SHAREHOLDER INFORMATION - The Walt Disney Company
DISNEY DIRECT DEPOSIT SERVICE
SHAREHOLDER INFORMATION
Please complete the information and return to:
Name
Name Address City, State, Zip Code
Disney Shareholder Services 500 S. Buena Vista St MC9722 Burbank, CA 91521-9722 or fax (818) 553- 7210
Disney's Account Number
Any questions - (818) 553-7200
INSTRUCTIONS
Funds cannot be deposited to a brokerage account, mutual funds, or money market account. Funds must be deposited into the shareholder's bank account. All registered shareholders must sign the form. Funds cannot be deposited into foreign bank accounts. For checking or savings accounts at Savings & Loans, Trust Banks, Credit Unions and Federal Savings Banks, checks and deposit tickets do not always contain the correct information for direct deposit. Please have a representative from your financial institution complete the Financial Institution Information sections of this form. Make sure to sign, date and return the form in the envelope we have provided for your convenience.
DIRECT DEPOSIT AUTHORIZATION
I (we) authorize Disney Shareholder Services to deposit my (our) dividend payment(s) into the account specified below, and, if necessary, to make debit entries or other adjustments for any deposits made in error. This authorization will remain in effect until I (we) give written notice to terminate it or until Disney has notified me (us) that this direct deposit service has been terminated.
I (we) understand that I (we) must give advance notice to allow reasonable time for my (our) instructions to be executed and that I
(we) am (are) responsible for notifying Disney of a change in bank account information. A verification of deposit advice will be
sent annually.
SHAREHOLDER ACCOUNT INFORMATION
Legal Shareholder Signature(s) as names appear above (If joint account, all persons must sign, if custodial, registered custodian)
1.
2.
Daytime Telephone Number ( )
Date
FINANCIAL INSTITUTION INFORMATION
Please Check: __________ New Account __________Change
Checking Accounts - For checking accounts at commercial banks, please enclose a voided check (deposit tickets are not acceptable)
or have a representative from your bank complete this section. For checking accounts at credit unions, trust banks, savings & loans or
federal savings banks, please have a representative from your bank complete this section.
Savings Accounts - Please have a representative from your bank complete this section.
Name of Bank or Other Financial Institution
Nine-digit ABA Transit Routing Number
____ ____ ____ ____ ____ ____ ____ ____ ____
Account Type
Checking Savings
Representative (Must Sign)
Bank's Account Number Telephone Number
11/8/05
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