WellsTrade Direct Registration System Stock Transfer Request (To ...
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WellsTrade? Direct Registration System
Stock Transfer Request (To Transfer stock held with Transfer Agent)
Account Number (Client to complete-Required)
Sub Firm # 205
Account Number
(Office Use Only)
Use this form to authorize Wells Fargo Advisors ("WFA") to transfer your securities, currently registered in certificateless form with the transfer agent (via DTC Direct Registration System "DRS"), to your WFA account.
Account Information
Name of Stock
CUSIP (9 digits)
Symbol
Account Number with Agent (Include all dashes or spaces)
Number of Whole Shares to be Transferred
Tax IDs on File with Agent - (Please confirm the number with the Agent. It may be different from what is on file in joint or trust accounts).
Primary Tax ID
Secondary Tax ID
DRS Instructions: Deposit
Agent Name
SSN or Tax ID Agent Account Number (use N/A if no account number)
Registration: (use agent registration for deposits and new owner registration for withdrawals
Address
City
State
Zip
Select from one of the following instructions to WFA:
Transfer all Whole Shares and have Agent Sell Fractions (A) Transfer all Whole Shares--Keep Fractions with Agent (P) Transfer all Whole Shares, have Agent Sell Fractions and Close Account with Agent (T) Move Specified Number of Whole Shares (no fractions). Number of Whole Shares to be Transferred:
Note: Agent will mail proceeds from the sale of fractions directly to Client. Please obtain and include a monthly statement dated within the past 90 days.
Authorization
I/We hereby authorize Wells Fargo Advisors, LLC ("WFA") to request the transfer agent/issuer to transfer the above listed stocks to my/our above-listed WFA account. I/We understand that a transfer from an individual account to an account with joint registration may change my/our ownership rights and may change the primary Social Security or tax ID number on the account. I/We also understand that the transfer may change the account registration and beneficiary designation(s). I/We will consult with our legal or tax advisor regarding our personal situation.
By signing below, I/we understand and accept any change of registration and ownership and agree to hold WFA and the delivering agent harmless from acting on these instructions, including any and all claims, liabilities, damages, taxes and actions (including attorney fees) resulting from compliance with this request.
Client Signature
Client Signature
X
Client Signature
X
Name of Trust (if applicable)
Print Name Print Name
Date Date
Trustee Signature
X
Print Name
Date
Please include a statement dated within the past 90 days. Shares will transfer into your WFA account within 3 to 5 business days of WFA receiving your request.
WellsTrade? - Submit your completed form to: Wells Fargo Advisors, PO Box 66535, St. Louis, MO 63166-9954, or Fax to 800-433-0738 Should you require assistance with this form, please call 1-800-TRADERS (1-800-872-3377).
Investment and Insurance Products: Not Insured by FDIC or any Federal Government Agency May Lose Value Not a Deposit of or Guaranteed by a Bank or Any Bank Affiliate
Wells Fargo Advisors, LLC is a registered broker-dealer and separate non-bank affiliate of Wells Fargo & Company
587495 (Rev 03 ? 02/13)
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