Form Rts-10 - Agent/client Change Form Page 2

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RTS-10
R. 01/13
Page 2
ADD
DELETE
Client Name and Mailing Address
RT
FEIN
*Effective
**Effective
Account No.
Begin Date
End Date
*Effective Begin Date is the date you begin representing your client. This date must be the beginning of a reporting period
(i.e., 1/1/07, 4/1/07, 7/1/07, 10/1/07).
**Effective End Date is the last day of the reporting period for which you represent the client (i.e., 3/31/07, 6/30/07, 9/30/07, 12/31/07).
(Attach additional sheets, if necessary.)

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