Computershare Trust Company, N. A. IRA (the “IRA Program”) For express deliveries, please send to The IRA Program The IRA Program c/o Computershare Trust Company c/o Computershare Trust Company, N.A. P.O. Box 173753 000 00xx Xxxxxx, Xxxxx 0000 Denver, CO 80217-3753 Denver, CO 80202-3323 Please print all items except signatures. If you have questions, call toll-free 0-000-000-0000 from 9 a.m. to 5 p.m., Eastern Time, Monday through Friday. Mail your completed form to the address above. Automatic investment is an easy way to make your IRA contribu- tions regularly and automatically. Keeping in mind the contribution limits for the IRA Program, you designate an amount of money you want deducted monthly from your checking, savings or cred- it union account. Please complete this form and provide the infor- mation requested. Computershare Trust Company will then work with your financial institution to set up your automatic investment, and you’ll soon be making monthly IRA contribution automatical- Type of contribution (Please check one. If no selection is made, the contributions will be recorded as voluntary deductible con- tributions to a Traditional IRA, or “regular” (annual) contributions to a Xxxx XXX.) ❑ Voluntary Deductible ❑ Voluntary Nondeductible ❑ SEP – Employer ❑ Regular Xxxx XXX Prearranged monthly contribution amount: $ ly. If you wish later to change or discontinue using automatic investment, simply notify Computershare Trust Company in writ- ing. Note: This form may be used for either Traditional or Xxxx XXX contributions. However, no conversion/rollover contributions may be deposited via this automatic investment option. Please note: Your IRA Program automatic investment is credited toward the current year’s IRA contributions. Although you may begin using this service at any time, the prearranged contributions will apply for the tax year in which they are received by Comput- ershare Trust Company (ending December 31). By authorizing automatic investment IRA contributions, you are designating those contributions for the current tax year. Automatic investment contributions will be discontinued for any account that transfers all share or terminates participation. AUTOMATIC INVESTMENT AUTHORIZATION To initiate your prearranged monthly current year IRA contribu- tions, please complete the following information and return this form to Computershare Trust Company. If automatic investment payments are to be made from your checking account, please sta- ple a voided check to the upper left corner of this form. If pay- ments are to be made from a credit union or savings account, you will need to provide us with a nine-digit “Routing Transit” number which you can obtain from your financial institution. Note: Please refer to the Company’s Program Literature for details about the minimum dollar amount for automatic invest- ment contributions. Financial Institution (from which debits are to be made) Name of Financial Institution Street Address City/State/Zip My bank account number is: Type of Account (please check one) ❑ Checking Account ❑ Savings Account ❑ Credit Union Account Bank Routing Transit Number (for savings or credit union account) Name (please print) My Computershare Trust Company IRA Program Account Num- ber (leave blank if establishing a new IRA) Type of Authorization (check one) ❑ Initial Authorization ❑ Change of Authorization Note: If the “Change of Authorization” box is checked because of a change in bank accounts or bank routing number, there will be a 35-day verification period during which no contributions will be made to the IRA or applied toward the purchase of shares. The automatic investment will occur on the 15th day of the month or monthly on the date outlined in your Program Literature. For those plans with multiple automated monthly investment dates, and if one of those dates is not the 15th, then the investment will take place on the earliest date each month. TERMS AND CONDITIONS OF AUTOMATIC INVESTMENT AUTHORIZATION I hereby authorize Computershare Trust Company, N.A., to effect payment for the amount specified by me to Computershare Trust Company, N.A., as such amount becomes due by initiating debit entries to my account indicated at the financial instituion named. I request that such financial institution accept any debit entries ini- tiated by Computershare Trust Company, N.A., to such account Automatic Investment (continued) and to debit the same to such account without responsibility for the correctness thereof. I understand that such optional invest- ments will be credited as voluntary deductible Traditional IRA con- tributions or regular Xxxx XXX contributions, as applicable (unless otherwise specified by me in writing) to my retirement plan for the tax year (ending December 31) in which they are received by Computershare Trust Company, N.A. I understand that this agree- ment may be terminated by me at any time by sending written notification to both my financial institution and to Computershare Trust Company, N.A. Any such notification to Computershare Trust Company, N.A., shall be effective only with respect to entries to be initiated by Computershare Trust Company, N.A., six
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Samples: www-us.computershare.com, cda.computershare.com, www-us.computershare.com
