Investment Club Certification Form
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1
2INVESTMENT CLUB CERTIFICATION
and AUTHORIZATION
Name of Investment Club
Number of Investment Club Members Required for Revocation
(hereafter referred to as "Investment Club")
Name(s) of Trading Member(s)
Yes
No
Does your Investment Club Agreement allow margin accounts?
The undersigned hereby represent and warrant to Scottrade, Inc. (Scottrade) that they are all the members in the Investment Club and the
undersigned hereby authorize Scottrade to open a securities account for the Investment Club.
The Member Trader(s) is (are) hereby the appointed agent of the Investment Club and is (are) authorized for its account in accordance with
the terms and conditions contained in Scottrade Investment Club Terms and Conditions and the Brokerage Account Agreement.
This Investment Club Certification and Authorization and agreement to the Investment Club Terms and Conditions is also a continuing one,
and shall remain in full force and effect until revoked by a written notice, addressed and delivered to Scottrade and signed by the
designated number of members. No such revocation shall affect any liability arising out of any transaction initiated prior to such
revocation.
This Investment Club Certification and Authorization and agreement to the Investment Club Terms and Conditions is in addition to, and in
no way limits or restricts, any rights which Scottrade may have under any other agreement or agreements between Scottrade and the
undersigned, or any of them now existing, or hereafter entered into, and is binding on the undersigned and their legal representatives,
successors and assigns.
By signing below, each of the undersigned Investment Club members hereby acknowledge that he/she has read, understood and agrees to
the Investment Club Terms and Conditions and the Scottrade Brokerage Account Agreement.
All current Investment Club members must sign.
X
Social Security Number
Date
Print Name
Signature
X
Date
Social Security Number
Print Name
Signature
X
Social Security Number
Date
Print Name
Signature
X
Social Security Number
Date
Print Name
Signature
X
Social Security Number
Date
Print Name
Signature
X
Social Security Number
Date
Print Name
Signature
X
Social Security Number
Date
Print Name
Signature
X
Social Security Number
Date
Print Name
Signature
X
Social Security Number
Date
Print Name
Signature
Please include with this document a copy of your Investment Club Agreement signed by all current members.
Page 1 of 2
SF1068/5-15
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