IMA Assignment Consent

CONSENT TO ASSIGNMENT

INSTRUCTIONS:

After reading the attached letter, and agreeing to the terms of assignment, please provide your name(s) and signature(s) as outlined below and return via the enclosed postage paid, self- addressed envelope.

If you are a/an:

  • Individual with an account or accounts in your name only managed by Fort Pitt Capital Group, Inc., please print and sign your name where indicated below.
  • Household with more than one adult account owner managed by Fort Pitt Capital Group, Inc., please print and sign each account owner’s name where indicated below.
  • Trustee(s) of an account managed by Fort Pitt Capital Group, Inc., please print and sign where indicated below, check the box for trustees, and fill in the trust account’s title.
  • Power of Attorney for an account owner(s) of an account managed by Fort Pitt Capital Group, Inc., please print and sign where indicated below, and check the box for Power of Attorney.
  • Authorized Agent for an institutional client that has an account(s) managed by Fort Pitt Capital Group, Inc., please print and sign where indicated below, and check the box for authorized agent.