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Electronic Payment
Electronic funds transfer (EFT) to a bank or credit union account using EFT instructions already in place on the
account. This form cannot be used to set up EFT. To add EFT to an account, go to Fidelity.com/eft or
complete the Electronic Funds Transfer (EFT) Authorization form.
A. EFT to your bank account. The name(s) on the bank account and the Fidelity account is (are) the same.
B. EFT to someone else. (Available for brokerage accounts only.) The names on the bank account and the
Fidelity account are different.
If EFT has not been established prior to the receipt of this request, a check will be mailed to the address
of record.
Bank Account Number
Bank Wire
Bank wire to a bank or credit union account in your name or someone else’s. The bank may charge a fee for
wire transfers.
Wire Recipient
Bank Routing /ABA Number Bank Name
Account Number Account Owner Name(s) Required
Address of Wire Recipient
City State/Province ZIP/Postal Code Country
For Further Credit/Additional Details (if applicable) Instructions to be included with the wire transfer.
Correspondent (Intermediary)
Correspondent Bank Routing/ABA Number Correspondent Bank Name
Account is OUTSIDE the United States:
SWIFT Code Name of Country
6. Signature and Date Participant / Authorized Individual must sign and date.
By signing below, you:
• Authorize and request Fidelity to withdraw
the amount indicated on this form.
• Understand that if this 529 plan account
was established as an UGMA / UTMA 529
account, the account assets belong to the
minor / beneficiary and may only be used
for the benefit of the minor / beneficiary.
• Accept that Fidelity is not responsible for
changes in the value of assets that may
occur during the distribution process.
• Certify that all information provided in this
form is true, accurate, and complete.
• Indemnify the plan and Fidelity, its agents,
successors, affiliates, and employees from
any liability in the event that you fail to
meet the IRS requirements.
• Indemnify the plan and Fidelity, its agents,
successors, affiliates, and employees from
any liability related to this withdrawal.
Customers requesting EFT:
• Authorize and request Fidelity to make
EFT withdrawals from the account listed in
this form by initiating debit entries to the
account indicated on this form.
• Authorize and request the bank named in
Section 5 of this form, or the bank specified
in your existing instructions, to accept debit
entries initiated by Fidelity in such account
and to debit the same account without
responsibility for the appropriateness or for
the existence of any further authorization.
• Acknowledge that you have read and
agree to the Important Information about
Electronic Funds Transfer (“EFT”) docu-
ment, if you have elected to use EFT.
• Acknowledge that you have read, under-
stand, and agree to the terms and
conditions set forth in the separate Fact
Kit as is currently and as may be amended
from time to time.
Provide bank informa-
tion ONLY if there are
multiple EFT instruc-
tions on the account
identified in Section 3.
All bank wire
requests MUST
have a Medallion
signature guarantee.
A notary seal/stamp is
NOT a Medallion
signature guarantee.
FULL address is
required for
international wires.
If the bank uses a
correspondent bank,
provide the information here.
Correspondent bank
information may not be
required for all wires.
Indicate if the recipient
bank is outside the
United States.
5. Distribution Method, continued
Signature and Date continues on next page.
