Account Maintenance Form

Account Maintenance Form

Client Name: Account Number:

Representative Name: Representative Phone #:

Account Address Change - (Rep must be licensed in State whether its clients Mailing or Legal address)

Mailing Address:

Phone Changes: Home:

Legal Address:

Work Cell

Dividend Cash / Reinvestment – Mutual Funds

Pay ALL Dividends & Capital Gains in cash. Pay ALL Dividends in cash, Reinvest Capital Gains.

Reinvest All Dividends & Pay Capital Gains in cash. Reinvest ALL Dividends & Capital Gains.

Check here for Specific Mutual Fund(s) is to be Paid in cash or to be reinvested. Attach a separate sheet listing the Mutual Fund Symbol(s), Name(s) and whether it is paid to cash or reinvest.

Dividend Cash / Reinvestment – Stocks - (Equity Dividend Reinvestment Form Required for ANY Stock Reinvesting)

Pay ALL Dividends in Cash

Dividends & Capital Gains must be coded same way

Reinvest ALL Stock Dividends

Dividends & Capital Gains must be coded same way

Check here for a Specific Stock(s) is to be paid in cash or to be reinvested. Attach a separate sheet listing the Stock Symbol(s), Name(s) of security and whether it is paid to cash or reinvest.

Account Payout Options

Pay Weekly – Paid on Friday

Pay Monthly – Paid last Friday of the month

Pay Semi-Monthly – Paid Second & Last Friday of the month

Pay Quarterly – Paid in March, June, September & December

Hold Cash in Account

Check / Debit Card Re-Order

Please send ___________ Book(s)

Please Re-Order Debit Card (must be damaged, lost or stolen)

Send by Fed Ex account number: ___________________________________________

Deliver to Alternate Address (Requires Client Signature)

Add Interested Party - Requires Client Signature

Please add following as Interested Party:

Name:

Address:

Close the NFS Account

Please close the account number indicated above. Account must have a zero balance and hold no positions.

Change of Investment Objectives - Requires Client Signature & Selections to be numbered, beginning with #1

_____Preservation of Capital

_____Income

_____Capital Appreciation

_____Speculation

_____Trading Profits

_____Other (Specify:_____________)

Risk Tolerance

Aggressive

Conservative

Moderate

Moderately Conservative

Moderately Aggressive

Combination:_________________

Investment Time Horizon

Near Term

Very Short

Short

Intermediate

Long

Combination:_________________

Authorized Signatures

Client Signature:

Rep Signature:

Principal Approval:

Date:

Date:

Date:

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