Fillable DEPOSIT INFORMATION WIRING AND ACH INSTRUCTIONS

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DEPOSIT INFORMATION WIRING AND ACH INSTRUCTIONS

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F9V3 Copyright © 2019 Madison Trust Company Inc. All Rights Reserved.
madisontrust.com
Corporate Headquarters: 401 E. 8
th
St. Suite 200, Sioux Falls, SD 57103
WIRING AND ACH INSTRUCTIONS
To wire funds to Madison Trust, please use the following informaion:
Insituion Name: Capital One Bank
Insituion Address: 46 E Rte 59, Nanuet, NY 10954
Rouing Transit Number (ABA): 065000090
Beneficiary Account Number: 7527846263
Beneficiary Account Name: Madison Trust Company Inc.
For Further Credit: FBO: [Accountholder’s name] [MTC Account #]
*Incoming Wire Fee applies: $25 per wire
DEPOSIT INFORMATION
Page 1 of 2
Processing Times:
Our standard processing ime for all forms and requests is 4 business days.
Our expedited service is 2 business days ($50 fee applies).
Forms received ater 1 PM EST will be considered received on the following business day (applies to both standard and expedited processing).
For ime sensiive transacions, you have access to the following services:
• Expedited Processing ($50)
• Overnight Mail ($50)
• Wire Transfer ($25)
Check Hold Policy:
7 business days.
Bank and other financial insituion checks will be held for 5 business days.
Incoming wires are available the next business day ($25 incoming wire fee applies).
Please issue all checks to “Madison Trust Company, Custodian FBO [Accountholder’s Name] [MTC Account #]”
Please mail to:
Madison Administraion Company
One Paragon Drive, Suite 275
Montvale, NJ 07645
PROCESSING & HOLD TIMES
CHECK INSTRUCTIONS
Please submit this document to Madison Trust:
Mail: Fax: Secure Upload: www.madisontrust.com/uploads
F9V2 Copyright © 2019 Madison Trust Company Inc. All Rights Reserved.
madisontrust.com
Corporate Headquarters: 401 E. 8
th
St. Suite 200, Sioux Falls, SD 57103
DEPOSIT INFORMATION
Page 2 of 2
A. ACCOUNTHOLDER IDENTIFICATION
C. DEPOSIT TYPE
B. AMOUNT AND DELIVERY METHOD
First name Last name Madison account number
Direct rollover of cash from an exising Qualified reirement Plan (e.g. 401k, 403b) – A direct rollover occurs when you instruct the administrator of your
current Qualified Reirement Plan to send your reirement funds directly to Madison Trust.
Exising plan name and plan account number
Indirect rollover from a previous IRA or Qualified reirement Plan – An indirect rollover occurs when you receive a distribuion of cash from your
previous IRA/Qualified Reirement Plan and then forward those funds into another reirement account within 60 days from the distribuion date.
Please select one of the following:
This is a rollover from an IRA/Qualifed PIan (other than a Roth) into a Madison Trust Tradiional or SEP IRA
This is a rollover from a Roth IRA/Qualified Plan into a Madison Trust Roth IRA
Annual Contribuion
Type of IRA: Tradiional Roth SEP/SIMPLE (Employer)
Contribuion year
Recurring Contribuion: I will make this contribuion on a (choose one)
monthly
quarterly
other
basis for the contribuion year indicated above.
Non-IRA Funds Deposit
Deposit from your IRA LLC
Deposit from an Investment
Principal/Interest $ (P) $ (I)
Asset name
Please submit this document to Madison Trust:
Mail: Fax: Secure Upload: www.madisontrust.com/uploads

Check
Wire 
$
Deposit amount
If applicable:
D. AGREEMENT & SIGNATURE
By signing this Deposit Informaion form, I hereby acknowledge that the deposit informaion is correct and that Madison Trust may rely on my characterizaion of
the deposits. I also acknowledge, understand, and accept the deposit hold policy stated above.
Accountholder signature Date (MM/DD/YY)
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DEPOSIT INFORMATION WIRING AND ACH INSTRUCTIONS

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Completed 23 June 2021

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