TDA 2422 F 08/19
Page 2 of 2
4. DISTRIBUTION METHOD
I instruct TD Ameritrade Clearing, Inc. to distribute the amount stated in the following manner:
Make this payment: (Please select one of the following options. If nothing is selected, your distribution will be mailed to the address listed
on your account.)
N
To another TD Ameritrade Coverdell ESA account number: _____________
For an education expense:
N
To my TD Ameritrade non-retirement account number: _____________
N
By mail
N
Check
Delivery method:
N
U.S. First-Class Mail
N
Overnight at my expense
N
To the address on record
N
To an alternate address
N
This is my new address of record
Address:
City: State: ZIP Code:
N
To an alternate payee
Name:
N
Wire funds at my expense
Name on Bank Account:
Bank Name: Phone:
Bank Address:
City: State: ZIP Code:
ABA/Routing Number: Bank Account Number:
Please attach a letter of instruction for two bank, brokerage and escrow wires to ensure we have all the information needed to process
your request. For International Wires please include the Wire Request (International) form to ensure all required information is included to
complete your request. This form can be located at www.tdameritrade.com.
N
Electronic (ACH) to my Checking or Savings *must have previously established connection with this bank via the website*
For previously set up ACH Bank, enter the nickname assigned to the setup or last 4 of the bank account number: _______________________
5. PLEASE READ AND SIGN THE FOLLOWING SECTION
I understand that, subject to the provisions of the Agreement, I have full discretion and control over the form of payment or payments of
the entire balance in the Account. I shall exercise control by directing that such payment or payments be made as described above, and
TD Ameritrade Clearing, Inc. shall have no responsibility or liability with respect to the choice of any such form of payment or payments. I
attest that I am the proper party to receive payment or payments from this ESA and that all information provided by me on this form, including
supplemental material, is true and accurate. I certify that no tax advice has been given to me by TD Ameritrade, Inc. or TD Ameritrade Clearing,
Inc., and that all decisions regarding this withdrawal are my own. I expressly assume the responsibility for any adverse consequences which
may result from the withdrawal; and I indemnify and hold harmless TD Ameritrade, Inc. and TD Ameritrade Clearing, Inc., their divisions,
ocers, employees, directors, representatives, owners, aliates, successors, and assigns.
✗
Custodian’s Signature:
Date:
Investment Products: Not FDIC Insured * No Bank Guarantee * May Lose Value
TD Ameritrade, Inc. and TD Ameritrade Clearing, Inc., members FINRA/SIPC. TD Ameritrade is a trademark jointly owned by
TD Ameritrade IP Company, Inc. and The Toronto-Dominion Bank. © 2019 TD Ameritrade.
