WTP
CM203-CTD
Revised 0714
Page 1 of 1
Move Money
Non-Retirement - Wired Funds
Instructions: Use this form to request a wire from your LPL Financial ("LPL") account to an account at another financial institution. LPL will not honor requests to
wire funds to a third party or to a foreign country.
Please mail the completed form to Trade Direct, P.O. Box 509049 San Diego, CA 92150-9049 or fax to (858) 202-8500.
Account Number
Member FINRA/SIPC
Account Holder Information
1.
Account Registration Social Security Number
Distribution Instructions2.
Note: Ensure cash and/or equivalent available in the account prior to submitting this request. For Optimum Market Portfolios necessary cash will be made available after submitting the request.
Additional processing time required for advisory accounts.
A $25 fee will be charged to your account.
Distribution Amount:
$
‡ Verify the Fed Fund Wire ABA number with your receiving financial institution.
Bank Name Bank Phone
Bank Address Fed Funds Wire ABA Number ‡
Bank Account Name Bank Account Number
Further Credit Name Further Credit Number
Distribution Frequency3.
On Demand Distribution
This feature allows LPL Financial to request a Wire from this account to a Checking/Savings account on your behalf, based on the instructions defined
above.
I/We hereby authorize LPL to wire funds from my/our account as indicated above and to process debit entries and adjustments as needed.
If this is a Custodial account, I/we acknowledge and agree that any funds or securities transferred out of the account and into the account of the custodian
shall be used or applied solely for the benefit of the minor.
If the minor has reached the age of majority per state guidelines then he/she is required to sign the request. A copy of the birth certificate will be
required.
By selecting On Demand and signing this form I/we understand that I/we are giving LPL authorization to remit monies as indicated from the above
referenced account without additional written authority on my/our part. This authorization and indemnity will remain in full force and effect for one
calendar year unless revoked by me/us by written notice addressed and delivered to LPL. Such revocation shall not affect any liability in any way resulting
from transactions initiated prior to such revocation. This form expires one year from the signed date. A new form must be executed and resubmitted to
LPL on an annual basis. I/We hereby finally and irrevocably release and discharge you of any claims by me/us or your legal representatives with reference
to the foregoing, including the proceeds of the sale or other disposition thereof.
Authorization form must be signed by all account holders, authorized corporate officers or the outside custodian.
4.
Account Holder Signature Account Holder Name (print) Date
Account Holder Signature Account Holder Name (print) Date
New set of instructions Additional set of instructions
or Total Amount
