Simply print and complete this form, enclose a check for your contribution, and return it to any Brookline Bank branch or mail to:           Brookline Bank, Attn. IRA Department           PO Box 470469           Brookline, MA 02447-0469                         MEMBER FDIC *   Visit www.BrooklineBank.com or call toll-free 877-668-2265 for rates. ** Due to banking regulations, we cannot open a new IRA plan without your tax ID number and birth date.