Account Linking Request Form Page 2
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1
2
3COMPLETION OF ALL INFORMATION IS REQUIRED
IV. Primary Scottrade
Account Information:
®
Primary Scottrade Account Number
Primary Scottrade Account Title
Primary Scottrade
Account Owner (Authorized Agent Information)
®
Name
First
Middle
Last
Social Security/Tax ID Number Date of Birth
(mm/dd/yyyy)
Primary Physical Address
Email Address
(no P.O. boxes or mail receiving/incorporation services)
City
State
ZIP
Primary Phone Number
Secondary Phone Number
1) Is the Agent a U.S. citizen?
Yes - skip to question #2.
No - Country of citizenship:
Yes - Alien Registration Number:
Is the Agent a permanent U.S. resident?
No - Visa type
:
(if applicable)
2) Is the Agent employed by or affiliated with a securities firm, a securities exchange, or FINRA?
Yes
No
If yes, Scottrade will inform the securities firm,
exchange or FINRA of your intention to maintain such account and provide duplicate copies of confirmations, statements or other information if requested. Provide organization name and
compliance department address in "Agent Affiliation Details" below.
3) Is the Agent a control person or affiliate of a public company as defined by the SEC?
This generally includes 10% shareholders, members of the Board of Directors,
Yes
No
If yes, provide company's name and CUSIP/trading symbol in "Agent Affiliation Details" below.
and policy-making officers.
Agent Affiliation Details:
4) Is the Agent a registered investment advisor (state or federal)?
Yes
No
Secondary Scottrade
Account Owner (Authorized Agent Information)
®
Name
First
Middle
Last
Social Security/Tax ID Number Date of Birth
(mm/dd/yyyy)
Primary Physical Address
Email Address
(no P.O. boxes or mail receiving/incorporation services)
City
State
ZIP
Primary Phone Number
Secondary Phone Number
1) Is the Agent a U.S. citizen?
Yes - skip to question #2.
No - Country of citizenship:
Is the Agent a permanent U.S. resident?
Yes - Alien Registration Number:
No - Visa type
(if applicable)
:
2) Is the Agent employed by or affiliated with a securities firm, a securities exchange, or FINRA?
Yes
No
if yes, Scottrade will inform the securities firm,
exchange or FINRA of your intention to maintain such account and provide duplicate copies of confirmations, statements or other information if requested. Provide organization name and
compliance department address in "Agent Affiliation Details" below.
3) Is the Agent a control person or affiliate of a public company as defined by the SEC?
This generally includes 10% shareholders, members of the Board of Directors,
and policy-making officers.
Yes
No
If yes, provide company's name and CUSIP/trading symbol in "Agent Affiliation Details" below.
Agent Affiliation Details:
4) Is the Agent a registered investment advisor (state or federal)?
Yes
No
Unless specifically accepted and authorized by Scottrade, by signing below, all parties agree that the Agent is not acting in a capacity that
would require registration as an investment advisor under SEC or state regulation. In addition, all parties agree that the Agent will not charge
fees for acting on this account. The Agent agrees to immediately notify Scottrade in writing if he/she becomes registered as an investment
advisor in the future.
By signing below I acknowledge that I have read and will adhere to the terms and conditions as stated in this Agreement
and the Scottrade
®
Brokerage Account Agreement.
X
Primary Account Owner / Authorized Agent Signature
Date
X
Primary Account Owner / Authorized Agent Signature
Date
SF1013/11-15
Page 2 of 3
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