Account Transfer Reimbursement Request Form

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ACCOUNT TRANSFER REIMBURSEMENT REQUEST
Simply complete the information below and mail, fax or personally deliver this reimbursement request along with your
account statement showing transfer fee(s) to your local branch office.
Scottrade Account Title (Name on Account)
Scottrade Account Number
Account Holder Telephone Number
Amount of Transfer Fee
Name of Previous Firm:
Signature:
Date:
SCOTTRADE USE ONLY
Date of Transfer Receipt
Amount of Transfer
Amount of Rebate
Branch ID:
Branch Rep. Signature:
Date:
**Terms and Conditions: Scottrade will reimburse the account transfer fees up to $100 charged by another broker when you transfer
your account with a value of $10,000 or more to Scottrade. Contact your local Scottrade branch office for additional details. You must
apply for the fee reimbursement offer by completing and submitting a Scottrade Account Transfer Reimbursement Request form and a
statement providing proof of imposed transfer fees. Account Transfer Reimbursement Request forms and proof of transfer fees can be
mailed, faxed or personally delivered to your local Scottrade branch office. Reimbursement will be made to your account via a credit
within 30 days of receipt of the Account Transfer Reimbursement Request form and proof of transfer fees. The transfer reimbursement
does not currently have a termination date. However, Scottrade reserves the right to terminate this offer at any time without prior notice
or extend the offer at its sole discretion. Void where prohibited. Member FINRA/SIPC.
Please attach a statement providing proof of transfer fees paid to this form, then mail, fax or
personally deliver to your local branch office.
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