EX-22.6 8 v05163_ex22c-vi.txt EXHIBIT 22(C)(VI) [LOGO OF BRIDGES INVESTMENT FUND, INC.] COVERDELL EDUCATION SAVINGS ACCOUNT APPLICATION
Mail to: Bridges Investment Fund, Inc. Overnight Express Mail to: Bridges Investment Fund, Inc. c/o U.S. Bancorp Fund Services, LLC c/o U.S. Bancorp Fund Services, LLC PO Box 701 615 E. Michigan St. FL 3 Milwaukee, WI 53201-0701 Milwaukee, WI 53202-5207 For additional information, please call toll-free 1-866-934-4700. ------------------------------------------------------------------------------------------------------------------------------------ In compliance with the USA PATRIOT Act, all mutual funds are required to obtain the following information for all registered owners and all authorized individuals: full name, date of birth, Social Security number, and permanent street address. This information will be used to verify your true identity. We will return your application if any of this information is missing, and we may request additional information for you for verification purposes. In the rare event that we are unable to verify your identity, the Fund reserves the right to redeem your account as an age-appropriate distribution at the current day's net asset value. ------------------------------------------------------------------------------------------------------------------------------------ 1. DESIGNATED ____________________________________ ______________________________________ BENEFICIARY FIRST NAME M.I. LAST NAME (Account Holder) ____________________________________ ______________________________________ PERMANENT STREET ADDRESS CITY / STATE / ZIP (PO BOX NOT ACCEPTABLE) _____________________________________________ ______________________________________ SOCIAL SECURITY NUMBER BIRTH DATE (Mo / Dy / Yr) ------------------------------------------------------------------------------------------------------------------------------------ 2. RESPONSIBLE ________________________________ ___ ______________________________________ PARTY FIRST NAME M.I. LAST NAME _____________________________________ ______________________________________ PERMANENT STREET ADDRESS (PO BOX NOT CITY / STATE / ZIP ACCEPTABLE) _____________________________________ ______________________________________ DAYTIME PHONE NUMBER RELATIONSHIP TO DESIGNATED BENEFICIARY _____________________________________ ______________________________________ SOCIAL SECURITY NUMBER BIRTH DATE (Mo / Dy / Yr) _____________________________________ ______________________________________ DRIVER'S LICENSE OR STATE ID NUMBER STATE OF ISSUE THE FOLLOWING 2 OPTIONS WILL BE ADDED TO YOUR ACCOUNT. IF YOU DO NOT WANT THESE OPTIONS, CHECK THE BOXES BELOW. I. The responsible party wishes to continue to control the account after the Account Holder attains age of majority in his/her state in accordance with the terms described in the optional portion of Article VI of the Coverdell Education Savings Account agreement. |_| The responsible party does not wish to control the account after age of majority. II. The responsible party may change the beneficiary designated under this agreement to another member of the designated beneficiary's family described in Article VII of the Coverdell Education Savings Account agreement. |_| The responsible party may not change the beneficiary. ------------------------------------------------------------------------------------------------------------------------------------ 3. ACCOUNT TYPE Select one of the following account types: |_| Coverdell Education Savings Account (CESA) Refer to disclosure For the Tax year __________. statement for eligibility requirements and |_| Rollover Account - specify the type of rollover: contribution limits. |_| Account Holder's CESA to Account Holder's CESA |_| Qualifying Family member's CESA to Account Holder's CESA |_| Transfer Account - a direct transfer from current CESA custodian
4. INVESTMENT CHOICES: |_| By check: Make check payable to Bridges Investment Fund, Inc. $ _____________ ($1000 Minimum) |_| By wire: Call 1-866-934-4700. Indicate amount of wire $ ____________ ------------------------------------------------------------------------------------------------------------------------------------ 5. AUTOMATIC INVESTMENT PLAN If you choose this option, funds will be automatically transferred from your bank account monthly. Please attach a voided check to Section 6 of this application. We Your signed application are unable to debit mutual fund or pass-through ("for further credit") accounts. must be received at least 15 business days prior to PLEASE KEEP IN MIND THAT: initial transaction. o There is a $25 fee if the automatic purchase cannot be made (assessed by redeeming shares from your account). o Participation in the plan will be terminated upon redemption of all shares. Amount per Draw ($100 Minimum) AIP Start Month AIP Start Day $_______________________________ ________________________________ _________________________________ ------------------------------------------------------------------------------------------------------------------------------------ 6. VOIDED CHECK FOR Based on the instructions in Section 5, funds will be automatically transferred from the BANK INFORMATION checking account on the slip below: Your signed application must be received at least 15 business days prior to initial transaction. Please include a