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Investment Club Cash Account
Please complete all sections. Section 2 identifies those individuals authorized by your Investment Club (i.e., your Partnership agreement) to transact business on the account. Please provide copies of those pages of the Partnership agreement that provide the
official name of the Partnership and all signatures. We will review and store only the portions of the Partnership agreement
containing this requested information. The undersigned certify that the attached pages of the Partnership agreement are true
and valid copies of the legal document currently in effect. Section 3 must be signed by all Investment Club partners. All signatures
must be witnessed. If you have any questions, please call our Brokerage Account Assistance Line, which is open 24 hours a day,
7 days a week, at 1-800-544-6666.
Return the completed form to: Fidelity Investments, P.O. Box 770001, Cincinnati, OH 45277-0002
1
Customer Information
–
– Investment Club Partnership Name
Brokerage Account Number
Address
–
Tax Identification Number
–
Daytime Telephone Number
CityState
Zip
2
Authorized Individual
All fields in bold are required.
Each authorized individual named is fully authorized to open a brokerage account in the name of the Investment Club Partnership identified as
the owner in Section 1, to place orders on the account, and to execute any instrument incidental to that (such as applying for margin or options),
to act in a sole capacity in these regards, and to act on behalf of the business entity as may be more fully described in the customer agreement.
Note: To add up to seven authorized individuals to this account, attach a copy of the information required below for each individual. Duplicate this
page with Authorized Individual changes and attach as an addendum if additional Authorized Individuals are needed.
The undersigned hereby represent and warrant to Fidelity Brokerage Services LLC (“Fidelity”) that they are all the partners in a general partnership
and hereinafter called the
known as Investment Club Name
“Partnership,” and the undersigned hereby authorize Fidelity to open a securities account for the Partnership to be known as the
Account.
Name of Partnership
Agent’s full legal name
Title
E-mail address
Date of birth (mm/dd/yyyy)
–
Social Security number
Permanent address
(no P.O. boxes)
–
–
–
–
or Taxpayer ID number
Street
City
State
Zip
Street
City
State
Zip
Mailing address
(if different from above)
Phone numbers Evening
Country of citizenship
U.S.
Other
–
–
Day
–
Country of
tax residence
–
U.S.
Ext.
Other
1.525026.106002740201
2
Authorized Individual (continued)
UNEXPIRED GOVERNMENT ID (foreign citizens ONLY) Identification document must have a reference number and
photo. Please attach a photocopy.
Place of birth
City
State/Province
Immigration status
Permanent resident
Non-permanent resident
Check which type of document you are providing:
U.S. driver’s license
DHS permanent resident card
Country
Non-resident
Passport with U.S. visa
Employment Authorization
Document
Passport without U.S. visa
Foreign national identity document
Document number and country of issuance (Number from the document checked above)
Employment status Employed
Not employed
Self-Employed
Retired Occupation
(if retired or not employed, indicate source of income)
If you are self-employed and your business address is the same as your legal home
address, please initial here that you work out of your home ______
Employer’s name _____________________________________________________________________________________________
Address _______________________________________________City ___________________________ State ____ Zip ________
Associations
C
heck this box if you are associated with, or employed by, a stock exchange or a member firm of an exchange or FINRA, a
municipal securities dealer, or Fidelity. If you checked the box, obtain and attach the compliance officer’s letter of approval
(“407 letter”) and indicate the name and address of the entity with which you are associated below. Failure to include an
approval letter may delay the processing of your request. We must tell the associated entity that you have applied for this
account. An account approval letter is not required for Fidelity employees.
Check here if your association is through your employer. (If you checked this box, you are not required to complete the
information below.)
Associated entity name _________________________________________________________________________________________
Address _______________________________________________City ___________________________ State ____ Zip ________
Check this box if you are a control person associated with either (a) another member, (b) a member organization, or (c) an
immediate family/household member of a control person, or are associated with a publicly traded company under SEC Rule
144 (this would include, but is not limited to, a director, 10% shareholder, policy-making officer, and members of the board
of directors).
Company
Trading symbol
Receive Account Documents Online:
For your convenience, certain account documents can be delivered to you electronically. These include account statements, trade
confirmations, prospectuses, and shareholder reports. In addition, as other documents become available, we will be able to deliver
them to you electronically instead of by U.S. mail.
