CERTIFICATE DEPOSIT FORM

Provide Name as it Appears on Certificate(s)
Certificate Holders' Name: ____________________________________________________
BUYandHOLD Account Number: ______________________________________
Tax ID/Social Security Number:_____________________________________

Please remember, you may only deposit certificates for those securities that are on the BUYandHOLD Companies List available at www.buyandhold.com/research/.
Security Information
(If you have certificates from multiple companies, please use a separate form for each certificate.)

Name of company in which you hold shares:

_______________________________

_______________________________

  

Certificate Numbers:

_______________

_______________
Total number of shares to be deposited:   ___________________
If depositing certificates to an IRA, please check one of the boxes below:
Account Transfer from existing contributory IRA from another financial institution
 Securities withdrawn from an IRA at another institution within the past 60 days
 Direct Rollover from Employer's Retirement Plan
Authorization
The undersigned does (do) hereby sell, assign and transfer to the above referenced shares and hereby irrevocably constitute and appoint Oppenheimer & Co. Inc. attorney to transfer the said stock on the books of said company, with full power of substitution in the premises.
Legal Shareholder Signature(s): (In the case of a rollover deposit, I irrevocably elect to treat this as such, as stated in the Rollover Section of the IRA Disclosure statement I agreed to in the establishment of this IRA Account. If joint account, all persons must sign; if custodial, registered custodian must sign.)

Print Name: __________________________________________

Print Name (Joint Applicant, If Applicable):________________________________

  Signature:
X______________________________________

Signature (Joint Applicant, If Applicable):
X______________________________________

Signature(s) must correspond with the name(s) exactly as shown on your certificate.

DATE:___________________ 		 
DAYTIME PHONE NUMBER:_____________________

Medallion Signature Guarantee Stamp*
(Can be obtained at most commercial banks and brokerage firms.)



*This stamp is only required if the name and account type on the certificate to be deposited do not match the name and account type on your receiving BUYandHOLD account.