Form Cc5200 - Mutual Fund Authorization To Change Dividend And/or Capital Gains

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Mutual Fund Authorization to Change Dividend/Capital Gains
ACCOUNT INFORMATION
Account Title
Account Number
To Scottrade, Inc.: Please change my current dividend and/or capital gains options to the following:
FUND OPTIONS
MUTUAL FUND SYMBOL
DIVIDENDS
CAPITAL GAINS
Payout
Reinvest
Payout
Reinvest
Payout
Reinvest
Payout
Reinvest
Payout
Reinvest
Payout
Reinvest
Payout
Reinvest
Payout
Reinvest
Payout
Reinvest
Payout
Reinvest
X
X
Account Holder's Signature
Date
Account Holder's Signature
Date
*CC5200*
For Scottrade Use Only
______
_______________________
X
DATE
B51 File Sent
(Initials)
CC5200/7-14

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