Money-Trade Request

Date*

Enter the date of this request.

Time*

:

Enter time request was taken (Note: Any trade that results from this request is discretionary as to the time it is executed as per our discretionary management agreement)

Person making the request?*

Client
Advisor
Manager
Custodian

Account Name(s) or List Name(s)*

Account Number(s) - if multiple accounts involved attach list*

Action*

One-Time Distribution Request
Systematic Distribution
Money Received
Cease Management
Close or Liquidate Account
Change of Allocation
Specific Trade Request
Update Model(s) to New Targets

Dollar Amount of Request

Source of funds*

By additional deposit into account at custodian
New account established or initial transfer in
Additional funds transferred from another custodian

Send funds by:*

Check
ACH
Wire

Does action require trades to be made?*

Money/Trade Request