11/11/22, 8:31 AM Checks/Debit Card Application

Fri Nov 11 2022 8:12:10 am ET

Checks/Debit Card Application

Would you like to receive checks? Yes No

Would you like to receive a free Visa® debit card? Yes No

Note: Foreign accounts and accounts with foreign addresses are not eligible
for checks or a Visa debit card, and IRAs are not eligible for a Visa debit card.

Account title: JORDLEY A PERAL

Account number: 255955142

Mailing address: 641 W NORTH TEMPLE ST

APT 103
SALT LAKE CITY, UT 84116-3476
UNITED STATES

Only account owners can be issued debit cards. Select the account holders who are requesting a debit card:

Account holder one ________________________________ Account holder three ________________________________

Account holder two ________________________________ Account holder four ________________________________

Return form to:

Fax: 866-468-6268

Mail: TD Ameritrade, Inc.

PO Box 2209
Omaha, NE 68103-2209

Please note: All account owners must sign this page. Any authorized agents with full trading authority must also sign.

Signature(s) of all account owners/authorized agents:

Signature ________________________________________________

Signature ________________________________________________

Signature ________________________________________________

https://invest.ameritrade.com/cgi-bin/apps/u/CheckingApplicationPrint 1/1