D.H. Hill Advisors, Inc Green Oak Place, Suite 100 Kingwood, Texas Fax: Client Profile/Account Application

Transcription

1 Advisor Use Only SLC/OFAC Rcvd:_ By:_ ( )Check ( )Transfer ( )Complete ( )On File ( )Missing ( )Incomplete Mailed/OVN On: To: Entd:_ By: D.H. Hill Advisors, Inc Green Oak Place, Suite 100 Kingwood, Texas Fax: *Denotes Required Field Client Profile/Account Application *IA Representative: *Phone: *: *Nature of Account Individual Joint IRA Trust Corporation Other For non-individuals, please submit copies of documents showing the existence of the entity, such as articles of incorporation, government-issued business license, partnership agreement, trust instrument, etc. Primary Owner *Account Registration: *Name * of Birth *SSN or Tax Id# *U.S. Citizen Yes No *Marital Status: *Address *City, State, and Zip *Home Phone/Cell Phone Work Phone *Photo ID# *ID State *Exp. *Employer (If retired, write Retired ) *Type of Business *Occupation Years Emp. Address *Employer Address *Employer City State & Zip Bank Name _ Branch Location *Advisor Name Joint Owner/Minor/Trustee *Account Registration: *Name * of Birth *SSN or Tax Id# *U.S. Citizen Yes No *Marital Status: *Address *City, State, and Zip *Home Phone/Cell Phone Work Phone *Photo ID# *ID State *Exp. *Employer (If retired, write Retired ) *Type of Business *Occupation Years Emp. Address *Employer Address *Employer City State & Zip Bank Name _ Branch Location *Advisor Name

2 Net Worth* Income* Investable Assets* Under $45,000 $45,000 - $59,999 $60,000 - $149,999 $150,000 - $199,999 $200,000 - $224,999 $225,000 - $249,999 $250,000 - $499,999 $500,000 - $749,999 $750,000 - $999,999 $1,000,000 - $1,499,999 $1,500,000 - $2,499,999 $2,500,000 - $3,499,999 $3,500,000 - $4,999,999 Over $5,000,000 Net Worth *Excluding home, home furnishings, and automobiles Under $45,000 $45,000 - $59,999 $60,000 - $199,999 $200,000 - $299,999 $300,000 - $499,999 $500,000 - $999,999 Over $1,000,000 Income Under $50,000 $50,000 - $99,999 $100,000 - $249,999 $250,000 - $499,999 $500,000 - $999,999 $1,000,000 - $1,999,999 Over $2,000,000 Investable Assets _ *Background Information: Is client employed by a broker/dealer or in any financial institution or affiliated with the American Stock Exchange or any other securities exchange? YES NO If yes, specify company and include 407 letter: _ Is client a director, 10% shareholder or policy making officer of a publicly traded company? YES NO If yes, specify company: Is client related to any D.H. Hill Advisors, Inc. manager or employee? YES NO If yes, specify firm: Has the client ever been a party to an arbitration or lawsuit (other than a class-action) concerning an investment, or has the client ever accepted a settlement over $1000 from a financial institution? YES NO If yes, please describe: IRA Custodian (if applicable) TCA Trust Management Community National Bank Other *Time Horizon Short (0-5 Yrs) Intermediate (5-10 Yrs) Long (Over 10 Yrs) *General Investment Knowledge Extensive Good Limited *Risk Tolerance Conservative Moderate Aggressive *Client Investment Experience Mutual Funds Stocks Variable Annuities Bonds Other _ None *Number of Years of Investment Experience *Is this a Discretionary Account? Yes No *Investment Objectives (Please check one or more): Income = I Growth = G Growth & Income = GI Tax Benefits = T

