appropriate) By: As: __ Address: ____________________________ ____________________________ Rev. 2/99 American LegalNet, Inc. www.FormsWorkFlow.com