Mail Suppression Request Form Trade Confirmations and Statements

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Mail Suppression Request Form Trade Confirmations and Statements Powered By Docstoc
					                                              Mail Suppression Request Form
                                            Trade Confirmations and Statements
1.    AdvisorCHANNEL.com Site User

Your Name

Company

Address
City, State                                             Zip Code                                   AdvisorCHANNEL.com
                                                                                                   User ID*

Work Phone                                              Work fax                                   G-number                            G

2.    Authorization to turn off receipt of paper-based duplicate copies of TRADE CONFIRMATIONS
      By marking this box, I request that FIIBG discontinue the mailing of paper-based duplicate copies of
      customers’ trade confirmations to my firm. I understand:
      • the compliance considerations of signing up for this service;
      • that Electronic Confirmations will be the only method by which my firm may obtain duplicate copies of
        customers’ trade confirmations;
      • that printing and mailing will be suppressed on or before the end of the month if this form is received at
          FIIBG by the 20th of the month.
3.    Authorization to turn off receipt of paper-based duplicate copies of FIDELITY ACCOUNT STATEMENTS
      By marking this box, I request that FIIBG discontinue the mailing of paper-based duplicate copies of
      customers’ statements to my firm. I understand:
      • the compliance considerations of signing up for this service;
      • that Electronic Statements will be the only method by which my firm may obtain copies of customers’
        statements;
      • that printing and mailing will be suppressed on or before the end of the month if this form is received at
        FIIBG by the 20th of the month.
4.    Authorized agent of Company


Signature                                                                                 Print Name:


5.    Please fax this form to: Fidelity Investments Institutional Brokerage Group
                                            AdvisorCHANNEL Site Administrator
                                            FAX: 617-476-4378
For FIIBG use only:                                                                                   Date Established:

Authorized Signature:___________________________________________                                     ___________________________________________


                                   (Please keep a copy of this document for your records)



Fidelity Investments Institutional Brokerage Group. 82 Devonshire Street, Boston, MA 02109 Clearing, custody or other brokerage services may be provided by National
Financial Services Corporation or Fidelity Brokerage Services, Inc. Members NYSE,SIPC. 76846

				
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posted:8/14/2009
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