Computershare Trust Company, N. A. IRA (the “IRA Program”) For express deliveries, please send to The IRA Xxxx XXX Program The IRA Program c/o Computershare Trust Company c/o Computershare Trust Company, N.A. P.O. Box 173753 000 00xx Xxxxxx, Xxxxx 0000 Denver, CO 80217-3753 Denver, CO 80202-3323 Please print all items except signatures. If you have questions, call toll-free 0-000-000-0000 from 9 a.m. to 5 p.m., p.m. Eastern Time, Monday through Friday. Mail your completed form to the address abovebelow. Automatic investment is an easy way to make your If stock certificates are enclosed, please return by registered mail. Program IRA contribu- tions regularly and automatically. Keeping in mind the contribution limits for the IRA Program, you designate an amount of money you want deducted monthly from your checking, savings or cred- it union account. Please complete this form and provide the infor- mation requested. c/o Computershare Trust Company will then work with your financial institution to set up your automatic investmentProgram Trustee P.O. Box 173753 Denver, and you’ll soon be making monthly CO 80217-3753 Please send express deliveries to: Program IRA contribution automatical- Type of contribution (Please check one. If no selection is made, the contributions will be recorded as voluntary deductible con- tributions to a Traditional IRA, or “regular” (annual) contributions to a Xxxx XXX.) ❑ Voluntary Deductible ❑ Voluntary Nondeductible ❑ SEP – Employer ❑ Regular Xxxx XXX Prearranged monthly contribution amount: $ ly. If you wish later to change or discontinue using automatic investment, simply notify c/o Computershare Trust Company in writ- ingProgram Trustee 000 00xx Xxxxxx, Xxxxx 0000 Denver, CO 80202-3323 Information and Instructions Do not send this form to your current trustee (if your assets are held at another trustee). Note: We will handle the asset transfer/rollover/ conversion process. Please be aware that these transactions take several weeks to complete; we do not have control over the inter- nal procedures of other companies. If the following Transaction Selection is a Xxxx XXX transfer, attach to this form a copy of your most recent account statement from the current Xxxx XXX trustee. If this is a partial transfer, the remaining assets of that Xxxx XXX are to remain intact under the trusteeship of the current trustee as a separate plan. We do not serve as co-trustee of such assets. If this is a Rollover or Conversion, you certify that the assets requested to be rolled/converted into this Xxxx XXX meet the requirements under law for a Qualifying Rollover Contribution/ Conversion as defined by law and the Xxxx XXX Trust Agreement. (See the Rollover/Conversion Statement.) You should also under- stand that the current (resigning) trustee may issue a tax form for the distributed value of the requested assets. By signing this form, you hold us harmless for any negative consequences of your request, including if the rollover/conversion is deemed invalid, creates unintended tax consequences or if you suffer any other penalties resulting from your requested transactions. Please consult the Xxxx Individual Retirement Account and Disclosure Statement for additional information about moving Xxxx XXX assets into this Xxxx XXX Investment Plan, and read the Company’s Investment Plan prospectus for information regarding The Xxxx XXX Program. This form may not be used for either Traditional or Xxxx XXX contributions. However, no conversion/rollover contributions may be deposited via this automatic investment option. Please note: Your IRA Program automatic investment is credited toward the current year’s IRA contributions. Although you may begin using this service at any time, the prearranged contributions will apply for the tax year in which they are received by Comput- ershare Trust Company (ending December 31). By authorizing automatic investment IRA contributions, you are designating those contributions for the current tax year. Automatic investment contributions will be discontinued for any account that transfers all share or terminates participation. AUTOMATIC INVESTMENT AUTHORIZATION To initiate your prearranged monthly current year IRA contribu- tions, please complete the following information and return this form to Computershare Trust Company. If automatic investment payments are to be made from your checking open an account, please sta- ple a voided check to the upper left corner of this form. If pay- ments are to be made from a credit union or savings account, you will need to provide us with a nine-digit “Routing Transit” number which you can obtain from your financial institution. Note: Please refer to the Company’s Program Literature for details about the minimum dollar amount for automatic invest- ment contributions. Financial Institution (from which debits are to be made) Name of Financial Institution Street Address City/State/Zip My bank account number is: Type of Account (please check one) ❑ Checking Account ❑ Savings Account ❑ Credit Union Account Bank Routing Transit Number (for savings or credit union account) Name (please print) My Computershare Trust Company IRA Program Account Num- ber (leave blank if establishing a new IRA) Type of Authorization (check one) ❑ Initial Authorization ❑ Change of Authorization Note: If the “Change of Authorization” box is checked because of a change in bank accounts or bank routing number, there will be a 35-day verification period during which no contributions will be made to the IRA or applied toward the purchase of shares. The automatic investment will occur on the 15th day of the month or monthly on the date outlined in your Program Literature. For those plans with multiple automated monthly investment dates, and if one of those dates is not the 15th, then the investment will take place on the earliest date each month. TERMS AND CONDITIONS OF AUTOMATIC INVESTMENT AUTHORIZATION I hereby authorize Computershare Trust Company, N.A., to effect payment for the amount specified by me to Computershare Trust Company, N.A., as such amount becomes due by initiating debit entries to my account indicated at the financial instituion named. I request that such financial institution accept any debit entries ini- tiated by Computershare Trust Company, N.A., to such account Automatic Investment (continued) and to debit the same to such account without responsibility for the correctness thereof. I understand that such optional invest- ments will be credited as voluntary deductible Traditional IRA con- tributions or regular Xxxx XXX contributions, as applicable (unless otherwise specified by me in writing) to my retirement plan for the tax year (ending December 31) in which they are received by Computershare Trust Company, N.A. I understand that this agree- ment may be terminated by me at any time by sending written notification to both my financial institution and to Computershare Trust Company, N.A. Any such notification to Computershare Trust Company, N.A., shall be effective only with respect to entries to be initiated by Computershare Trust Company, N.A., six.
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