Investment Application And Agreement Template Page 4
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4Account Number:
Officer Authorization Signature Form
Date:
Church/Agency:
Choose ONE of the following:
The following persons are authorized
This is an update for all our
Use the names already on file for our
for this account only.
existing accounts.
existing accounts. (Leave this form blank!)
Please list those Trustees or officers authorized by the Investor to request withdrawals from or prescribe other changes to
the account. At least two persons must be listed. Include home addresses and original signatures.
______________________
________________________
1. Signature:
4.
Signature:
Print Name: ______________________
Print Name:
________________________
Title:
______________________
Title:
________________________
______________________
________________________
Address:
Address:
______________________
________________________
Phone:
______________________
Phone:
________________________
______________________
________________________
Email:
Email:
_______________________ 5. Signature:
_______________________
2. Signature:
Print Name:
_______________________
Print Name:
_______________________
Title:
_______________________
Title:
_______________________
_______________________
_______________________
Address:
Address:
_______________________
_______________________
Phone:
_______________________
Phone:
_______________________
_______________________
_______________________
Email:
Email:
________________________ 6.
_______________________
3. Signature:
Signature:
Print Name:
________________________
Print Name: _______________________
Title:
________________________
Title:
_______________________
________________________
_______________________
Address:
Address:
________________________
_______________________
Phone:
________________________
Phone:
_______________________
________________________
_______________________
Email:
Email:
** To update this form send a letter signed by two of the persons listed above and accompanied by a new signature
form (available from the Foundation office) delivered to the Foundation office at the following address:
Missouri United Methodist Foundation * PO Box 1076 * Columbia, MO 65205-1076
Page 4 of 4
Investment Agreement 2015
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