Dividend Reinvestment Authorization

You must use a separate form for each account.

Step 1: Enter your account and your brokerage firm related information. All fields marked with an asterisk (*) are required.

*Client Account Name:
*10 digit Brokerage Account #:
Brokerage Firm Name:
* Phone Number:
E-mail Address:

Dividend reinvestment is available on margin eligible securities. Generally, this includes all U.S. listed stocks, including Nasdaq issues valued at greater than or equal to $4.00 a share.

Step 2: Choose either Option 1 to reinvest dividends on all securities, or Option 2 for selected securities.

Option 1:

Check this button to reinvest dividends on all eligible securities in your brokerage account.
  • The account must contain at least one security to have the entire account coded for dividend reinvestment.

Option 2:

Complete the section below to reinvest dividends on selected securities only held in your account.
  • Select either the Add or Delete button for each security entered. Select the Delete button to discontinue dividend reinvestment.
  • You may submit a maximum 100 entries using this form.
  • Click "PROCESS" when you are finished or "ADD MORE" to enter more security names.

Add/Delete
 Security Name Cusip#/Symbol/Ridge#