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CollegeChoice Advisor 529 Savings Plan
Broker Dealer Change Request Form
• Please complete this form to authorize the change of the Financial Advisory rm listed on your CollegeChoice Advisor 529 Savings Plan Account.
• Investments may be made through Financial Advisors that have entered into a selling agreement with Ascensus Broker Dealer Services, Inc.
• Type in your information and print out the completed form, or print clearly, preferably in capital letters and black ink. Mail the form to the
address below. Do not staple.
Forms can be downloaded from our website at www.collegechoiceadvisor529.com, or you can call us to order any form — or request
assistance in completing this form — at 1.866.485.9413 any business day from 8 a.m. to 8 p.m. Eastern time.
Mail this form and any other required documents to:
CollegeChoice Advisor 529 Savings Plan
P.O. Box 219354
Kansas City, MO 64121
For overnight delivery or registered mail, send to:
CollegeChoice Advisor 529 Savings Plan
1001 E 101st Terrace, Suite 200
Kansas City, MO 64131
1.
Account information
Account Number
Name of Account Owner (rst, middle initial, last)
2.
New Financial Advisor information
(To be completed by the Financial Advisor.)
Firm Name
Financial Advisor Name (rst, middle initial, last)
Branch Number (if applicable) Advisor ID Number/IRD Number BIN Number (if applicable)
Matrix Level
Mailing Address
City State Zip Code
Telephone Number
3.
SIGNATURE — MUST SIGN BELOW
I certify that the information provided herein is true and complete in all respects, and that I have read and understand, consent, and
agree to all the terms and conditions of the CollegeChoice Advisor 529 Savings Plan Disclosure Statement.
SIGNATURE
Signature of Account Owner Date (mm/dd/yyyy)
SIGNATURE
Signature of Financial Advisor Date (mm/dd/yyyy)
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