CERTIFICATION: Under penalties of perjury, I certify(1)that the number shown on this form is my correct tax payer Identification number, (2) that I am not subject to backup Withholding either because I have not been notified that I am subject to backup Withholding as a result of failure to report all interest or dividends, or the Internal Revenue Service has notified me that I am no longer subject to backup Withholding and (3) that I am a U.S. person (including a U.S. resident alien).
INSTRUCTION: If you have been notified by the IRS that you are currently subject to backup withholding because of under reporting interest or dividends on your tax return, you cannot use this form to open an account. Please contact us at 1-800-676-2541 so we can get you the proper documentation to open an account.
SIGNATURES: BY CLICKING SUBMIT YOU AND ANY JOINT OWNER LISTED AGREE(S) TO THE TERMS STATED ON THE MEMBER ACCOUNT AGREEMENT (Available by clicking here) GOVERNING THE ACCOUNT TYPE AND OWNERSHIP SELECTED ABOVE, and acknowledges receipt of at least one copy OF IAACU'S TERMS AND CONDITIONS (Available by clicking here) on the date stated above. THE INTERNAL REVENUE SERVICE DOES NOT REQUIRE YOUR CONSENT TO ANY PROVISION OF THIS DOCUMENT OTHER THAN THE CERTIFICATIONS REQUIRED TO AVOID BACKUP WITHHOLDING.
PLEASE NOTE: Per our Terms and Conditions, when you apply for an account you agree that we may verify your credit, employment history, and identification by any necessary means, including the preparation of a credit report by a credit reporting agency.
PROXY: By submitting this form, member agrees to the terms of the proxy in the MEMBER ACCOUNT AGREEMENT. To opt out of the proxy terms, please contact our service center at 1-800-676-2541.