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USAA 529 College Savings Plan™
Payroll Deduction/Government Allotment Instruction Form
Please complete this form to establish or change payroll deduction/government allotment instructions on your USAA 529 College Savings Plan account. If you are opening
a new USAA 529 College Savings Plan account, you must also complete and return a new 529 College Savings Plan account application. The amount contributed by payroll
deduction or government allotment will be invested in the allocation instructions currently on file at the time of receipt of the contribution. For help completing this form,
call toll-free at (800) 292-8825, Monday through Friday, 7:30 a.m. to 8:00 p.m. Central Time and Saturday from 8:00 a.m. to 5:00 p.m. Central Time or visit us at usaa.com.
Upon receipt of this form, we will provide a letter of instruction with the information you need to sign and provide to your employer’s payroll department. For government
allotments, a partially completed U.S. Treasury Department Standard Form 1199A (Direct Deposit Sign-Up Form) will be included with the letter of instruction.
1. Current Account Information (please print)
Account Number
Account Owner
Account Owner/Trustee/Custodian First Name
MI
Last Name
Name of Trust (if applicable)
—
—
Account Owner Social Security/Taxpayer ID Number
Account Owner USAA Number (if any)
47901-0315
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USAA 529 College Savings Plan™ Payroll Deduction/Government Allotment Instruction Form
2. Payroll Deduction/Government Allotment Instructions
Minimum contribution amount of $50 per beneficiary is required.
Check One:
Check One:
Payroll Deduction
Start
Government Allotment
Change
Stop
$
Account Number
,
Dollar Amount
Beneficiary First Name
MI
Last Name
$
Account Number
,
Dollar Amount
Beneficiary First Name
MI
Last Name
$
Account Number
,
Dollar Amount
Beneficiary First Name
MI
Last Name
$
Account Number
,
Dollar Amount
Beneficiary First Name
MI
Last Name
Total Amount of Deduction
$
,
3. Signature
I certify that the instructions and information provided herein are true, complete, and correct and comply with applicable law and with the terms set forth in the Plan Description
and Participation Agreement which I have read and have agreed with the terms set forth therein.
X
Account Owner/Trustee/Custodian signature Please print name
Date
Please print name
Date
X
Co-Trustee Signature (sign only if a trust account) Mailing address:
USAA 529 College Savings Plan
P.O. Box 55354
Boston, MA 02205-5354
For overnight delivery or registered mail, send to:
USAA 529 College Savings Plans
95 Wells Ave Ste 155
Newton, MA 02459
47901-0315
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