TDA 082 DS 05/20
Page 1 of 1
PO Box 2760
Omaha, NE 68103-2760
1. PERSONAL INFORMATION
Account Owner’s Full Legal Name:
2. FUNDING YOUR ACCOUNT
• Please make check payable to TD Ameritrade Clearing, Inc. We accept checks payable in U.S. dollars and through a U.S. bank, as well as
checks drawn o Canadian banks.
° Acceptable Foreign Instruments (checks drawn o Canadian banks). TD Ameritrade receives a referral fee from a third-party service
provider on eligible currency exchange transactions. To facilitate the currency exchange process, banks receive revenue based
on an assessed currency markup rate.
• Always include your account number in the memo section of your check.
• Please refer to our “Check-Writing Guidelines,” available online or at your local branch, for more information.
Amount of Deposit: Check Number:
3. SECURITY DEPOSIT
• Please sign and endorse certiﬁcate(s).
• Always include your account number on the face of each stock certiﬁcate.
Symbol Number of Shares Symbol Number of Shares
Send your deposit to one of the following addresses:
For Standard Delivery:
TD Ameritrade, Inc., PO Box 2229, Omaha, NE 68103-2229
For Overnight Delivery:
TD Ameritrade, Inc., 200 S 108th Ave, Omaha, NE 68154-2631
4. DEPOSIT AGREEMENT
By my signature below, I authorize TD Ameritrade Clearing, Inc. to deposit the funds or securities in the manner instructed. (Account owner
understand that until a check deposit clears, which can take 4-5 business days, we restrict withdrawals and trading of some securities.)
By Depositing a foreign instrument, you:
Agree to indemnify and hold TD Ameritrade and the third party service provider, harmless from any and all losses, costs, claims, or
ﬁnancial obligations that may arise from any act or omission with respect to your account and from any and all losses, costs, claims,
or ﬁnancial obligations that may arise from acting upon the instructions provided herein.
Certify that (i) you have the authority to enter into the transactions set forth above; and (ii) you understand that transactions are
governed by an account agreement executed by the account owner with TD Ameritrade (the “Agreement”).
You understand and agree that the third party service provider, will convert the funds into U.S. Dollars using the conversion rate and
transmit the proceeds to the designated recipient. You also acknowledge and agree that TD Ameritrade cannot guarantee when the
service provider will post the funds for credit, and this process may take several days, during which the funds will be held by the
service provider in its bank account commingled with other assets of that provider, and while there: (i) are not protected by SIPC or
TD Ameritrade’s excess SIPC coverage, (ii) will not bear interest and (iii) will not be eligible for other earnings credits.
Account Owner’s Signature:
Deposit Slip (Non-IRAs)
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. © 2020 TD Ameritrade.