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Alternate Payee/address Authorization Form

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Alternate Payee/Address Authorization

This form serves as a Letter of Authorization to issue checks to an alternate payee or address from your Scottrade

account.

Please fill out the Alternate Address Information if the check is for the account holder at an alternate address.

If the check is for someone other than the account holder, a physical address for the payee must be provided even if the check is being sent to the

active Scottrade address.

SCOTTRADE ACCOUNT INFORMATION

Scottrade Account Number

Account Title/Registration

Date

Telephone Number

Requested by

ALTERNATE PAYEE INFORMATION

Check if applicable

Make Check Payable to

ALTERNATE ADDRESS INFORMATION

Check if applicable

Address

City, State, ZIP Code

Check if applicable

Third party recipient's street address (if different from section 2)

Recipient's account number at the bank or financial institution (memo on check)

AMOUNT OF CHECK REQUEST

All Available Cash

Overnight - $25 fee*

Delivery Method:

Regular Mail

* May not be available for IRA distributions; contact your local branch office for more information.

Scottrade reserves the right to request additional verification prior to processing a check request.

Signature of All Account Holders:

Account Holder's Signature

Date

Account Holder's Signature

Date

*CC3401*

CC3401/1-16

Brokerage products and services offered through Scottrade, Inc. Member

FINRA

/ SIPC.

Alternate Payee/address Authorization Form

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