AMEREN - INVESTOR SERVICES
800.255.2237
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P.O. BOX 66887
ST. LOUIS, MO 63166-6887 |
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DIRECT DEPOSIT AUTHORIZATION
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| I
(we) authorize Ameren to deposit my (our) dividend payment by electronic funds transfer
into the account specified herein. I (we) also authorize Ameren to initiate corrections to any
amounts credited in error and I (we) waive any claim, without
limitation, against Ameren or my (our) financial institution with the
respect to the operation of this service. |
| This
authorization will remain in effect until I (we) give written notice to
terminate it or until Ameren notifies me (us) that this service has been
terminated. |
| I
(we) understand that I (we) must allow Ameren a reasonable amount of time
for initiating or terminating Direct Deposit and that I (we) am
responsible for notifying Ameren of change in financial institution
information. |
| ALL
STOCKHOLDERS must sign below. If the account name at your financial
institution is different from the Ameren stock account, NOTARIZED
signatures of ALL STOCKHOLDERS must be provided on this form. |
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___________________________________________
Stockholder Signature
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___________________________
Date
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___________________________________________
Stockholder Signature
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Stockholder Account Number
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Taxpayer ID Number (TIN)
Social Security Number or Employer Identification
Number |
Daytime Telephone Number
--
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Stockholder Name(s)
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DIRECT DEPOSIT FINANCIAL
INSTITUTION INFORMATION
(Your Financial Institution Must Be A Member Of The Automated Clearing House (ACH) Network)
MUST BE PERSONAL CHECKING OR SAVINGS ACCOUNT
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Name of Financial Institution
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Account Number at Financial Institution
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Address of Financial Institution
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Bank Routing and Transit Number
If Unknown,
Contact your Financial Institution
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City
State Zip
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Check
One:
Checking*
Savings*
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Telephone Number of Financial Institution
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*IF
CHECKING ACCOUNT - You Must Attach a Voided Check.
IF SAVINGS ACCOUNT - Attach Deposit Slip- Savings Accounts Have No
Check Writing
Privileges. |
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NOTARIZATION OF STOCKHOLDER SIGNATURE(S)
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| NOTARIZED
signatures of ALL STOCKHOLDERS are required if the name(s) on the bank
account to receive dividends is NOT EXACTLY the same as the name(s) on
your Ameren stock account. |
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State of
______________
County
of
____________
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On
this________ day of__________ 20___, ________________
personally appeared before me, known to me to be the person who executed this
document for the purposes stated therein. |
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_____________________________________
Stockholder Signature and Date
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________________
Notary Public
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State of
______________
County
of
____________
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On
this________ day of__________
20___, ________________
personally appeared before me, known to me to be the person who executed this
document for the purposes stated therein. |
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_____________________________________
Stockholder Signature and Date
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________________
Notary Public
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