Electronic Funds Transfer (EFT) Authorization Instructions

Enter the name of the owner(s) exactly as it appears on the 3rd party bank account.

Enter the routing or ABA number for the 3rd party bank account.

Enter the full legal name of the 3rd party bank.

Enter the checking or savings account number for the 3rd party bank account.

Enter the first name of the primary account owner.

Enter the middle name of the primary account owner.

Enter the last name of the primary account owner.

Provide the full name of the additional owner or authorized individual.

Enter the name(s) of the account owner(s) exactly as they appear on the bank account.

Enter the bank's routing number, also known as the ABA number.

Enter the full legal name of the bank.

Enter the checking or savings account number.

Check this box if the bank account you are providing is a checking account.

Check this box if the bank account you are providing is a savings account.

Check this box if the bank account is a checking account.

Check this box if the bank account is a savings account.

Enter the first Fidelity account number for which you want to establish Electronic Funds Transfer.

Enter the second Fidelity account number for which you want to establish Electronic Funds Transfer.

Enter the third Fidelity account number for which you want to establish Electronic Funds Transfer.

Enter the first Fidelity account number for establishing 3rd Party EFT.

Enter the second Fidelity account number for establishing 3rd Party EFT.

Enter the third Fidelity account number for establishing 3rd Party EFT.

Provide the reason for requesting standing instructions to send money to a financial institution located in a non-U.S. country that is different from the treaty country listed on your W-8.

Provide the printed name of the owner, authorized individual, plan administrator, or trustee for the first signature.

Provide the printed name of the owner, authorized individual, or trustee for the second signature.