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Third-Party Release Form
(Please do not fax this form; an original is required.)
PO Box 2226  Omaha, NE 68103-2226
Account Name:
Account Number:
I hereby give my permission to deposit:
Asset Description and/or Stock Symbol
Number of Whole Shares Asset Description and/or Stock Symbol Number of Whole Shares
STOP HERE PLEASE! This document must be signed at the time of obtaining a signature guarantee.
Please note: A notary public cannot provide a signature guarantee.
For each signature, please obtain a Medallion signature guarantee from a commercial bank, savings and loan, trust company, or credit union.
✗
Signature:
Date:
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Signature Guarantee Stamp:
✗
Signature:
Date:
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Signature Guarantee Stamp:
Investment Products: Not FDIC Insured * No Bank Guarantee * May Lose Value
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The Toronto-Dominion Bank. © 2015 TD Ameritrade IP Company, Inc. All rights reserved. Used with permission.
*TDA096*
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