Fillable Letter of Authorization (LOA)

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Letter of Authorization (LOA)

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588287 (Rev 16 – 11/21) Page 1 of 3
Office Use Only:
Sub Firm # Account Number
Letter of Authorization (LOA)
Section 1 Tell Us About Your Wells Fargo Advisors Brokerage Account
Complete all
fields, including
your 8-digit
account
number.
Wells Fargo 8-Digit Brokerage Account Number
Account Type (e.g., Individual, Joint, Trust, etc.)
Account Name(s) (e.g., John Doe, John and Mary Doe, the Doe Family Trust, etc.)
Purpose for Transfer – required for UTMA/UGMA:
Section 2 Tell Us About Your Transfer Request
One-Time Disbursement (Any future requests will require a new form)
If no selection is made, one-time disbursement is the default.
Standing Instructions (Requests for transfers at your discretion with amount not to exceed your
specified threshold. You must initiate each request.)
Not to exceed amount: $
Recurring* (only available for cash)
*Automated transfer of a specific dollar amount or type
Amount $:
AND/OR Types(s) (dividends, interest, etc.):
Start Date: Frequency (monthly, quarterly, etc.):
Expiration Date or transfers will continue until you revoke:
Investment and Insurance Products are:
• Not Insured by the FDIC or Any Federal Government Agency
• Not a Deposit or Other Obligation of, or Guaranteed by, the Bank or Any Bank Affiliate
• Subject to Investment Risks, Including Possible Loss of the Principal Amount Invested
SR #
Wells Fargo Advisors is a trade name used by Wells Fargo Clearing Services, LLC, a registered
broker-dealer and non-bank affiliate of Wells Fargo & Company.
Use the Letter of Authorization (LOA) form to transfer cash and/or investments between Wells Fargo brokerage accounts, or to
make a partial outgoing transfer to an outside brokerage account.
Clear Form
Print Form
205
588287 (Rev 16 – 11/21) Page 2 of 3
Office Use Only:
Sub Firm # Account Number
Section 3 Tell Us How You Want To Move Assets
Time of
completion
varies based on
account activity
and method of
distribution.
Move via Journal to another Wells Fargo Advisors Account
8-Digit Account Number
Account Title
Send shares to another Financial Firm
Receiving Account Number
Receiving Account Name
Receiving Firm Name Delivery Instructions
Firm or DTC Number
Checks cannot
be mailed
directly to the
IRS or other
taxing
authorities.
Check cannot
be overnighted
to a P.O. Box.
Check
Payee Information – Make Check Payable To:
Payee Name:
Delivery Instructions – Mail to Address:
Street Address
City
State
Zip Code Country (if outside of US)
Optional Memo Note:
Delivery Method
Regular Mail (default)
Overnight Delivery (Fee will apply, overnight is not an option for recurring instructions)
Section 4 Tell Us What You Want To Transfer
You may elect
to distribute
cash only,
securities only,
or both cash
and securities.
All Cash and Securities – does not include residuals
All Cash and Securities – including 90 day cash residual transfer
Cash $:
or write in ALL
All Securities
Only the securities listed below
Need more space? Attach separate pages including Tax Lot Selections if applicable; any attachments must
also be signed.
Number of Shares/
Contracts (or for standing
instructions, list not to
exceed quantity)
Security Description Symbol or CUSIP
For standing instructions,
provide maximum market
value based on prior
business day's closing value
205
588287 (Rev 16 – 11/21) Page 3 of 3
Investment and Insurance Products are:
• Not Insured by the FDIC or Any Federal Government Agency
• Not a Deposit or Other Obligation of, or Guaranteed by, the Bank or Any Bank Affiliate
• Subject to Investment Risks, Including Possible Loss of the Principal Amount Invested
Wells Fargo Advisors is a trade name used by Wells Fargo Clearing Services, LLC, a registered broker-dealer and non-bank
affiliate of Wells Fargo & Company.
Office Use Only:
Sub Firm # Account Number
Section 5 Provide Signature(s) and Date
The undersigned acknowledges that I/we have read this form in its entirety and understand and agree to be bound by this Letter
of Authorization and the Terms and Conditions located on page 3.
Account Owner/Trustee Signature
X
Print Name
Date
Account Owner/Trustee Signature
X
Print Name
Date
Section 6 Next Steps - For Non-Electronic Signatures
Fax
844-879-1439
Questions: 1-800-TRADERS (872-3377)
Mail
Wells Fargo Advisors – Attention: MAC N9160-01P
PO Box 77046,
Minneapolis, MN 55480-9902
Terms and Conditions
WELLS FARGO CLEARING SERVICES, LLC, ("WFA"), and Wells Fargo Bank, N.A., are separate affiliates of Wells Fargo &
Company. As separate legal entities, none are responsible for the obligations of the others. Stocks, bonds, mutual funds, and
other securities bought and sold through WFA are not bank deposits of any bank and are not insured or otherwise protected by
the Federal Deposit Insurance Corporation or any other government agency; are not an obligation of any bank or any affiliate of
WFA; are not endorsed or guaranteed by Wells Fargo & Company, WFA, or any bank or any affiliate of WFA; and involve
investment risk including possible loss of principal. Accounts are carried by Wells Fargo Clearing Services, LLC, member
NYSE/SIPC.
In consideration of WFA accepting the instructions on this document, I release and discharge WFA and its affiliates from any
liability or claims in connection with these instructions and agree to indemnify and hold WFA harmless against any losses from
any action, claim, or demand of any person based upon WFA acting under these instructions.
For transfers to third party accounts in which you have no ownership interest, you agree that by signing this document that you
are irrevocably relinquishing all rights, title, and interest to the asset(s) listed on this document.
I acknowledge that I have read and understand the terms of this request to transfer assets and further acknowledge that the
terms of this request are binding regardless of any other agreement(s) between me and the recipient(s) of these assets.
OFFICE USE ONLY:
The undersigned certifies that the account holder(s) authorized the terms of the transfer of funds and/or securities as described
in this form.
Associate’s Signature
X
Associate’s Name
Date
205
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Letter of Authorization (LOA)

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Completed 7 March 2022

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