5182 New Account Request

RESET
PD F 5182 E
Department of the Treasury
Bureau of the Public Debt
(Revised June 2001)

OMB NO. 1535-0069

NEW ACCOUNT REQUEST

www.treasurydirect.gov
1-800-722-2678

SEE INSTRUCTIONS - TYPE OR PRINT IN INK ONLY - NO ALTERATIONS OR CORRECTIONS

1. TreasuryDirect ACCOUNT INFORMATION

FOR DEPARTMENT USE

ACCOUNT NAME
DOCUMENT AUTHORITY

APPROVED BY

DATE APPROVED

ADDRESS

EXT REG
FOREIGN

BACKUP
City

State

ZIP Code
REVIEW

2. TAXPAYER IDENTIFICATION NUMBER
CLASS

1st Named
Owner

OR
Social Security Number

Employer Identification Number

3. TELEPHONE NUMBERS

Home

Work

4. PAYMENT INFORMATION
ROUTING NUMBER
FINANCIAL INSTITUTION
(Limited to 30 characters/spaces)

NAME ON ACCOUNT
(Limited to 22 characters/spaces)

Checking
Savings
(Check One)

ACCOUNT NUMBER
5. AUTHORIZATION

I submit this request pursuant to the provisions of Department of the Treasury Circulars, Public Debt Series Nos. 2-86 (31 CFR Part 357),
and 1-93 (31 CFR Part 356).
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me) and
2. I am not subject to backup withholding 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.
I further certify that all other information provided on this form is true, correct and complete.

Signature

Date

SEE INSTRUCTIONS FOR PRIVACY ACT AND PAPERWORK REDUCTION ACT NOTICE.

(OVER)

PD F 5182 E
Department of the Treasury
Bureau of the Public Debt
(Revised June 2001)

INSTRUCTIONS FOR COMPLETING
A NEW ACCOUNT REQUEST

www.treasurydirect.gov
1-800-722-2678

PURPOSE
You may use this form to establish a TreasuryDirect account (WITHOUT PURCHASING SECURITIES). The Department of the
Treasury will establish and maintain your book-entry account for the future deposit of securities. This form cannot be used for the
purchase of securities or to request a change to an existing account.
IMPORTANT NOTICES
• If you are submitting a tender, you do NOT need to complete this form. A TreasuryDirect account will be established
on the basis of the information you provide on the tender.
• To avoid delays, read the instructions carefully and print clearly in ink only. Where spaces are provided, enter only one letter
or number in each space.
• REQUESTS WILL NOT BE ACCEPTED WITH ALTERATIONS OR CORRECTIONS.
• This form must be signed. Only original signatures and forms will be accepted (stamped signatures are not acceptable).
1. TreasuryDirect ACCOUNT INFORMATION
ACCOUNT NAME
Enter the name(s) of the owner(s) for whom the TreasuryDirect account will be established. Accounts may be established in the
names of one or two individuals, an estate, a trust, corporation, association, natural guardian, etc. See the table of common
registrations on the last page of these instructions. Because registrations establish clear ownership and survivorship rights, we
recommend that you consult your TreasuryDirect office when you have questions about the proper wording.
ADDRESS
Provide a complete address, including ZIP code. All mailings [including notices, statements, confirmations, checks (where
permitted), and tax reporting documents] will be sent to this address.
2. TAXPAYER IDENTIFICATION NUMBER
Provide the taxpayer identification number required on tax returns and other documents submitted to the Internal Revenue Service
(IRS). For individuals, this is the social security number (SSN) of the person whose name appears FIRST on the account. The
SSN of a minor or incompetent is required for accounts established in a fiduciary capacity for these individuals. In the case of a
partnership, company, organization or trust, use the employer identification number (EIN) assigned by the IRS. [If you are not a
United States citizen, please attach IRS Form W-8 BEN or W-8 ECI.]
To use the TreasuryDirect Electronic Services, you must have a TreasuryDirect account and a taxpayer identification number. If
you’re not a U.S. citizen and want to use our electronic services, you can get an individual taxpayer identification number (ITIN). To
apply for an ITIN or just obtain more information, visit the Internal Revenue’s web page at www.irs.ustreas.gov/prod/ind_info/
itin.html or call (215) 516-4846.
3. TELEPHONE NUMBERS
Please provide the telephone numbers (including area codes) where you may be contacted if there are questions about this
request or your account.
4. PAYMENT INFORMATION

