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Deposit Slip

Account Information

Your Name:

Account Number:

Asset Description or Number:

Date:

Deposit Amount:

Email:

Investment Income?

Rental Income

Rental Income

Dividend

Dividend

Return of Prior Payment

Return of Prior Payment

Note Payment

Note Payment

Other

Other

Other Comment:

Interest $

Principal $

Account Deposit?

Contribution Year

Contribution Year

Comment:

Employee Cont.:

Employee Cont.(401k, SIMPLE)

Employee Cont. Comment:

Employee Cont.:

Employee Cont.(401k, SEP, SIMPLE)

Employee Cont. Comment:

Fees

Fees

Is this a recurring deposit:

**Check payable to: New Vision Trust Company CFBO (Account Owner Name)(Account Type)**

Mail to: American IRA, LLC, 135 Broad Street, Asheville, NC 28801

Corporate Headquarters: New Vision Trust Company, 401 E. 8th Street, Suite 200R, Sioux Falls, South Dakota 57103