CHANGE OF BROKER/DEALER FORM - Feltl and Company
CHANGE OF BROKER/DEALER FORM
Mutual Funds
TO: FIDELITY INVESTMENTS
INSTITUTIONAL OPERATIONS COMPANY, INC.
PO BOX 770002
CINCINNATI, OH 45277-0083
1-800-221-5207
RE: _________________________________
(Fund Name)
_________________________________
(Fund Account Number)
_________________________________ ______________________________
(Shareholder Name)
________________________________
_________________________________
_________________________________
(Address)
Dear Shareholder Services:
Please make the following changes in designation of Broker/Dealer and Registered Representative of the above referenced account(s). This change does not otherwise alter the terms and provisions of my account. This change of dealer authorization will become effective on the date that you receive it.
NEW REPRESENTATIVE: NEW DEALER DESIGNATION:
Feltl and Company
_____________________________ P.O. Box 2980
Minneapolis, MN 55402
REP #:_______________________
_________________________________ ____________________________________
(Signature of Investor) (Date) (Signature of Investor, if Joint Account) (Date)
ALL PARTIES LISTED ON THE ACCOUNT MUST SIGN.
Change of BD Form.doc 07/02/02
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