Questions? Go to Fidelity.com/eft or call 800-343-3548.
Electronic Funds Transfer (EFT) Authorization
Use this form to establish standing Electronic Funds Transfer (EFT) instructions on your Fidelity account, including eligible retirement
and nonretirement accounts. Do NOT use this form to request a specific transaction. Type on screen or fill in using CAPITAL letters and
black ink. If you need more room for information or signatures, make a copy of the relevant page.
Helpful to Know
• EFT can be used to make routine transfers to or from
your bank, and 3rd Party EFT can be used to make
routine transfers to someone else’s bank. Note: 3rd Party
EFT may not be used to make transfers for commercial
purposes.
• EFT and 3rd Party EFT may not be available during the
first four to five days after the feature is established on
your account.
• Any transaction in your Fidelity IRA initiated with the
instructions you create will result in a distribution from your
Fidelity IRA and will be reported to the IRS. Note that:
– Such distribution will generally result in taxable
income to you for the year distributed to you, unless
it is rolled over to another IRA or qualified employer
plan within 60 days. It is your responsibility to ensure
that the subsequent account is qualified to accept
rollover amounts.
• EFT and 3rd Party EFT are not available for:
– Workplace Self-Directed Brokerage
– Money Purchase and Profit Sharing Plans
– Investment-Only Retirement Accounts
• 3rd Party EFT is also not available for:
– Self-Employed 401(k)
– Mutual Fund Only Accounts
– Health Savings Accounts (HSAs)
– Business Accounts
• Trust accounts are eligible for EFT:
– If your bank account is the same trust, the supporting
document should list both the full name of the trust
and a name of a trustee.
– If your bank account is personally owned, the supporting
document should list your full name.
• For SIMPLE IRAs, ONLY 3rd Party EFT is available.
• For Self-Employed 401(k)s, ONLY transfers FROM the
outside bank TO Fidelity are available. You will not be
able to transfer from Fidelity to the outside account.
The Plan Administrator must sign in Section 5.
• Transaction limits may apply.
• There is no fee to use the EFT service, although your
financial institution may charge transaction fees.
• See “Important Information about Electronic Funds
Transfer (EFT)” included with this form.
1. Account Owner(s)
First Name
Middle Name
Last Name
Additional Owner/Authorized Individual Name
2. EFT Authorization for Your Bank Account
To establish EFT that allows for the transfer of money both to and from your Fidelity account(s), you must be an owner
of the account at the other financial institution and the registration types must match (ex: individual account to individual
account). You will need to attach a voided check, deposit slip, or bank statement with the account number and all owner
names preprinted on it. Your name on your supporting bank documents must match your name on your Fidelity accounts.
Provide your Fidelity account number(s) for establishing EFT:
Fidelity Account Number
Fidelity Account Number
Fidelity Account Number
Provide bank account information below to set up the EFT feature.
Bank Account
Checking
Savings
Be sure each
account listed is
eligible for EFT.
1.932149.113
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026911201
EFT Authorization for Your Bank Account continues on next page.
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026911202
Owner(s) Name(s) Exactly as on Bank Account
Bank Routing /ABA Number
Bank Name
Checking or Savings Account Number
3. 3rd Party EFT Authorization
For brokerage accounts only.
Complete this section if you are not an owner on the account at the other financial institution. This option ONLY allows you to
move money FROM Fidelity to the outside account.
Provide your Fidelity account number(s) below for establishing 3rd Party EFT:
Fidelity Account Number
Fidelity Account Number
Fidelity Account Number
Provide bank account information below to set up the 3rd Party EFT feature.
Bank Account
Checking
Savings
Owner(s) Name(s) Exactly as on Bank Account
Bank Routing /ABA Number
Bank Name
Checking or Savings Account Number
Complete this section
and attach an account
statement, voided
check, or deposit slip.
Be sure each
account listed is
eligible for 3rd
Party EFT.
Check ONLY one.
To establish this feature,
you MUST obtain a
Medallion signature
guarantee in Section 5.
2. EFT Authorization for Your Bank Account, continued
Attach here:
ABA Transit Routing Number Account Number
Account number
and all owner
names must be
preprinted and
unaltered.
