TO:         Registrar and Transfer Company

 

 

AUTHORIZATION FOR AUTOMATIC DIVIDEND REINVESTMENT FOR SHAREHOLDERS

OF GETTY REALTY CORP.

 

  GETTY REALTY CORP.

125 Jericho Turnpike, Suite 103

        Jericho, NY 11753

 

 

 

NOTE: THIS IS NOT A PROXY

              I hereby authorize Getty Realty Corp. to pay to Registrar and Transfer Company, as my agent for my account all cash dividends due me on shares of Getty Realty Corp. for which I am the holder of record, as set forth on the reverse side of this card. I want to reinvest dividends on all shares registered in my name for the purchase of full or fractional shares of Getty Realty Corp. Common Stock in accordance with the terms of the Getty Realty Corp Dividend Reinvestment/Stock Purchase Plan ("Plan").

 

              I further authorize the investment of $___________________ for the purchase of additional shares of Getty Realty Corp. Common Stock as of the next Investment Date (minimum of $100.00, maximum of $3,000.00 per quarter), in accordance with the Plan. Please make checks payable to: Registrar and Transfer Company. Please do not transmit funds earlier than 30 days before the next dividend payment date.

 

 

I understand that the purchases 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 Registrar and Transfer Company.

 This authorization form, when signed, should be mailed to: Registrar and Transfer Company, Attention: Dividend Reinvestment/Stock Purchase Plan Administrator.

10 Commerce Street, Cranford, New Jersey 07016. An addressed envelope is provided for that purpose.

  

 

_________________________________________________________________________

   Shareholder

 

 _________________________________________________________________________

   Shareholder

 

 _________________________________________________________________________

   Date

 

Please sign exactly as name(s) appears on reverse side of this card. If shares are held jointly, each shareholder must sign.