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Representative Authorization Form

You must complete this authorization form to allow your Representative to gain access to your account information.

This form does NOT authorize your Representative to execute any transactions on your behalf, nor does it authorize them to give us verbal confirmations regarding investments, distributions and expense payments on your behalf.

To remove and/or replace a Representative on your account, please complete Section 3 of this form.

To change your “Primary Contact” designation, complete Section 4 of this form.

You can submit the form by using one of the following methods.

DocuSign

This is the preferred way to complete the form.  You can fill out the form online and sign it electronically by DocuSign.

DocuSign is a fast and secure way to process your form. It allows you to digitally sign forms without having to go through the hassle of downloading software or mailing the originals.

You will receive an email with a copy of the form after signing is completed.  There is no need to mail in the form.

Click here to DocuSign Form

 

PDF Download

If you do not submit the form by DocuSign, you can fill out the form manually by downloading the PDF.

This is an interactive form contains fields that you can select or fill in. Please note that some browsers may not fully support all of the Adobe PDF capabilities. You may need to configure your browser to use the Adobe PDF plug-in.

After you complete the PDF form, you need to deliver the form to us by either email, fax, regular mail or overnight mail.

Email: NewAccounts@IRAServices.com
Fax: (650) 745-2902
Regular Mail: IRA Services
P.O. Box 7080, San Carlos, CA 94070-7080
Overnight Mail: IRA Services
1160 Industrial Road, Unit 1,
San Carlos, CA 94070-4128
Click here to Download Form