Wealthscape Registration Form

Wealthscape Investor Assisted Registration

Please complete this form to request a user ID and password for access to Wealthscape Investor^SM if you are not listed as an Owner/Holder on your account and are ineligible to use the self-registration process because:

Your account was established with a Tax Identification Number (TIN) or institutional name (for example: Corporation, Investment Club, Limited Liability Company, Professional Association, Unincorporated Association or Unincorporated Church/Religious Order).

Your investment portfolio includes one or more accounts on which Fidelity Brokerage Services LLC serves as the broker/dealer

Contact Information

Please complete the information below as it appears on your account(s). If completing for an Entity or Institution type account, be sure to include the name of the Entity/Institution and information for the authorized individual requesting the access update.

To receive electronic notifications, you may need to add the following email address to your safe sender's email list: LFNFasteamSupport@lfg.com

Entity or Institutional Name (if applicable)

Authorized Individual Information:

First name

Middle initial

Last name

Address line 1

Address line 2

City

ZIP Code

Phone Number

Fax

Email Address

Account Number(s):

Please provide each account number you are authorized to access and wish to view using your Wealthscape Investor ID:

Prefix 1

Account Number 1

Prefix 2

Account Number 2

Prefix 3

Account Number 3

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