Security Account Confirmation Form

SECURITY ACCOUNT CONFIRMATION FORM

RECITALS

WHEREAS, Client Name: (hereinafter "Client") has requested that Firm Name: (hereinafter "Firm") establish and confirm a securities account and related services pursuant to the terms and conditions set forth herein.

WHEREAS, the parties desire to confirm in writing the account registration, services to be provided, authorizations, fees and the mutual representations and covenants applicable to the Account Number: and associated assets.

NOW, THEREFORE, in consideration of the mutual covenants contained herein and other good and valuable consideration, the receipt and sufficiency of which are acknowledged, the parties agree as follows.

ACCOUNT INFORMATION

Registration Type: Individual Joint Tenants Trust Corporation Partnership IRA/Retirement Other

SCOPE OF SERVICES

The Firm shall provide the following services with respect to the Account: brokerage services, custody of securities and cash, trade execution, settlement processing, account statements and such additional ancillary services as agreed in writing. The parties expressly agree that the Firm's duties are limited to those expressly set forth herein and in any separate account agreement executed by the parties.

AUTHORIZATIONS AND INSTRUCTIONS

By signing below, Client authorizes the Firm to accept and execute instructions for purchases, sales and transfers of securities for the Account and to follow funding and distribution instructions as provided. Client elects the following authorizations (select all that apply):

Trading authority (non-discretionary) Discretionary trading authority (if checked, attach discretionary authorization) Margin account authorization Options trading authorization

FUNDING AND TRANSFER INSTRUCTIONS

Funding Method: Wire Check In-kind Transfer ACH

PAYMENT TERMS

Client agrees to pay the Firm fees, commissions and charges in accordance with the Firm's fee schedule as provided to Client and acknowledged below.

TERM AND TERMINATION

This Agreement shall commence on the Start Date: and shall continue until the End Date: , unless earlier terminated in accordance with the terms below.

Either party may terminate this Agreement for any reason upon written notice to the other party delivered no fewer than Notice Period (days): days prior to termination. Termination shall not relieve Client of obligations to pay fees and charges incurred through the effective date of termination.

CONFIDENTIALITY

Each party shall maintain in confidence and shall not, without the prior written consent of the other party, disclose to any third party any non-public information concerning the business, operations, customers, account positions or strategies of the other party that was obtained in connection with the Account, except as required by law, regulation, regulatory authority or court order. The receiving party shall use at least the same degree of care to protect confidential information as it uses to protect its own confidential information, but in no event less than reasonable care.

REPRESENTATIONS AND WARRANTIES

Client represents and warrants that (a) the information provided in this Form is true, complete and correct; (b) Client has the power and authority to open and maintain the Account and to enter into this Agreement; and (c) Client will promptly notify Firm of any material change to the information provided. Firm represents that it is authorized to provide the services described herein and that it will perform such services in a manner consistent with applicable professional standards and regulatory obligations.

GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the State of , without regard to its conflicts of laws principles. The parties submit to the exclusive jurisdiction of the state and federal courts located in that state for disputes arising under this Agreement.

ENTIRE AGREEMENT

This Form, together with any account agreement, fee schedules, disclosures and written addenda expressly incorporated by reference, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous understandings, agreements or representations, whether written or oral. No amendment or modification shall be effective unless in writing and signed by both parties.

ACKNOWLEDGMENT AND CONFIRMATION

By signing below, Client confirms that Client has received and reviewed the Firm's account disclosures and fee schedule, understands the nature and risks of investing in securities, and authorizes the Firm to open and operate the Account in accordance with the terms of this Form.

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