Hold All Mail
Instructions: Please fill out completely and fax it to (786-265-9406) or e-mail it on a pdf format to ham@
Attention: SkyBox Hold All Mail Service
CUSTOMER INFORMATION SUITE 051-
name: ________________________________________________________________________________
Address: _____________________________________________________________________________
pHONE:______________________ Fax:___________________ E-mail ____________________________
Country__________________________City______________ State:_______________Zip___________
|CONTACT IN U.S. (Where applicable): |
CONTACT NAME: __________________________________ TITLE: ________________________________
PHONE: ______________________________ FAX:_____________________________________________
E-MAIL: _____________________________________________________
|BROKER INFORMATION |
| |
|Referring Brokers Name: ___________________________ Financial Phone Number: __________________ |
| |
|Financial Institution: ○ Bank of America ○ Bank Boston ○ Commerce Bank ○ Goldman Sachs |
|○ Lehman Brothers ○ Oppenheimer ○ Merrill Lynch ○ Northern Trust Bank |
|○ Prudential ○ Smith Barney ○ UBS ○ Wachovia |
|○ Independent ○ other (Which one:) _______________________________ |
| |
|Frequency of shipping: ○ Monthly ○ Quarterly ○ Hold for pickup ○ Ship on Instructions |
| |
|Destroy everything once a year: ○ Yes ○ No |
|BANKING INFORMATION |
METHOD OF PAYMENT
CREDIT CARD NUMBER*
NAME AS IT APPEARS ON THE CARD _______________________________ SECURITY CODE __________
EXPIRATION DATE _________________________ SIGNATURE _______________________________
* The credit card you specify on your application will be billed for the US$ 160 annual fee as well as any applicable shipping charges.
PERSONS AUTHORIZED TO WITHDRAW MAIL RELATIONSHIP TO BOX HOLDER SIGNATURE
1. _________________________________ _____________________________ _______________
2. _________________________________ _____________________________ _______________
UPON COMPLETION OF THIS FORM, PLEASE FAX TO (305) 593-0172; ATTENTION SKYBOX HOLD ALL MAIL SERVICE; OR E-MAIL IT ON PDF FORMAT TO HAM@
YOU INDICATE THAT YOU HAVE READ, UNDERSTOOD AND ACCEPT THE TERMS AND CONDITIONS OF HOLD ALL MAIL AT WWW. AND AGREE TO PAY THE ANNUAL MEMBERSHIP FEE OF US$220 A YEAR.
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VISA
MASTER
DINERS
WIRE TRANSFER
CHECK
AMEX
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