Printable forms: Broker authorization form

Use the following instructions to accurately complete the DRS form:

1. Only check this space, if now, or in the near future you want to move your book entry shares electronically to your Broker/Dealer. If you check this space, items 5-7 must also be completed. 
    
2. Check this space to change the Broker/Dealer information on your account records at Computershare. If you check this space, items 5-7 must also be completed. 
    
3. If you check this space, Computershare will electronically transfer a specified number of your whole book entry shares to your current Broker/Dealer, as indicated on our records. If we do not currently maintain this information on our records you are required to provide it by completing items 5-7.
    
4. Provide the number of whole book entry shares you wish to electronically transfer to your Broker/Dealer. 
    
5. The full name of your Broker/Dealer.
    
6. A number used by your Broker/Dealer when clearing securities through their depositories. This number should be obtained from your Broker/Dealer.
    
7. The number used to identify your account on the records of your Broker/Dealer. Please use it when inquiring about your account at your Broker/Dealer.
    
8. Signature of current owner(s) exactly as it appears on the account registration. Please note that the signature(s) must be guaranteed by an Eligible Guarantor Institution such as a Commercial Bank, Trust Company, Securities Broker/Dealer, Credit Union, or Saving Association participating in a Medallion Program approved by the Securities Transfer Association, Inc. Unfortunately, no other form of signature verification can be accepted.