Questions? Go to Fidelity.com/transfermoneyshares or call 800-343-3548.
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Deposit Slip
Use this form to make deposits into your Fidelity account. Type on screen or fill in using CAPITAL letters and black ink.
Write your account number in the memo field of the check(s) and mail to:
• Regular mail: Fidelity Investments, P.O. Box 770001, Cincinnati, OH 45277-0047
• Overnight mail: Fidelity Investments, 100 Crosby Parkway, KC1H, Covington, KY 41015-4325
Helpful to Know
• Do NOT use this form to purchase individual securities
other than mutual funds. Visit Fidelity.com or call a
representative at 800-343-3548 to place a trade after this
deposit has posted to your account.
• All deposits must meet mutual fund eligibility and minimum
investment requirements as described in the applicable
fund prospectus or fact kit. You cannot invest in accounts
that are restricted. If purchasing a new fund, you must have
read the prospectus and agree to its terms.
• Only checks payable to the Account Owner, Fidelity
Brokerage Services LLC, or to the Fidelity fund name will
be accepted. Fidelity does not accept third-party checks.
Checks payable to the Account Owner must be endorsed.
Make checks payable as follows:
• Brokerage Accounts (all account types) — Fidelity Brokerage
Services LLC
• Mutual Fund Accounts (all account types) — Fidelity Fund
Name (e.g., Fidelity Government Cash Reserves)
1. Account Owner
Name Fidelity Account Number
Daytime Phone Extension
2. Deposit Information All deposits may be subject to a clearing period of four business days.
Deposit Type:
Nonretirement
Cash Management Account
529 College Savings Plan
ABLE Account
Current Year: Traditional IRA,
Roth IRA, or HSA
Prior Year: Traditional IRA,
Roth IRA, or HSA
60-Day Rollover
Direct Corporate Rollover
(e.g., 401(k), 403(b), 457)
Roth Conversion
SEP IRA Employer Only
Fidelity Retirement Plan/Keogh
Employer Only
List Checks:
Check Number Amount
$
.
Check Number Amount
$
.
Total Investment
$
.
Deposit Instructions For deposits to mutual funds within a Brokerage or Mutual Fund Only account.
Fund Name Symbol Amount
$
.
Fund Name Symbol Amount
$
.
For retirement or
HSA contributions, if
the Deposit Type is
not indicated or if the
contribution is received
after the prior-year
IRS deadlines, the
contribution will be made
for the current year.
529/ABLE/Fidelity
managed accounts:
Investments will be
allocated according to your
current model portfolio
or your most recent
investment allocation
information on file.
Brokerage accounts:
Investments will be placed
in the core position unless
you specify mutual fund
position(s). Do NOT list
individual securities
other than mutual funds
on this form.
Mutual Fund Only
accounts:
Investments
will be placed in the
mutual fund position(s)
as specified. Only
Fidelity mutual funds
may be listed.
On this form, “Fidelity” means Fidelity Brokerage Services LLC and its affiliates. Brokerage services are
provided by Fidelity Brokerage Services LLC, Member NYSE, SIPC. 377585.8.0 (05/18)
