EXHIBIT 99.(a)(1)(D)
ELECTION FORM
I have received the Offer to Amend Options relating to Gladstone Capital Corporations (the
Company) offer to amend the terms of all outstanding stock options to change the expiration date
of these options to September 30, 2006. I understand that Options consist of all options to
purchase the Companys common stock granted under the Gladstone Capital Corporation Amended and
Restated 2001 Equity Incentive Plan that are outstanding on the date the offer expires.
I understand that if I elect to amend my Options, the option expiration dates for all of my Options
will be accelerated to September 30, 2006.
Set forth in the table below are the Grant Number, Grant Date, Exercise Price and total number
unexercised shares subject to each Option I have been granted, and I have checked the appropriate
box to indicate whether I wish to amend or not amend all of my Options.
I understand that I may change the terms of my election to amend my Options by submitting a new
Election Form or a Notice to Change Election From Accept to Reject prior to the termination date of
the Offer to Amend Options, which is currently May 31, 2006.
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Total Number of |
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Applicable |
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Unexercised Shares |
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Grant |
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Grant |
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Exercise |
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Subject to the |
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I elect to amend these |
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I elect not to amend |
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Price |
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Option |
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Option Grants |
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these Option Grants |
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¨ |
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o |
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If I have checked the box marked I elect to amend these Option Grants in the
table above, I hereby agree that, unless I revoke my election before 5:00 p.m., Eastern Time on May
31, 2006 (or a later expiration date if the Company extends the offer), my election will be
irrevocable, and if accepted by the Company, all of my Options will be amended to shorten the
expiration dates thereof to September 30, 2006.
I further understand and agree that I can only elect to amend all shares subject to all Options I
have been granted.
I acknowledge and agree that neither the ability to participate in the offer nor actual
participation in the offer shall be construed as a right to employment with the Company (except on
an at-will basis, unless otherwise required by local law). I agree that the Company has made no
representations or warranties to me regarding this offer or the future pricing of the Companys
common stock, and that my participation in this offer is at my own discretion.
I AGREE THAT THE COMPANY SHALL NOT BE LIABLE FOR ANY COSTS, TAXES, LOSS OR DAMAGE THAT I MAY INCUR
THROUGH MY ELECTION TO PARTICIPATE IN THIS OFFER.
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Option Holder Signature
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Social Security Number |
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Option Holder Name (Please Print)
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E-mail Address
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Date |
PLEASE
DELIVER YOUR SIGNED AND COMPLETED ELECTION FORM TO PAULA NOVARA BY
MAIL, COURIER,
E-MAIL
(e-mail address: paula.novara@gladstonemanagement.com), FAX (fax number: (703) 287-5801) OR
PERSONAL DELIVERY NO LATER THAN 5:00 P.M., EASTERN TIME ON MAY 31, 2006 (OR A LATER EXPIRATION DATE
IF THE COMPANY EXTENDS THE OFFER). IF YOU CHOOSE TO DELIVER YOUR ELECTION FORM BY E-MAIL OR FAX,
YOUR ELECTION WILL ONLY BE EFFECTIVE IF IT IS RECEIVED BY THE EXPIRATION DATE AND IF THE ORIGINAL
ELECTION FORM IS RECEIVED BY JUNE 15, 2006 (OR A LATER DELIVERY DATE IF THE COMPANY EXTENDS THE
OFFER).