Deposits, Contributions, Rollovers, and Transfers Client Name/Names* Advisor Name:* Casey Short Dan Thomas David McEntire Jay Beerley Tony Rizzo Summary of Funds Coming Into the Clients Account*Is this a Deposit, Contribution, Transfer, or Rollover? Deposit to a Non-Qualified Account Contribution to a Qualified Account Transfer to an Account Rollover to an Account What Company/Custodian is this Going To? TDA With PA TDA With Gradient An Annuity Company – Please Note in Summary Please enter the last four digits of the account number. Is Paperwork Required (Check all that apply)* No Paperwork is Required New Move Money Form Rollover Form Transfer Form Gradient’s Portfolio Change Request Form FS Investment Form Instructions for Required Paperwork – If ApplicableIs there a Move Money on file that needs to be used? Yes, On File Not Sure No, please send them the form. Is there an internal transfer? Yes, Internal Transfer No If funds are transferring in from their bank, or another institution, do not use this form. Continue to the next field. Account Funding Partial Full Will a FedEx Label be Required (>$10,000) Yes, Please Send a Label with Instruction Email No Add Special Notes about FedEx Delivery Here:Investment Instructions*