REQUIRED
Tape your voided check or preprinted deposit slip here.
Form continues on next page.
4. W-8-Certified Customers (Non-U.S. Citizens)
Explanation for standing instructions
requested for a country different from the country of tax residence.
If you are requesting standing instructions to send money to a financial institution located in a non-U.S. country that is different from the
treaty country listed on your W-8, provide the reason below.
Reason
250 characters maximum
5. Signature and Date
Form cannot be processed without signature(s) and date(s).
In the section below, “Fidelity,” “us,” and “we” refer to Fidelity Brokerage Services LLC and National Financial Services LLC and their affili-
ates, and their employees, agents, representatives, shareholders, successors, and assigns as the context may require; “you” and “account
owner” refer to the owner indicated on the account form; and for any account with more than one owner (such as a joint or trust account),
“you” and “account owner” or “account owners” refer to all owners, collectively and individually.
By signing below, you:
• Authorize Fidelity to act on all instructions
given in this form.
• Accept all terms and conditions described
in this form.
• Certify that all information provided in this
form is true, accurate, and complete.
• Agree, if you are a trustee, a custodian,
or the fiduciary of an employer-sponsored
retirement plan, that you are responsible
for complying with your legal and fiduciary
obligations.
• Authorize us, upon receiving instructions
from you or as otherwise authorized by
you, to make payments from you and to
you or your designee, by credit or debit
entries to the designated account at the
financial institution indicated in the form
(“Bank”). You authorize the Bank to pro-
cess such entries and to credit or debit
the designated account at that Bank for
such entries. You ratify such instructions
and agree that neither we nor any mutual
fund will be liable for any loss, liability,
cost, or expense for acting upon all such
instructions believed to be genuine if we
employ reasonable procedures to prevent
unauthorized transactions. You agree that
this authorization may only be revoked
by written notice to us in such time and
manner as to afford us and the Bank a
reasonable opportunity to act upon it.
• Warrant and represent that (i) the third
party’s account identified in Section 3 is
owned by a natural person, (ii) that person
has authorized his/her account to be cred-
ited in accordance with your instructions,
and (iii) the account has been established
for personal, family, or household use, and
not for commercial purposes.
• Acknowledge that Fidelity will not be
liable for any loss, expense, or cost arising
out of your instructions, provided that it
institutes reasonable procedures to pre-
vent unauthorized transactions.
• Acknowledge that you have read and
agree to the Important Information about
Electronic Funds Transfer (EFT) document.
• Understand that Fidelity may purge
unused EFT instructions from your
account(s) on a periodic basis without
notice to you.
• Understand that Fidelity may terminate
the EFT instructions from your account(s)
at any time in its sole discretion.
• If the account is owned by a business or
entity, certify that you are authorized to
enter into these transactions on behalf of
the organization.
Required to be
completed if
applicable.
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026911203
Form continues on next page.
On this form, “Fidelity” means Fidelity Brokerage Services LLC and its affiliates. Brokerage services are
provided by Fidelity Brokerage Services LLC, Member NYSE, SIPC. 592521.14.0 (10/23)
Did you sign the form and attach a check or any necessary documents?
Send the ENTIRE form and any attachments to Fidelity Investments. You will
receive a “Revised Account Profile” confirming your updates.
Questions? Go to
Fidelity.com/eft or call 800-343-3548.
Regular mail
Fidelity Investments
PO Box 770001
Cincinnati, OH 45277-0002
Overnight mail
Fidelity Investments
100 Crosby Parkway KC1K
Covington, KY 41015
1.932149.113
Page 4 of 4
026911204
One authorized signature is required unless you have a Mutual Fund Account (the account number begins with a 2 followed by two
letters) in which case all owners must sign.
A Medallion signature guarantee is required to establish 3rd Party EFT instructions for a bank account that is not in your name.
If the form is completed at a Fidelity Investor Center with all signers present, the Medallion signature guarantee is not required. You can get
a Medallion signature guarantee from most banks, credit unions, and other financial institutions. A notary seal/stamp is NOT a Medallion
signature guarantee.
