Brokerage Application Form

Brokerage Application and Service Agreement

This Brokerage Application and Service Agreement (the Agreement) is entered into as of by and between Applicant Name: and Brokerage Firm Name: .

WHEREAS

WHEREAS, the Applicant seeks to engage the Brokerage Firm to provide securities brokerage, advisory and related intermediary services as set forth herein; and

WHEREAS, the Brokerage Firm is duly authorized and qualified to provide such brokerage services and has represented that it will comply with applicable laws, regulations and industry standards in the provision of services; and

WHEREAS, the parties desire to record their understandings and Applicant's representations, consents and authorizations in connection with account opening and provision of brokerage services.

Applicant Information

Individual    Corporation    LLC    Partnership    Trust    Other

Business & Licensing Information

Scope of Services

Describe the brokerage services requested, including account types, transaction authority, and any special instructions. The Brokerage Firm will perform services as described below, subject to the terms of this Agreement.

Payment Terms

Applicant agrees to pay brokerage commissions, fees and charges as set forth below. All fees are non-refundable except as expressly provided.

Term and Termination

This Agreement commences on the effective date and will continue until the end date specified below or until earlier terminated in accordance with this Section.

Either party may terminate this Agreement for convenience upon written notice to the other party delivered at least days prior to the effective termination date. Termination for cause may be immediate where a party materially breaches any obligation and fails to cure within a reasonable period not to exceed 15 days following written notice.

Confidentiality

Each party shall treat as confidential all non-public information received from the other party in connection with this Agreement and shall not disclose such information to third parties except to its employees, agents, auditors or legal advisors on a need-to-know basis, or as required by law. Confidential information does not include information that is or becomes generally available to the public other than through a breach of this Agreement.

Representations, Warranties and Compliance

Applicant represents and warrants that the information supplied in this Application is true, complete and correct. Applicant agrees to provide documentation reasonably requested by the Brokerage Firm to verify identity, financial condition, and authority to enter into this Agreement. Applicant further agrees to comply with all applicable anti-money laundering, know-your-customer and securities laws and regulations.

Authorizations and Consents

By signing below, Applicant authorizes the Brokerage Firm to obtain background checks, credit reports and any regulatory or disciplinary history checks as necessary for account opening and ongoing compliance. Applicant also authorizes the Brokerage Firm to act on behalf of Applicant only to the extent expressly authorized in writing.

Applicant consents to background and regulatory checks.    Applicant consents to credit checks where applicable.

Governing Law; Entire Agreement

This Agreement shall be governed by and construed in accordance with the laws of the state of , without regard to conflict of laws principles. This Agreement, including all schedules and documents incorporated by reference, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings and communications, whether written or oral.

Severability; Amendment

If any provision of this Agreement is held invalid or unenforceable, the remaining provisions shall remain in full force and effect. This Agreement may be amended only by a written instrument signed by authorized representatives of both parties.

Attachments and Documents

Applicant must attach or provide copies of identification, corporate formation documents (if applicable), recent financial statements, and any licenses referenced herein. Failure to provide requested documentation may delay account approval or result in rejection.

Declarations

The undersigned declares that the information provided in this Application is true and complete and acknowledges that any material misstatement or omission may constitute grounds for immediate termination of this Agreement and forfeiture of any funds or positions as permitted by law.

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