HTML Preview Fund Transfer Authorization Letter page number 1.
Account # ______________ Branch # ________ IC# ______
LETTER OF AUTHORIZATION TO TRANSFER
FUNDS OR SECURITIES BETWEEN ACCOUNTS
Date: __________________
I. I herby authorize the transfer of funds and/or securities
From
Account number: ________________________________
Account name: ________________________________
To
Account number: ________________________________
Account name: ________________________________
Bank Routing Information, if applicable
Bank name: ________________________________
Bank address: ________________________________
Routing number: ________________________________
II. Amount of funds to be transferred: ________________________________
OR
Quantity and Description of Securities to be Transferred:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
III. Reason for the above Transfer / Special Instructions:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Signed: ______________________ Signed: ______________________
Print Name: ______________________ Print Name: ______________________
Title: ______________________ Title: ______________________
Medallion Guarantee Stamp (Optional): Medallion Guarantee Stamp (Optional):
If more than two signatures are required, please complete additional forms as necessary.
This LOA must be received by FSI’s Margin Department no later than 2:30pm to be processed the same day.
Date Requested:
Rep#:
Branch#:
Approved By:
Principal of the firm