Limited Power Of Attorney Trading Authorization
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4Interactive Brokers
Limited Power of Attorney – Trading Authorization
This form may be used to designate a third party agent (“Agent”) to conduct certain limited activity in your
Interactive Brokers account. The designated Agent will be able to execute trades and to request information
regarding your account, as specified below. The Agent will not be authorized to request or alter any security
information for the account or to initiate asset transfers into or out of the account.
Please complete the below form and return it and all necessary identification documents for your Agent (as
described below) to Interactive Brokers Document Processing Department:
Fax:
(312) 984-1017
Courier/Overnight Service:
Interactive Brokers
Document Processing Department
209 South LaSalle St.,10th Floor
Chicago, IL 60604
(312) 542-6900
Regular Mail:
Interactive Brokers
(Please allow additional time for
Document Processing Department
processing)
P.O. Box 5544
Chicago, IL 60680-5544
Customer Information:
Account Number:
________________________________________________________
Name of Account Holder:
________________________________________________________
Social Security or Tax I.D.
Number of Account Holder: ________________________________________________________
Name of Joint Account
Holder (if any):
________________________________________________________
Social Security or Tax I.D.
Number of Joint Acct.
Holder:
________________________________________________________
Account Number(s):
________________________________________________________
E mail Address:
________________________________________________________
Phone Number:
________________________________________________________
Power of Attorney Agent Information:
Name of Agent:
________________________________________________________
Agent’s Date of Birth:
________________________________________________________
Agent’s Residential
Address:
________________________________________________________
________________________________________________________
Agent’s Phone Number:
________________________________________________________
Version 1/24/2005
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