voided bank check. PLEASE ATTACH VOIDED CHECK HERE o $25.00 fee will be assessed if your bank refuses the automatic purchase draw. o Participation in the plan will be terminated upon redemption of all shares. o Automatic Investments will be reported as current year contributions. ------------------------------------------------------------------------------------------------------------------------------------ 7. BENEFICIARY INFORMATION (IF YOU NEED MORE SPACE, PLEASE ENCLOSE A SEPARATE SHEET OF PAPER.) PRIMARY _____________________________ ____________ __________________ ____________________ _______ _______ NAME RELATIONSHIP CITY / STATE / ZIP SOCIAL SECURITY NUMBER DOB % _____________________________ ____________ __________________ ____________________ _______ _______ NAME RELATIONSHIP CITY / STATE / ZIP SOCIAL SECURITY NUMBER DOB % SECONDARY _____________________________ ____________ __________________ ____________________ _______ _______ NAME RELATIONSHIP CITY / STATE / ZIP SOCIAL SECURITY NUMBER DOB % _____________________________ ____________ __________________ ____________________ _______ _______ NAME RELATIONSHIP CITY / STATE / ZIP SOCIAL SECURITY NUMBER DOB %
8. SIGNATURE I have read and understand the Disclosure Statement and Custodial Account Agreement. I adopt the Bridges Investment Fund, Inc. Custodial Account Agreement, as it may be revised from time to time, and appoint the Custodian or its agent to perform those functions and appropriate administrative services specified. I have received and read the prospectus for the Bridges Investment Fund, Inc. (the "Fund"). I understand the Fund's objectives and policies and agree to be bound to the terms of the prospectus. I acknowledge and consent to the householding (i.e. consolidation of mailings) of documents such as prospectuses, shareholder reports, proxies, and other similar documents. I may contact the Fund to revoke my consent. I agree to notify the Fund of any errors or discrepancies within 45 days after the date of the statement confirming a transaction. The statement will be deemed to be correct, and the Fund and its transfer agent shall not be liable if I fail to notify Bridges Investment Fund, Inc. within such time period. I certify that I, as the Responsible Party, am of legal age and have the legal capacity to make this purchase. I understand that the fees relating to my account may be collected by redeeming sufficient shares. The Custodian may change the fee schedule at any time. I authorize the Fund to perform a credit check based on the information provided, if necessary. The Fund, its transfer agent, and any officers, directors, employees, or agents of these entities (collectively " Bridges Investment Fund, Inc.") will not be responsible for banking system delays beyond their control. By completing section 5, I authorize my bank to honor all entries to my bank account initiated through U.S. Bank, NA, on behalf of the applicable Fund. Bridges Investment Fund, Inc. will not be liable for acting upon instruction believed to be genuine and in accordance with the procedures described in the prospectus or the rules of the Automated Clearing House. When AIP transactions are presented, sufficient collected Fund must be in my account to pay them. I agree that my bank's treatment and rights to respect each entry shall be the same as if it were signed by me personally. I agree that if any such entries are dishonored with good or sufficient cause, my bank shall be under no liability whatsoever. I further agree that any such authorization, unless previously terminated by my bank in writing, is to remain in effect until the Fund's transfer agent receives and has had reasonable amount of time to act upon a written notice of revocation. ______________________________________________________ ________________________ DEPOSITOR / LEGALLY RESPONSIBLE INDIVIDUAL'S SIGNATURE DATE (Mo / Dy / Yr) Appointment as Custodian accepted: U.S. Bank, NA /s/ [Illegible] ------------------------------------------------------------------------------------------------------------------------------------ 9. DEALER INFORMATION _______________________________________________ _____________________________________________________ Please be sure to DEALER NAME REPRESENTATIVE'S LAST NAME FIRST NAME MI complete representative's DEALER HEAD OFFICE INFORMATION: REPRESENTATIVE'S BRANCH OFFICE INFORMATION: first name and middle initial. _______________________________________________ _____________________________________________________ ADDRESS ADDRESS _______________________________________________ _____________________________________________________ CITY / STATE / ZIP CITY / STATE / ZIP _______________________________________________ _____________________________________________________ TELEPHONE NUMBER TELEPHONE NUMBER ------------------------------------------------------------------------------------------------------------------------------------ BEFORE YOU MAIL, HAVE YOU: |_| Completed all USA PATRIOT Act required information? |_| Enclosed your check made payable to Bridges Investment - Social Security or Tax ID numbers in Sections 1 Fund, Inc.? and 2? |_| Included a voided check, if applicable? - Birth dates in Sections 1 and 2? |_| Signed your application in Section 8? - Full names in Sections 1 and 2? - Permanent street addresses in Sections 1 and 2?