PRINT OWNER/AUTHORIZED INDIVIDUAL/PLAN ADMINISTRATOR NAME
MEDALLION SIGNATURE GUARANTEE
OWNER/AUTHORIZED INDIVIDUAL/PLAN ADMINISTRATOR SIGNATURE
SIGN X
DATE
MM/DD/YYYY
DA
TE X
PRINT OWNER/AUTHORIZED INDIVIDUAL NAME
MEDALLION SIGNATURE GUARANTEE
OWNER/AUTHORIZED INDIVIDUAL SIGNATURE
SIGN X
DATE
MM/DD/YYYY
DA
TE X
5. Signature and Date, continued
Questions? Go to Fidelity.com/movemoney or call 800-343-3548.
Important Information about Electronic
Funds Transfer (EFT)
Keep this information for your records.
Privacy Statement
You understand that Fidelity will disclose information to third
parties about your account or the transfers you make:
(i) Where it is necessary for completing transfers, or
(ii) In order to verify the existence and condition of your account
for a third party, such as a credit bureau or merchant, or
(iii) In order to comply with a government agency or court order, or
(iv) If you give Fidelity your written permission, or
(v) For other purposes in accordance with Fidelity’s privacy statement
Fees
There is no fee to use the EFT service, although your financial
institution may charge transaction fees.
Limitations for EFTs
There may be a four-day period after Fidelity processes your request
to establish EFT, during which the service will be unavailable to
transfer funds to or from your bank account. The minimum amount
for EFTs initiated on
Fidelity.com is $1 for nonretirement brokerage
accounts and $10 for retirement brokerage accounts (or with respect
to a Fidelity mutual fund account, the fund minimum). In most cases,
EFTs initiated on
Fidelity.com are subject to a maximum cumulative
daily amount of $100,000 for transfers out of your Fidelity account,
and $250,000 for deposits into your Fidelity account. Transfers
out of your Fidelity account initiated on
Fidelity.com are typically
limited to three per day.
Brokerage Account Minimum Balances
There is no minimum account balance to process an EFT transaction;
however, your core account must have adequate funds to cover
a redemption.
Mutual Fund Account Minimum Balances
There is no minimum account balance to process an EFT transac-
tion; however, you must have an adequate balance in your mutual
fund position to cover a redemption.
Business Days
For purposes of EFTs, Fidelity’s business days are Monday through
Friday. Bank and New York Stock Exchange holidays are not included.
Documentation Periodic Statement
You will receive a monthly account statement from Fidelity, unless
there are no transactions in a particular month. In any case, you will
receive a statement quarterly.
Direct Deposits
If you have arranged to have direct deposits made to your Fidelity
Account or Fidelity Mutual Fund Account, at least once every sixty
(60) days from the same person or company, you can call Fidelity
at 800-343-3548 to find out whether or not the deposit has
been made.
Special Disclosure for Covered Transfers
In general, your use of the EFT service for transfer of funds
electronically other than those for which the primary purpose is
the purchase or sale of securities (“Covered Transfers”) is covered
under the Electronic Funds Transfer Act and the Bureau of Consumer
Financial Protection’s Regulation E and related laws and regulations.
The following terms and disclosures apply to Covered Transfers:
Unauthorized Transfers
You will tell Fidelity promptly if you believe your password has been
lost or stolen or may have been used without your permission.
Telephoning Fidelity at the number listed below is the best way of
keeping your possible losses down. If you believe your password has
been lost or stolen, and you tell Fidelity within two (2) business days
after you learn of the loss or theft, you can lose not more than $50
for Covered Transfers if someone used your password without your
permission. If you do NOT tell Fidelity within two (2) business days
after you learn of the loss or theft of your password, and Fidelity can
prove Fidelity could have prevented any unauthorized use if you had
told Fidelity, you could lose as much as $500. Also, if your statement
shows Covered Transfers that you did not make, you will tell Fidelity
promptly. If you do not tell Fidelity within sixty (60) days after the first
statement was mailed to you, you may not get back any money you
lost after sixty (60) days if Fidelity can prove that Fidelity could have
stopped someone from taking the money if you had told Fidelity in
time. In extenuating circumstances, Fidelity may extend such time
periods. Additional protection may be available from Fidelity for
specific accounts under certain circumstances.