Try using Pay Direct ®—a secure way to buy securities without checks. It’s easy! Just ask
your financial institution to verify if your account can accept debit transactions. We’ll withdraw
the exact amount from your bank account to pay for whatever security you’ve bought.

Enter the following information:
• ROUTING NUMBER (your financial institution's ABA identifying number)
• FINANCIAL INSTITUTION (the name of the institution to which payments are to be made)
• NAME ON ACCOUNT (the name as it appears on the account at your financial institution)
• ACCOUNT NUMBER (the account number at your financial institution) Remember to mark your account type
(checking or savings).
Payments to you will normally be made by direct deposit to the financial institution you designate. (This is also the account that
will be debited when you choose Pay Direct as the method of payment on your tender.) Payments will be made by check if a
payment is due to you before we have confirmed direct deposit arrangements for your account. If both the TreasuryDirect account
and the receiving financial institution account are in the names of individuals, then at least one of the individuals named on the
TreasuryDirect account must also be named on the deposit account at the receiving financial institution. The ROUTING NUMBER
can be obtained at your financial institution or found on the bottom line of a check (see following example). When providing your
ACCOUNT NUMBER, please include hyphens. A hyphen is represented by the symbol ''' .

We suggest you provide a voided check
with this request. This will enable us to
verify your payment routing information—and
prevent delays in your receipt of direct deposit
payments.
Caution: Some financial institutions use
payment routing information which is not fully
displayed on a check.

5. AUTHORIZATION
This section must be signed and dated. Requests in the names of two individuals may generally be signed by either.
However, if the second-named owner signs, then an IRS Form W-9 signed by the first-named owner must be submitted with
the request. If the IRS has notified you that you are subject to backup withholding and you have not received notice from the IRS
that backup withholding has terminated, you should strike out the language certifying that you are not subject to backup
withholding.
SUBMISSION
Completed forms must be submitted to one of these TreasuryDirect offices:
TreasuryDirect
P.O. Box 2076
Boston, MA 02106-2076

TreasuryDirect
P.O. Box 660657
Dallas, TX 75266-0657

TreasuryDirect
P.O. Box 9150
Minneapolis, MN 55480-9150

CONTACT
Call us toll-free in the United States at 1-800-722-2678. Outside the U.S.? Call us at (617) 994-5500.
CONFIRMATION OF ESTABLISHED ACCOUNT
You will receive a TreasuryDirect Statement of Account confirming the establishment of your account.

TreasuryDirect Electronic Services
Enjoy the convenience of our TreasuryDirect electronic services from the comfort of your home using your
computer (www.treasurydirect.gov) or a touch-tone phone (1-800-722-2678).
Great hours! 8-8 ET, Monday through Friday, except for Federal holidays (24 hours a day for Reinvest Direct ®!)
Here’s what you can do:
• Buy a security
• Reinvest maturing securities
• Order a Statement of Account

• Request a duplicate interest income form
• Get your overall account par balance (Web users get even more details!)
• Change your address and phone number, too! (Web users only)