If you do not want electronic delivery of your account documents, you should check off one or more of the boxes below. In order
to enroll in the eDelivery program and begin receiving account documents electronically, you will need to read the Electronic
Delivery Agreement and consent to its terms. You will receive the Electronic Delivery Agreement in an e-mail, unless you select all
the options below.
I would prefer to receive the following documents by U.S. mail:
Monthly Account Statements
Trade Confirmations and Related Prospectuses
Prospectuses, Shareholder Reports, and
Other Documents
The Agent identified in Section 2 of this form is hereby appointed the agent and attorney-in-fact of the Partnership, and for its
account and risk, to buy, sell, trade, and otherwise deal in, through Fidelity as brokers, stocks, bonds, options, and any other
securities, listed or unlisted, on margin or otherwise (including short sales) in said account in accordance with Fidelity’s terms and
conditions. Fidelity may conclusively assume that all action taken and instructions given by said agent and attorney-in-fact have
been properly taken or given pursuant to authority vested in such agent and attorney-in-fact by all the partners in the partnership.
Fidelity is authorized to follow the instructions of the said agent and attorney-in-fact in every respect concerning said account and to
make delivery of securities and payment of monies to him or her or as he or she may order and direct and to send to him or her all
demands, notices, reports, confirmations, statements of account, and communications of every kind relating to the account. The said
agent and attorney-in-fact is hereby authorized to execute and deliver on behalf of the Partnership and its members the Customer
Agreement, and any other agreements Fidelity may require, to act for the undersigned in every respect concerning said account, and
to do all other things necessary or incidental to the conduct of said account. The undersigned agree that if new partners are admitted
to the Partnership, the undersigned will cause such new members to adopt and be bound by this authorization and indemnity.
This authorization and indemnity is in addition to, and in no way limits or restricts, any rights that Fidelity may have under any
other agreement or agreements between Fidelity and the undersigned, or any of them, now existing or hereafter entered into,
and is binding on the undersigned and their legal representatives, successors, and assigns. This authorization and indemnity is
also a continuing one and shall remain in full force and effect until revoked by a written notice, addressed to Fidelity Brokerage
Services LLC (“Fidelity”) and delivered to Fidelity’s main office, signed by any
(indicate the number of partners
required) partners. No such revocation shall affect any liability arising out of any transaction initiated prior to such revocation.
The undersigned, jointly and severally, agree to indemnify and hold Fidelity harmless from and to pay Fidelity promptly on any
debit balance in said account.
It is further agreed that in the event of death of any of the undersigned, the survivors shall immediately give Fidelity written
notice thereof, and Fidelity may, before or after receiving such notice, take such proceeding, require such papers, retain such
portion of and/or restrict transactions in the account as Fidelity may deem advisable to protect Fidelity against any liability,
tax, or penalty under any present or future laws or otherwise. The estate of any of the undersigned who shall have died shall
be liable, and each survivor shall continue to be jointly and severally liable, to Fidelity on the foregoing indemnity and for any
debit balance or loss in said account resulting from the completion of transactions initiated prior to the receipt by Fidelity of
the written notice of the death of the decedent or incurred in the liquidation of the account or the adjustment of the interests of
the respective parties.
This authorization and indemnity shall inure to the benefit of Fidelity’s present firm and its successors in business, irrespective
of any change or changes of any kind in the personnel thereof for any cause whatsoever.
The undersigned agree that any information given on this authorization and indemnity is subject to verification, and authorizes
Fidelity to obtain a credit or other financial responsibility report with respect to the registered account holder as well as any
individual authorized to transact business on behalf of the registered account holder, and that the undersigned are authorized
to express the consent of such authorized individuals to obtain a report, and that such individuals have been notified of the
possibility thereof. Upon written request, Fidelity will provide the name and address of the credit reporting agency used
The undersigned consent to have only one copy of Fidelity mutual fund shareholder documents, such as prospectuses and
shareholder reports (“Documents”), delivered to you and any other investors sharing your address. Your Documents will be
householded indefinitely; however, you may revoke this consent at any time by contacting Fidelity at 800-544-3018 and you
will begin receiving multiple copies within 30 days. As Documents for other investments become available in the future, these
Documents may also be householded in accordance with this authorization or any notice or agreement you received or entered
into with Fidelity or its service providers.
3
Signature All partners must sign.
Signature
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448899.3.0
Fidelity Brokerage Services LLC, Member NYSE, SIPC
B.604-FORM-0513
1.525026.106