Contribution Transmittal Form - MG Trust F4709-1015-01
Fax this form to 813.425.9781 or mail to: Aspire, 4010 Boy Scout Blvd., Suite 450, Tampa, FL 33607. Maintain a copy for your records.
Questions? Call Client Services at 866.634.5873, M - F, 8am - 8pm ET.
IRA Contribution Transmittal Form
This form can be used to remit a contribution by check -OR-
initiate, modify, or cancel an ACH authorization.
STEP 1
ACCOUNT HOLDER AND BANK INFORMATION
IRA ACCOUNT BANK ACCOUNT CONTRIBUTION YEAR* ASPIRE IRA ACCT#
Traditional Roth | Checking Savings
(Check Only) (If Available)
___________________________________________________ _______________________________________________
First Name Last Name
FOR AUTOMATED CLEARING HOUSE (ACH) AUTHORIZATIONS ONLY
Indicated below is the depository nancial institution, hereinafter called DEPOSITORY, for the account from which the ACH will be debited.
Account Holder acknowledges that the origination of ACH transactions to the IRA account must comply with the provisions of U.S. law.
___________________________________________________________________________________ _________________________________________________________________
Bank Name Branch
_______________________________________________________________________________________________________________________________________________________
Address
____________________________________________________________________________________________________ _______________________ ________________________
City State Zip
CHECK – Attach executed check and mail original
Make checks payable to: MG Trust Company FBO “Account Holder Name.”
In the memo: Be sure to include the Aspire IRA Account number.
Mail this form and check to the following address:
Aspire Financial Services, LLC, 4010 Boy Scout Blvd., Suite 450, Tampa, FL 33607
ACH – Attach Voided Check for Account from which the ACH will be debited.
Account Holder acknowledges and agrees that:
• For all ACH contributions, the year in which the ACH amount was processed will be the contribution year; it may not be retroactive.
• For the 1st ACH debit processing time can take up to one month after receipt of the request. Once started, the ACH debit will
occur on or about the 15th of each month.
*If the contribution year is not notated above, Aspire will use the year in which the contribution was received.
Account Holder acknowledges and agrees that, if the Depository for the account from which the ACH will be debited requires more than 1
signature for this authorization and any subsequent revocation, the Account Holder will provide those names and signatures to Aspire in
addition to this IRA Contribution Transmittal Form. For ACH this authorization is to remain in full force and effect until Aspire has received
written notication from Account Holder of its termination in time and such manner as to afford Aspire and DEPOSITORY a reasonable
opportunity to act on it.
____________________________________________________________________________________
Account Holder Name
Social Security Number
New Updated Cancel
STEP 2
SUBMISSION INSTRUCTIONS
Name
Pay to the order of
$
0001
1123456789112233582492 0001
Routing Number
DO NOT INCL
Account Number
11234567891 12233582492 0001
Name
Pay to the order of
$
Routing Number Account Number
ACH: Attach voided check for Account from which the
ACH will be debited. (MAY BE FAXED)
STEP 3
AUTHORIZATION & SIGNATURE (ACH ONLY)
4
Date (month | day | year)
Account Holder Signature
Amount Of Monthly Contribution
