Irrevocable Stock Power Form printable pdf download

Irrevocable Stock Power Form

950 Milwaukee Ave., Ste. 102

Glenview, IL 60025

Tel:

1-800-92-REGAL

Fax: 1-877-367-8466

Web:

for value Received, the undersigned do hereby sell, assign, and transfer unto ________________________

____________________________ , _______________ shares of the capital Stock of __________________

_________________________________________________ standing in the name of the undersigned on the

books of said company, represented by certificates no. __________________________ herewith, and hereby

irrevocably constitute and appoint Hilltop Securities, Inc. attorney to transfer the said stock on the books of

the within named company with full power of substitution in the premises.

Account number

Process ID number (broker use only)

Account holder’s Signature

Date

Account holder’s name Printed

Joint Account holder’s Signature

Date

Joint Account holder’s name Printed

A DIvISIon of REGAL SEcuRItIES, Inc. MEMbER fInRA/SIPc

AccountS cARRIED wIth HILLTOP SECURITIES, INC. REV. 01-22-2016

Irrevocable Stock Power Form