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AMEREN - INVESTOR SERVICES
800.255.2237

P.O. BOX 66887
ST. LOUIS, MO 63166-6887

 

DIRECT DEPOSIT AUTHORIZATION

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.


___________________________________________
Stockholder Signature


___________________________
Date


___________________________________________
Stockholder Signature


Stockholder Account Number

Taxpayer ID Number (TIN)

Social Security Number or Employer Identification Number

Daytime Telephone Number
--

Stockholder Name(s)


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

 Name of Financial Institution
 Account Number at Financial Institution
 Address of Financial Institution
 Bank Routing and Transit Number 

If Unknown,  Contact your Financial Institution
 City                         State   Zip
   
Check One:
Checking
*   Savings*
 Telephone Number of Financial Institution
--
 
*IF CHECKING ACCOUNT - You Must Attach a Voided Check.
   IF SAVINGS ACCOUNT - Attach Deposit Slip- Savings Accounts Have No Check Writing
   Privileges.

NOTARIZATION OF STOCKHOLDER SIGNATURE(S)

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.
State of ______________

County of ____________

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.


_____________________________________
Stockholder Signature and Date


________________
Notary Public

   
State of ______________

County of ____________

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.


_____________________________________
Stockholder Signature and Date


________________
Notary Public

     

 
 Copyright 2011 Ameren Services