Fillable PROMISSORYNOTE LETTEROFAUTHORIZATION AccountInformation InvestmentInformation (United Bank)

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PROMISSORYNOTE LETTEROFAUTHORIZATION AccountInformation InvestmentInformation (United Bank)

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The PROMISSORYNOTE LETTEROFAUTHORIZATION AccountInformation InvestmentInformation (United Bank) form is 3 pages long and contains:

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48 other fields

Country of origin: US
File type: PDF

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Remove Field

ADD FIELDS

Name



(asitappearsonyouraccount)

AccountNumber AccountType

(Trad.,ROTH,SEP)

EmailAddress DaytimePhoneNumber

Borrower'sName

(IndividualorEntity)

FaceValueofNote PercentageofOwnership

Borrower'sAddress City State ZipCode

PaymentFrequency





MonthlyQuarterlySemi‐AnnuallyAnnuallyOther

Total#ofPayments DateofFirstPayment DateofLastPayment

PeriodicPaymentAmount InterestRateoftheNote

DateofBalloonPayment BalloonPaymentAmount

PaymentMethod

BankName BankPhoneNumber

BankABA/RoutingNumber AccountNumber

ForFurtherCreditTo/PaymentDetails

RegularCheck IssueCashier's

Check

($30.00OvernightFeeApplies)

UPSOvernightMail

($30.00FeeApplies)

Name

TelephoneNumber

(OvernightMailOnly)

Address City,State,ZipCode

InvestmentFundingInstructions

WireTransfer

($15.00FeeApplies)

RegularMail

MailingAddress

(IfdifferentfromPayeeAddress)

YesNo

DOESTHISNOTEHAVEABALLOONPAYMENT?

BALLOONPAYMENTINFORMATION(IFAPPLICABLE)

PROMISSORYNOTE

LETTEROFAUTHORIZATION

AccountInformation

InvestmentInformation

v11.16

LETTEROFAUTHORIZATION

RealProperty(LegalDescriptionattachedhereto,ifapplicable)

Address City State ZipCode





Vehicle/MobileHome

Year Make/Model IdentificationNumber(e.g.‐VIN#)





Other‐Describe

NameasitAppearsonCard BillingAddress

City,State,ZipCode CardNumber ExpirationDate

SecurityCode

Signature Date

CollateralInformation

PROMISSORYNOTE

PaymentofFees(IfApplicable)

UDirectIRAAccount EnclosedCheck CreditCard

(CompleteCreditCardSection)

Allfeesassociatedwiththistransactionaredueandpayableatthetimeofprocessingthisrequest.Ifnopaymentelectionismade,

feeswillbedeductedfromyourUDirectIRAAccount.Thistransactionwillnotbeprocessedifsufficientfundsarenotavailable.

CreditCardInformation(ForPaymentofFees)

CardType

(ChooseOne)MasterCardVisa

IherebyauthorizeUnitedBanktochargethecreditcardlistedaboveforthefeesassociatedwiththisLetter

ofAuthorization,and/orforanyfeesassociatedwithmyaccount.Ifmycreditcardisdeclined,UnitedBank

mayrefusetohonorthisLetterofAuthorization.Ifmycreditcardisdeclined,

UnitedBankmaychargemy

UDirectaccountforthefees.ImayremainobligatedtopayfeesevenafterIterminateUnitedBankasmy

custodianasperouragreements.IguaranteeandwarrantthatIamthelegalcardholderforthiscreditcard

andthatIamlegallyauthorized

toenterintothisbillingagreementwithUnitedBank.Iagreethat

electronicexecutionofthisauthorizationiseffectiveasmyoriginalsignature.

v11.16

LETTEROFAUTHORIZATION

AccountOwnerSignature

Signature Date

Iagreethatelectronicexecutionofthisauthorizationiseffectiveasmyoriginalsignature.Electronicexecutionmeansaffixinganimageofmy

signatureinthesignaturebox;placing/s/infrontoforbehindmyprintednameinthesignaturebox;oranyothermethodthatreflectsmynameor

signature

whichcanbeverified

Youmayexecutethisauthorizationusinganelectronicsignature.Insertanimageofyoursignatureinthesignaturebox;orplacea/s/infrontofor

behindyourprintednameinthesignaturebox;or,useanyothermethodthatreflectsyournameorsignatureand

whichcanbeverified.

IunderstandthatUnitedBankisa“fiduciary”formyaccount assuchtermisdefinedintheInternalRevenueCode,ERISA,oranyapplicablefederal,

stateorlocallaws.Iagreetorelease,indemnify,defend,andholdUnitedBankharmlessfromanyclaimsarisingoutof

thisinvestment,butnot

limitedtoclaimsthataninvestmentisnotprudent,proper,diversifiedorotherwiseincompliancewithERISA,theInternalRevenueCodeorany

otherapplicablefederal,stateorlocallaws.IalsounderstandandagreethatUnitedBankasCustodianwillnotberesponsibletotake

anyaction

shouldtherebeanydefaultwithregardtothisinvestment.

Iamdirectingyoutocompletethistransactionasspecifiedabove.Iconfirmthatthedecisiontoconductthistransactionisinaccordancewiththe

rulesofthisaccountandthatIagreetoholdharmlessandwithoutliability

UnitedBankasCustodianofmyaccount.

I,theundersignedIRAaccountholderoftheSelf‐DirectedIndividualRetirementAccountidentifiedabove,indirectingUnitedBankasCustodianof

myIRA,doherebycertifyandaffirmthatthistransactiondoesnotviolatethestandardsofprohibitedtransactionscontainedintheUnited

States

Code,theInternalRevenueCode,orcaselawand/oragencyissuedopinionsinterpretingthelawasapplicabletomyaccount.Iaffirmthatin

interpretingthesesourcesoflaw,IhavesoughttheadviceofoutsidecounselorIbelievemyknowledgeofthesesourcesoflawisadequateto

direct

theCustodiantocompletethetransaction.IagreetoprovidesufficientdocumentationtotheCustodian,ifrequested,toassisttheCustodianwith

determiningthedetailsofthetransaction.IfurtheragreethattheCustodianmayrefusetocompletethistransactioniftheCustodianbelievesthat

thetransactionviolatesprovisions

oftheUnitedStateCodeandRegulationsthereunder,oranyapplicablelocal,federalorstatelaw.UnitedBank,at

itssolediscretion,mayrefusetocompletethistransactionevenifthereisnoapparentlegalviolation.

Iunderstandthatmyaccountisself‐directedandthatUnitedBankasCustodiandoes

notreviewthemeritsand/oracceptabilityorsuitabilityofany

investment.IunderstandthatUnitedBankdoesnotdeterminewhetherthisinvestmentisacceptableundertheEmployeeRetirementIncome

SecurityAct(ERISA),theInternalRevenueCodeand/oranyotherapplicablefederal,stateorlocallaws,includingsecuritieslaws.Iunderstandthat

it

ismyresponsibilitytoreviewanyinvestmentstoensurecompliancewiththeserequirements.

PROMISSORYNOTE

v11.16

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PROMISSORYNOTE LETTEROFAUTHORIZATION AccountInformation InvestmentInformation (United Bank)

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Completed 31 January 2021

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