Brokerage Account Application - Scottrade Form
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Account #
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BROKERAGE ACCOUNT APPLICATION
Select an Account:
Individual
Joint - type:
Custodial
Conservator/Guardianship
Update Acct #:
The following account types require additional paperwork - please refer to the Advisor Services Forms Center.
LLC
Non-Corporate
Estate
Sole Prop
Trust - type:
Corporate - type:
Partnership - type:
Investment Club
Qualified Plan
Investment Advisor Information (to be completed by the Investment Advisor ONLY)
Book of Business Name (if applicable)
Investment Advisor Firm Name
Investment Advisor Name
Investment Advisor Email Address
Master Account Number
Fee Collection Account Number
Applicant
Co-Applicant
Information about the primary account holder - depending on the account type, this may be
Information about the secondary account holder - depending on the account type, this may
the minor, protected person, or organization (trust, corporation, partnership, etc.).
be a custodian, trustee, trading officer/partner, or other authorized representative.
Name of Individual/Organization
Name
First
Middle
Last
- for individuals, list first, middle & last names
Mr.
Mr.
Mrs.
Mrs.
Ms.
Ms.
Dr.
Dr.
Primary Physical Address
Primary Physical Address
no P.O. boxes or mail/receiving incorporation services
no P.O. boxes or mail/receiving incorporation services
acct mail will
acct mail will
be sent here
be sent here
City
State
ZIP
City
State
ZIP
(legal residence)
(legal residence)
Mailing Address
Mailing Address
(optional)
(optional)
acct mail will
acct mail will
be sent here
be sent here
Primary Email
Email Address
Address
Per section VI-B, Notices, Email and Electronic Communications; Consent to Electronic Delivery, of the Brokerage Account Agreement, by providing your email address, you
consent to receive electronic account statements and trade confirmations, which will be sent to the primary email address unless you choose to have them sent to the mailing
Monthly Paper Statements ($2 per month)
Paper Trade Confirmations ($1 each)
address of record by checking:
If no email address is provided, or only your advisor's email address is provided, your account settings will default to monthly paper statements and paper trade confirmations
and your account may be charged respectively for each. You may change these elections at any time by logging into your Scottrade account and updating your preferences.
Phone
Home
Cell
Phone
Home
Cell
Work
Work
ext.
ext.
check
check
preferred
preferred
Social Security/Tax ID #
Date of Birth
Are you a U.S. citizen?
Social Security/Tax ID #
Date of Birth
Are you a U.S. citizen?
No - provide
Yes - skip to
Yes - skip to
No - provide
employment
citizenship info
employment
citizenship info
Citizenship
Citizenship
Country:
Country:
Yes -
Alien Registration Number:
Yes -
Alien Registration Number:
Are you a permanent
Are you a permanent
U.S. resident?
U.S. resident?
No*-
visa type:
visa type:
No*-
*If you will be in the U.S. 183 days or less, contact our International Department.
*If you will be in the U.S. 183 days or less, contact our International Department.
Employment
Employment
Status:
Employed
Self-employed
Unemployed
Student
Status:
Employed
Self-employed
Unemployed
Student
Homemaker
Retired
Homemaker
Retired
Occupation:
Occupation:
Employer:
Employer:
Employer
Employer
Address:
Address:
Sales Proceeds:
Mail or
Hold
Dividends & Interest:
Mail
or
Hold
Affiliations:
Yes
No
Is any applicant employed by or affiliated with a securities firm, a securities exchange, or FINRA?
If yes, provide organization name and compliance
department address in"Affiliation Details" below.
Yes
No
Is any applicant 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
. If yes, provide company's name and CUSIP/trading symbol in "Affiliation Details" below.
Yes
No
Is any applicant, member of immediate family, or business associate a senior foreign political official?
Applicant Affiliation Details:
Co-Applicant Affiliation Details:
*SF2362*
Accepted by Principal
AA
SF1000/12-16
Registered Principal
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