This form contains 40 fields organized into 10 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name	Type	Description
Account Owner
Account Owner First Name	Text	Enter the first name of the account owner.
Account Owner Middle Name	Text	Enter the middle name of the account owner.
Account Owner Last Name	Text	Enter the last name of the account owner.
Account Owner Social Security or Taxpayer ID Number	Text	Enter the Social Security Number or Taxpayer ID Number of the account owner. Max length: 9 characters
Accounts Included Selection
1st Accounts Included Selection: All Eligible Accounts	Checkbox	Check this box if you want to include all eligible accounts associated with the Social Security or Taxpayer ID Number provided above.
2nd Accounts Included Selection: Only Listed Accounts	Checkbox	Check this box if you want to include only the specific accounts that you will list in the provided fields below.
Alternate Trusted Contact Address
Alternate Trusted Contact Street Address	Text	Please enter the street address for the alternate trusted contact.
Alternate Trusted Contact City	Text	Please enter the city for the alternate trusted contact.
Alternate Trusted Contact State/Province	Text	Please enter the state or province for the alternate trusted contact. Max length: 2 characters
Alternate Trusted Contact ZIP/Postal Code	Text	Please enter the ZIP or postal code for the alternate trusted contact.
Alternate Trusted Contact Country	Text	Please enter the country for the alternate trusted contact.
Alternate Trusted Contact Details
AltEmail	Text
AltRelationship	ComboBox	Aunt/Uncle Neighbor Grandmother Brother Sister Grandfather Son Granddaughter Friend Other Mother Spouse/Partner Father Daughter Nephew/Niece Grandson
AltDaytime Phone	Text	Max length: 10 characters
AltDaytime Phone2	Text	Max length: 10 characters
Alternate Trusted Contact Name
Alternate Trusted Contact First Name	Text	Enter the first name of the alternate trusted contact.
Alternate Trusted Contact Middle Name	Text	Enter the middle name of the alternate trusted contact.
Alternate Trusted Contact Last Name	Text	Enter the last name of the alternate trusted contact.
Fidelity Account Numbers
Fidelity Account Number 1	Text	Enter the first Fidelity account number to be included. Max length: 9 characters
Fidelity Account Number 2	Text	Enter the second Fidelity account number to be included. Max length: 9 characters
Fidelity Account Number 3	Text	Enter the third Fidelity account number to be included. Max length: 9 characters
Fidelity Account Number 4	Text	Enter the fourth Fidelity account number to be included. Max length: 9 characters
Fidelity Account Number 5	Text	Enter the fifth Fidelity account number to be included. Max length: 9 characters
Fidelity Account Number 6	Text	Enter the sixth Fidelity account number to be included. Max length: 9 characters
General
Print	Button
Reset	Button
Save	Button
Owner/Authorized Individual Printed Name
Owner/Authorized Individual Printed Name	Text	Enter the printed name of the owner or authorized individual.
Primary Trusted Contact Address
Primary Trusted Contact Street Address	Text	Enter the street address for the primary trusted contact.
Primary Trusted Contact City	Text	Enter the city for the primary trusted contact's address.
Primary Trusted Contact State/Province	Text	Enter the state or province for the primary trusted contact's address. Max length: 2 characters
Primary Trusted Contact ZIP/Postal Code	Text	Enter the ZIP or postal code for the primary trusted contact's address.
Primary Trusted Contact Country	Text	Enter the country for the primary trusted contact's address.
Primary Trusted Contact Information
Primary Trusted Contact First Name	Text	Provide the first name of the primary trusted contact.
Primary Trusted Contact Middle Name	Text	Provide the middle name of the primary trusted contact.
Primary Trusted Contact Last Name	Text	Provide the last name of the primary trusted contact.
Primary Trusted Contact Email	Text	Provide the email address of the primary trusted contact.
Primary Trusted Contact Relationship to Owner	Combobox	Provide the relationship of the primary trusted contact to the account owner (e.g., Spouse, Child, Parent, Sibling, Friend, or Other). Aunt/Uncle Neighbor Grandmother Brother Sister Grandfather Son Granddaughter Friend Other Mother Spouse/Partner Father Daughter Nephew/Niece Grandson
Primary Trusted Contact Primary Phone	Text	Provide the primary phone number for the primary trusted contact. Max length: 10 characters
Primary Trusted Contact Secondary Phone	Text	Provide the secondary phone number for the primary trusted contact. Max length: 10 characters

Fidelity Trusted Contact Authorization Form Instructions