Signature By Mark Form
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SIGNATURE BY MARK
CUSTOMER INFORMATION
Name
Scottrade Account Number
X
Signature by Mark
Date
We certify that on this day, the attached document was read to the customer named on this document, and he/she affixed this
mark in the presence of the following two witnesses to signify his/her intention to effectuate the action described on the attached
document.
WITNESSES CANNOT BE RELATED TO CUSTOMER
WITNESS INFORMATION
WITNESS NUMBER 1
WITNESS NUMBER 2
Name
Name
Street Address
Street Address
City
State
ZIP
City
State
ZIP
X
X
Witness #1 Signature
Date
Witness #2 Signature
Date
THIS DOCUMENT MUST BE ATTACHED TO
ANY DOCUMENT SIGNED WITH A MARK
*SF1077*
SF1033/7-14
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Parent category: Business