NOTICE UNDER THE PRIVACY AND PAPERWORK REDUCTION ACTS
The collection of the information you are requested to provide on this form is authorized by 31 U.S.C. Ch. 31 relating to the
public debt of the United States. The furnishing of a social security number, if requested, is also required by Section 6109 of
the Internal Revenue Code (26 U.S.C. 6109).
The purpose for requesting the information is to enable the Bureau of the Public Debt and its agents to issue securities,
process transactions, make payments, identify owners and their accounts, and provide reports to the Internal Revenue Service.
Furnishing the information is voluntary; however, without the information Public Debt may be unable to process transactions.
Information concerning securities holdings and transactions is considered confidential under Treasury regulations (31 CFR,
Part 323) and the Privacy Act. This information may be disclosed to a law enforcement agency for investigation purposes;
courts and counsel for litigation purposes; others entitled to distribution or payment; agents and contractors to administer the
public debt; agencies or entities for debt collection or to obtain current addresses for payment; agencies through approved
computer matches; Congressional offices in response to an inquiry by the individual to whom the record pertains; as otherwise
authorized by law or regulation.
We estimate it will take you about 10 minutes to complete this form. However, you are not required to provide information
requested unless a valid OMB control number is displayed on the form. Any comments or suggestions regarding this form should
be sent to the Bureau of the Public Debt, Forms Management Officer, Parkersburg, WV 26106-1328. DO NOT SEND completed
form to the above address; send to the correct address shown in the instructions.

Common Registration Options
Investors in marketable Treasury securities have a broad choice of registration options under TreasuryDirect which are designed to address
their needs and ownership situations. These options establish clear ownership and survivorship rights. Other options for natural guardians,
custodians, IRA’s, and government entities are available—for guidance, consult your TreasuryDirect office.

To register your security like this:

Select this option:

Provide this:

An account in the name of one individual.
Your name should appear the way you usually use it
(preferably with at least one full given name).

Single Ownership
Mary Benson Doe

SSN

An account in the names of two people, joined by the word
“and” and ending with “with right of survivorship.”
This creates a conclusive right of survivorship. Both
owners must authorize transaction requests.

Joint Ownership with
Right of Survivorship
Elizabeth Black and Jane Brown,
with right of survivorship

An account in the names of two people, joined by the word
“and” and ending with “without right of survivorship.”
This does not create a right of survivorship. If one owner
dies, his or her share passes on to the estate, not to the other owner.
Both owners must authorize transaction requests.

Joint Ownership Without
Right of Survivorship
John B. Butte and Mary B. Doe,
without right of survivorship

An account in the names of two people, joined by the
word “or.” This creates a conclusive right of survivorship.
Either owner may authorize transaction requests.

Co-ownership
James Black or Carolyn Black

An account in your name, followed by the words “payable
on death to” or “POD” another individual or the United States
Treasury (proceeds would then be used to reduce the public debt).
The beneficiary has no ownership rights prior to the owner’s death.
You must identify the beneficiary’s status in the registration
if he or she is a minor or incompetent. The owner authorizes
transaction requests. No consent from the beneficiary is needed.

Beneficiary
Jane Investor, payable on death to
Junior Investor, a minor

An account in the name of an executor, administrator, legal
guardian, conservator or other representative of an estate.
You must make sure the name of the estate is adequately identified
in the registration. If there are several representatives,
you may omit some by using language that indicates they exist.
You may need to provide evidence when you open this type
of account. Contact your TreasuryDirect office.

Estate Representative
John Smith and Joseph Jones,
Executors of the
Will of James Brown, deceased

An account in the name of the trustee(s) of a trust. Trusts
may be created by wills, agreements, indentures, deeds,
declarations of trust, or similar instruments. You must
include language that adequately identifies the
authority or document by which the trust was created.
If there are several trustees, you may omit some names as long as
you include language that indicates they exist. You may need to
provide evidence when you open this type of account.
Contact your TreasuryDirect office.

Trustees
Robert C. Jones and
Mary E. Doe, Trustees
under declaration of trust
dated 9/2/76

An account in the name of a private corporation,
unincorporated association or partnership. You must
include the full legal name and status (corporation, unincorporated
association or partnership). You may reference a particular
account or fund, other than a trust fund.

Private Organizations
The Standard Manufacturing
Corporation

Jack S. Jones, payable
on death to Ellen H. Jones

, Pay Direct ® and Reinvest Direct ® are registered trademarks of the Bureau of the Public Debt.

SSN of the first-named owner

SSN of the first-named owner

SSN of the first-named owner

SSN of the owner

SSN of the owner

EIN or SSN of the decedent

EIN or SSN of the first-named owner

EIN