Grantor Information Name Street Address City County State Zip Code Telephone Email Occupation Spouse's Name Spouse's Occupation Co-Grantor Information (if applicable) Name Street Address City County State Zip Code Telephone Email Occupation Spouse's Name Spouse's Occupation Capital Contribution & Payment Capital Contribution ($) Investment Payment Method Wire Transfer ACH Check Interest on Trust Records Indicate how your interest should be shown on the trust records (choose one). Individual Joint Tenancy Tenants in Common Company * Trustee ** IRA Corporation *** Other (Describe) Describe * If a limited liability company, please include a copy of the Articles of Organization, Operating Agreement and a certificate of action of the manager(s) or other document authorizing the investment. ** If a custodian, trustee or agent, please include a copy of the trust, agency or other agreement and an entity certificate authorizing the investment. *** If a corporation, please include a copy of the Articles of Incorporation and a certified corporate resolution or other document authorizing the investment. Beneficiary Information (for Inheritance Purposes) While a designation of your beneficiary is not required for investment, you may provide the information below. If you live in a state with community property statutes and do not designate your spouse as the sole primary beneficiary, you represent and warrant that your spouse has consented to such a designation. Primary Beneficiary Contingent Beneficiary Beneficiary Name Address City State Zip Submit
