EFTA00289233.pdf

Reset Form Print Form Web Site or Search Engine Scat BROKERAGE ACCOUNT APPLICATION TV or Radio Advertising Magazine / Newspaper Ad News Article Friend Referral / Promotion Code Select Account Type: O Individual 9 Joint - type: WROS I'm an Existing Scottrade Customer O Custodial (use minor's SSN) 0 Coverdell ESA 0 IRA - type: 0 Qualified Plan type: O Investment Club O Trust D Guardianship/Conservatorship El Partnership - type: D Non-Corporate Organization ❑ Estate 0 Corporate - type: 0 Update Account # APPLICANT CO-APPLICANT (IF ANY) Title of Account (If applicable. name of oxporation/partnersNp/trust/etc-) Mr. Name First Middle Last Mr. Name First Middle Last Mrs. Ms. Address (P.O. Box or do address rot perm tied) Street Address (P.O. Box or do address not perm Mid) City State ZIP plus 0 City State ZIP plus 0 Home Phone Number Work Phone Number Cell Phone Number Home Phone Number Work Phone Number Cell Phone Number Mailng Address (if different from home address. P.O. Boxes may be used) Social Security or Tax ID Number Date of Birth Sods Security or Tax ID Number Date of Birth Are you a U.S. Citizen? Nan-U.S. Citizens: Country of Citizenship: A YES - Skip to "Occupation' NO - Complete the section below Are you a U.S. Citizen? Nal-U.S. Citizens: Country of Citizenship: ❑ YES - Skip to 'Occupation" ❑ NO - Complete the section below Are you a permanent U.S. Resident? Are you a permanent U.S. Resident? 0 YES - Alien Registration Number ❑ YES - Alien Registration Number 0 NO - Indicate your Visa type AND complete and sign El NO - Indicate your Visa type AND complete and sign the U.S. Visa Holder Statement (form number SF1039)* the U.S. Visa Holder Statement (form number SFI039)' 'if you plan on staying in the U.S. 183 days or less. contact our International Department 'If you plan on staying in the U.S. 183 days or less. contact our International Department to may far an accotre. to apery for an account. Occupation Occupation ❑ Employed (specify occupation) El Employed (specify occupation) O Self-Employed 0 Unemployed 0 Retied 0 Homemaker 0 Student ❑ Self-Employed 0 Unemployed 0 Retired 0 Homemaker 0 Student Employer (If self-employed, specify job function) Employer (If self-employed. specify job function) Employer Address Employer Address Please answer the following: ❑ Yes 0 No Is any applicant employed by Or Shined with a securities arm. a securities exchange. or FINFtA? (ri yes. provide name and address of Compliance Dept.) ❑ Yes ❑ No Is any applicant a 'control person or lintiaie of a public company as defined by the SEC? TM would generally include 10% shareholders. members of the Board Of Dvectors and putcy.maldng officers. (dyes. provide traIng symbol and company) Yes 0 No Is any appkcant or member of immediate family a baseless associate a senor fortgn political official'? Type of Account (Choose A or B): E-coal Address Referred By. (Name and/or Referral Number) A) Internet Trading (Requires e-mail address) El Internet: Al securities 8 proceeds held in account Trade confirmations and monthly account statements will be posted to your online account free of charge. To receive paper copies for a fee, check one or both of the following: Mail trade confirmations (31 each) OMall account statements (32 each) B) Non4ntemet Trading (Be advised that non-Intemet Commission Rates vns apply.) Indicate Instructions: ❑ Hold Proceeds OR ❑ Mail Proceeds 0 Safekeeping Hold Dividends & Interest OR Mail Dividends & Interest Addhlonal Services: 0 Margo (IRAs exardedjc Sign Margin Agreement below ElOptions: Send me an Opeon Applcaticn a Cep:loam Document ❑ Transfer Account to ScoUrade: Send me the Account Transfer farm Under penalties of perjury. I certify that: (1) the number shown on this form Is my correct taxpayer identification number (or I am waiting for a number to be issued to me): (2) I am not subject to backup withholding because: (a) I am exempt from backup withholding. (bit have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of failure to report all interest or dividends. or (c) the IRS has notified me that I and no longer subject to backup withholding: and (3)1am a U.S. person (Including a U.S. resident alien). The IRS does not require my consent to any provision of this document other than the certification required to avoid backup withholding. Applicants who are subject to backup withholding must cross out Item (4. BY SIGNING THIS AGREEMENT I ACKNOWLEDGE THAT I HAVE RECEIVED, READ AND AGREE TO ABIDE BY THE TERMS OF THE ACCOMPANYING BROKERAGE ACCOUNT AGREEMENT, WHICH CONTAINS A PRE-DISPUTE ARBITRATION CLAUSE AT SECTION 29. X X Applicant/Authorized Person's Signature Date Co-Applicant/Authorized Person's Signature Date MARGIN PRIVILEGES - SIGN BELOW ONLY IF YOU DESIRE A MARGIN ACCOUNT By signingMb agreement I sancededge pal t nave Noshed. reed and spree to abide by tie lernIS dins eccompanyhe eir0kennee ACOXMI AgeHIDent Including Me MeV° ACC00nt BOCtiton starling et Section 53 Applicant/Authorized Person's Signature Date Co-ApplicantlAuthodzed Person's Signature Date FOR SCATTRADE USE ONLY SNAP Approved Online Application Entry Registered Rep Registered Prncipal New Accounts Rep EFTA00289233