EFTA01242465.pdf

Agent Authorization 1D Ameritrade Limited to Account Inquiry PO Box 2760 • Omaha, NE 68103-2760 Fax: 866-468-6268 This form only grants the ability to inquire about account status, transfers, positions or balances. The undersigned hereby authorizes Authorized Agent (the inquinng Agent): Account Number(s): (whose signature appears below) as the undersigned's agent to inquire about account status, transfers, positions and balances for the undersigned's account and in the undersigned's name or number on TD Amerittade's books in accordance with the terms and conditions set forth in the Standard Account Agreement, and those terms and conditions otherwise established by TO Ametitrade. If the undersigned is a fiduciary on the account, then the undersigned hereby states and affirms that this authority is granted in such fiduciary capacity and within the fiduciary powers consistent with the fiduciary duties of said fiduciary. The undersigned hereby agrees to indemnify and hold TO Ameritrade harmless from and to pay promptly on demand any and all losses arising therefrom or debit balances due thereon. This authorization and indemnity is in addition to (and in no way limits or restricts) any rights which TD Ameritrade may have under any other agreement or agreements between the undersigned, the Introducing Broker, and TD Ameritrade. This authorization and indemnity is a continuing one and shall remain in full force and effect until revoked by the undersigned by a written notice addressed to the Introducing Broker and delivered to its office. Such revocation shall not affect any liability in any way resulting from transactions initiated prior to receipt by the Introducing Broker and the Clearing Broker of written notice of such revocation. This authorization and indemnity shall inure to the benefit of the Introducing Broker and TO Ameritrade and of any successor firms irrespective of any change or changes at any time in the personnel thereof for any cause whatsoever and of the assigns of the Introducing Broker and TD Ameritrade of any successor firm(s). This authorization supersedes any prior inquiring authorization the undersigned may have executed with regard to his/her account with the Introducing Broker and TD Ameritrade. Original Signature required: electronic signatures and/or fonts are not authorized. ACCOUNT OWNER Printed Name. Account Owner Signature. Date: X ACCOUNT CO-OWNER Of Joint account, both owners must sign.) Printed Name )(' Account Co-Owner Signature: Date: INQUIRING AGENT Full Legal Name. Date of Birth: Pla - Numb, (MM-DO-WYY) Street Address: City. State ZIP CCCe Erna Address: Employer Name: Occupation: X Agent Signature: Date: Investment Products: Not FDIC Insured • No Bank Guarantee ' May Lose Value TD Ameritrede. Inc . member FINRA/SIPONFA and TD Ameritrade Clearing. Inc.. member FINFIA/SIPC. TD Ameritrade is a trademark jointly owned by TD Ameritrade P Comp . Inc. d The Toronto-Dorn nion Bank. 102013 TDAmeritrade IP Company. Inc. All rights reserved. Used with permission. Page I d1 TDA 831 F 09113 EFTA01242465