Stop Payment Procedures
If you have told Fidelity in advance to make regular Covered
Transfers out of your Fidelity account, you can stop any of these
payments. Here’s how: you can call or write to Fidelity using the
contact information listed below. Your notice must be made in
time for Fidelity to receive your request at least three (3) business
days or more before the payment is scheduled to be made. If you
call, Fidelity may, as an additional measure, require you to put
your request in writing and get it to Fidelity within fourteen (14)
days after you call. Unless otherwise provided, you may not stop
payment of electronic funds transfers; therefore, you should not
employ electronic access for purchases or services unless you are
satisfied that you will not need to stop payment.
1.964554.105
Page 1 of 2
Fidelity’s Liability for Failure to Make
Covered Transfers
If Fidelity does not complete a Covered Transfer to or from your
Fidelity account on time or in the correct amount according to Fidelity’s
agreement with you, Fidelity may be liable for your losses or damages.
However, there are some exceptions. Fidelity will not be liable
for instance:
• If, through no fault of Fidelity’s, you do not have enough money in
your Fidelity account to make the Covered Transfer.
• If the money in your Fidelity account is subject to legal process or
other claim restricting such transfer.
• If the transfer would exceed your margin availability, if any.
• If the bank account information you provided to Fidelity when
you established the EFT service was incorrect or has subsequently
become incorrect.
• If circumstances beyond Fidelity’s control (such as fire or flood) pre-
vent the transaction, despite reasonable precautions taken by Fidelity.
• If there was a technical malfunction which was known to you at
the time you attempted to initiate a Covered Transfer or, in the
case of a preauthorized Covered Transfer, at the time the transfer
should have occurred.
• There may be other exceptions stated in our agreement with you.
Error Resolution
In the case of errors or questions about your Covered Transfers, you
will call or write Fidelity using the contact information listed below,
promptly. You will call or write Fidelity if you think your statement
is wrong or if you need more information about a Covered Transfer
on the statement. Fidelity must hear from you no later than sixty
(60) days after Fidelity sent the FIRST statement on which the
problem or error appeared. You will:
• Tell Fidelity your name and account number.
• Describe the error or the Covered Transfer that you are unsure
about, and explain as clearly as you can why you believe it is an
error or why you need more information.
• Tell Fidelity the dollar amount of the suspected error.
If you notify Fidelity orally, Fidelity may require that you send your
complaint or question in writing within ten (10) business days. Fidelity
will tell you the results of its investigation within ten (10) business
days after Fidelity hears from you and will correct any error promptly.
If Fidelity needs more time, however, it may take up to forty-five (45)
days to investigate your complaint or question. If Fidelity decides
to do this, it will credit your account within ten (10) business days
for the amount that you think is in error, so that you will have the
use of the money during the time it takes Fidelity to complete its
investigation. If Fidelity asks you to put your request or question in
writing and it does not receive it within ten (10) business days, or if
your account is a brokerage account subject to Regulation T of the
Board of Governors of the Federal Reserve System (Credit By Brokers
and Dealers, 12 CFR 220), Fidelity may not credit your account. For
questions involving new accounts, point of sale or foreign initiated
transactions, we may take up to ninety (90) days to investigate
your complaint or question. With respect to new accounts, we may
take up to twenty (20) business days to credit your account for the
amount you think is in error. Fidelity will inform you of the results
of its investigation within three (3) business days of its completion.
If Fidelity decides that there was no error, Fidelity will send you a
written explanation. You may ask for copies of the documents that
Fidelity used in the investigation.
Contact Information
Fidelity Investments
PO Box 770001
Cincinnati, OH 45277
Phone: 800-343-3548
Representatives are available 24 hours per day, seven days per week,
to take your call.
Important Information, continued
1.964554.105
Page 2 of 2
On this form, “Fidelity” means Fidelity Brokerage Services LLC and its affiliates. Brokerage services are
provided by Fidelity Brokerage Services LLC, Member NYSE, SIPC. 652049.6.0 (04/23)
