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 NEW ACCOUNT DRPlus APPLICATION
   
 

 

REGISTRATION OF COMMON STOCK ACCOUNT

 
Names(s):

              If more than one name is entered, add a comma after each full name.
Address:
City:  State:  Zip:
Daytime Phone Number: --
  Individual Account
  Joint Tenants with Right of Survivorship
  Custodian Account for Minor
(Circle the Minor's Name and Provide Minor's SSN on Substitute Form W-9)
  Transfer on Death (TOD)
(Limited to One Beneficiary Per Account. Circle the Beneficiary's Name.)
  Trust Account
(Provide Trustee Names, Date of Trust, and Trust Name)
  Other:
   

REQUEST FOR ALTERNATIVE ADDRESS

If you are unable to reach me at the above address of record, please contact:

Name:

Address:

City:   State:   Zip:
Daytime Phone Number: --
 

INITIAL CASH FOR INVESTMENT
A check or money order payable to Ameren Corporation must be enclosed with this DRPlus Application to establish the account.
Amount Enclosed: $
Minimum initial investment is $250.
Subsequent minimum cash investment is $25. Maximum investment per calendar year is $120,000.
 

INSTRUCTIONS FOR DIVIDENDS
Dividends payable on my DRPlus account should be:
  Reinvested

  Paid by Check
 

AUTHORIZATION
I acknowledge the following:

     (1)

 I have read the DRPlus Plan Prospectus and agree to the terms and conditions set forth therein.
(2) Each person named in the proposed registration is of legal age unless the account is designated as a custodian account.
 
Signature: ____________________________________________________
 
Date: _______________________________________________
 

SUBSTITUTE FORM W-9
REQUEST FOR TAXPAYER ID NUMBER
Certification - Under penalties of perjury, I certify that:
(1)

The number shown on this form is my correct TIN (or I am waiting for a number to be issued to me); and
(2) I am not subject to backup withholding either because: (a) I am exempt from backup withholding; or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends; or (c) the IRS has notified me that I am no longer subject to backup withholding, and
(3) I am a U.S. person (including a U.S. resident alien).

Taxpayer ID Number (TIN):  
(Social Security Number or Employer Identification Number)
 
Name of Person or Entity Whose TIN is Shown:
   
Signature of U.S. Person:______________________________________________
 
Date:   ______________________________________________
   
MUST BE COMPLETED, SIGNED AND DATED.

 
   
   
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