©2014 Charles Schwab & Co., Inc.
All rights reserved. Member SIPC.
CS22082-19 (0413-2666) APP13297ADA-09 (12/14)
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APP13297ADA-09
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Schwab Account Number Home Telephone Number
( )
Business Telephone Number
( )
Other Telephone Number Where You Can Be Reached Immediately
( )
Name(s) on Your Schwab Account (as they appear on your statement)
Schwab Account Number In the Name of
One-Time Transfer
All Assets (cash balance and security positions) Please close this account.
Cash Amount: $
• Funds must be cleared on transfer date.
• Please call 1-800-435-4000 if you need to sell securities to cover this amount.
Security Position(s): shares of
shares of
shares of
Recurring Authorization to Transfer
(This service available for CASH only and may be terminated at any time by calling 1-800-435-4000.)
Cash Amount: $
• Funds must be cleared on transfer date.
• Please call 1-800-435-4000 if you need to sell securities to cover this amount.
Monthly Beginning Semi-monthly on 1st Transfer Day and 2nd Transfer Day
Quarterly Beginning Semi-annually on 1st Transfer Day and 2nd Transfer Day
Annually Beginning Last Business Day of Each Month Beginning
Other: Every Calendar Days (3-364) Beginning
Other Transfers Between Accounts
Check this box to provide recurring authorization to transfer funds between accounts according to parameters other than those set forth above.
Please describe the parameters clearly in the space below. Schwab may need to obtain your verbal authorization before initiating EACH transfer.
Letter of Authorization (LOA)
For Movement of Funds in Schwab Accounts
• Remember to sign the completed application on page 2 of this form.
• NOTE: Distribution forms may be required for retirement accounts. Call 1-800-435-4000 to
request the correct form.
1. This Is My Written Authorization to Transfer Assets As Described in Section 2 or 3.
2. Select One-Time Transfer or Recurring Authorization to Transfer. Shares will be transferred based on the current cost basis method
on the account.
Schwab may need to contact you to verify your request to transfer assets to a third party.
Transfer funds to:
Select only one of the following options:
www.schwab.com
1-800-435-4000 (inside the U.S.)
+1-602-355-7300 (outside the U.S.)
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©2014 Charles Schwab & Co., Inc.
All rights reserved. Member SIPC.
CS22082-19 (0413-2666) APP13297ADA-09 (12/14)
Page 2 of 2
3. Third-Party Check Disbursement
NOTE: Verication required prior to processing.
Issue Check for: $ Made Payable to:
To Be Picked Up by:
Select one of the following options:
Pick up at a local branch:
Mail to the following address (if different from address displayed on your statement):
Home Street Address City State Zip Code
4. Read and Sign Below
I understand that, in most cases, Schwab will make the transfers on the days and for the amounts that I specify. A scheduled transfer that falls on a
weekend or Schwab holiday is made the next business day. If I do not have sufcient available funds in my account to cover a transfer, Schwab may not
complete the transfer.
I further acknowledge that I may cancel this service at any time by calling Schwab at 1-800-435-4000 or writing to Schwab at the address noted on
my statement.
If this is a Custodial account, I acknowledge and agree that any funds or securities transferred out of the account, and into the account of the custodian
or other account, shall be used or applied solely for the benet of the minor.
Area Below for Schwab Use Only
Signature(s) and Date(s) Required
X
Account Holder Signature
Print Name Date
X
Additional Account Holder Signature
Print Name Date
Schwab Verication Stamp
00126678
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