ハーブ herb パンチングアンクルブーツ（IV）

WFM Adjustme nt (L.O.I) Request Form
WFM Advisor Name
.
Date:
Request by:
We request the following be processed:
Code
__
___
WFM Account #:
Client Name:
Client #:
Details of the Fund/Transaction to be adjusted
Fund Code
Fund Acct
Wire Order#
$ Amount
I,
, hereby indemnify and
save harmless Worldsource Financial Management and
, from any costs that arise as a
result of following my request. I have reviewed the
transaction and have informed my client of how we are
proceeding to adjust this transaction.
This LOI Request Form should be filled out in its entirety to expedite
processing the request. Missing information could lead to unnecessary
delays. If you have any questions about this form, you may contact
Advisor Services at 1-800-341-1013.
This request must be faxed to Worldsource Financial Management
Inc. at 1-888-219-3278, Attn: Advisor Services
__________________________________
Authorized Signature
________________
Date
Note: If this is a Branch Initiated Adjustment, it is the
Branch (Rep Code below) that will assume any losses.
Yes:
Rep Code responsible:
Initial

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