Back Office Butler Form

* Indicates required fields. If you do not have information for other non-required fields, you may leave them blank and we will highlight those areas on the paperwork we send to you.

Questions? Call 1-800-506-1666

Representative Information

Note: If you currently have an active account with AbsCap, only name, zip and email are required.

* Name(s)		Broker/Dealer
Phone Number		Fax Number
Address		Social Security No.
* City, State, Zip		Date of Birth
* Email		B/D ID # Branch #

Client Information

* Client Name(s)	NOTE: Please include middle initial(s).
Address		Social Security No.
City, State, Zip		Date of Birth
Phone Number		Driver's License #	State

Account Information

* Type of Account
* Custodian

Money Management Program

* Program

Method of Paperwork Delivery

* Method

Beneficiary Information

Beneficiary 1

Beneficiary Type:	Primary
Beneficiary Name
Address		Social Security No.
City, State, Zip		Date of Birth
Relationship		Beneficiary 1 Percentage	%

Beneficiary 2

Beneficiary Type
Beneficiary Name
Address	Social Security No.
City, State, Zip	Date of Birth
Relationship	Beneficiary 2 Percentage	%

If you need additional beneficiaries, please list them in the Your Note to Absolute Capital section

Additional Information

Your Note to Absolute Capital