3 In consideration of your opening one or more accounts for me we, us and our are each substituted for I, me and my respectively, in the case of multiple account holders, corporations and other entities, and you re agreeing to act as Investment Advisor for me in the purchase or sale of securities, commodities, options and other property, it is agreed in respect to any and all accounts, whether upon margin or otherwise, which I now have or may at any future time have with D.H. Hill Advisors, Inc., or your successors (herein-after referred to as you or your or DHHA ), that: 1. Except as herein provided, no provision of this Agreement may be waived, altered, modified or amended unless the same is in writing and signed by an authorized official of DHHA. 2. Communications may be sent to the mailing address on file with you, or at such other address as I may hereafter provide, and all communications so sent, whether by mail, telegraph, messenger or otherwise shall be deemed given to me personally, whether actually received or not. Transactions entered into for my account(s) shall be confirmed in writing to me where required by applicable law or regulation. I agree that transactions reflected on any such confirmations and statements shall be conclusively deemed accurate as stated unless I notify DHHA in writing within ten (10) days of mailing, that the information contained in such confirmation or statement is inaccurate. Such notice must be sent by me to DHHA by telegram or letter directed to the attention of the Compliance Officer at the home office of DHHA. Failure to so notify DHHA shall also preclude me from asserting at any later date that such transaction was unauthorized. 3. I authorize you at your discretion to obtain reports concerning my credit standing and my business conduct. You may ask credit reporting agencies for consumer reports of my credit history. Upon my request you will inform me whether you have obtained any such consumer reports, and if you have, you will inform me of the name and address of the consumer reporting agency that furnished the reports to you. 4. I hereby represent that I am of the age of majority. Unless I advise you to the contrary in writing, and provide you with a letter of approval from my employer, where required, I represent that I am not an employee of any exchange, or of any corporation of which any exchange owns a majority of the capital stock, or of a member of any exchange, or of a member firm or member corporation registered on any exchange, or of any corporation, firm or individual engaged in the business of dealing, either as a broker or as principal, in securities. I further represent that no one except those signing this Agreement has an interest in my account. 5. This Agreement contains a pre-dispute arbitration clause. By signing an arbitration agreement the parties agree as follows: (A) All parties to this Agreement are giving up the right to sue each other in court, including the right to a trial by jury, except as provided by the rules of the arbitration forum in which a claim is filed. (B) Arbitration awards are generally final and binding; a party s ability to have a court reverse or modify an arbitration award is very limited. (C) The ability of the parties to obtain documents, witness statements and other discovery is generally more limited in arbitration than in court proceedings. (D) The arbitrators do not have to explain the reason(s) for their award. (E) The panel of arbitrators will typically include a minority of arbitrators who were or are affiliated with the securities industry. (F) The rules of some arbitration forums may impose time limits for bringing a claim in arbitration. In some cases, a claim that is ineligible for arbitration may be brought in court. (G) The rules of the arbitration forum in which the claim is filed, and any amendments thereto, shall be incorporated into this Agreement. I agree that all controversies that may arise between me and DHHA and/or any of DHHA s present or former officers, directors, employees, representatives, or agents, and their successors, assigns, and affiliates related to this Account, any transaction or the construction, performance or breach of this Agreement, whether arising before, on or after the date this Account is opened, shall be determined by arbitration in accordance with the rules then prevailing of the American Arbitration Association. Judgment upon any arbitration award may be entered in any court of competent jurisdiction. No person shall bring a putative or certified class action to arbitration, nor seek to enforce any pre-dispute arbitration agreement against any person who has initiated in court a putative class action; or who is a member of a putative class who has not opted out of the class with respect to any claims encompassed by the putative class action until: (i) the class certification is denied; or (ii) the class is decertified; or (iii) the customer is excluded from the class by the court. Such forbearance to enforce an agreement to arbitrate shall not constitute a waiver of any rights under this Agreement except to the extent stated herein. The agreement to arbitrate does not entitle the Client to obtain arbitration of claims that would be barred by the relevant statute of limitations if such claims were brought in a court of competent jurisdiction. If at the time a demand for arbitration is made or an election or notice of intention to arbitrate is served, the claims sought to be arbitrated would have been barred by the relevant statute of limitations or other time bar, any party to this Agreement may assert the limitations as a bar to the arbitration by applying to any court of competent jurisdiction, and the Client expressly agrees that any issues relating to the application of a statute of limitations or other time bar, are referable to such a court. The failure to assert such bar by application to a court, however, shall not preclude its assertion before the arbitrators. Notwithstanding anything contained herein to the contrary, nothing herein shall be deemed to (i) limit or contradict the rules of any self-regulatory organization; (ii) limit the ability of a party to file any claim in arbitration; (iii) limit the ability of a party to file any claim in court permitted to be filed in court under the rules of the forums in which a claim may be filed under the Agreement; or (iv) limit the ability of arbitrators to make any award. This arbitration provision is continuous and shall apply to and be deemed incorporated by reference into any and all agreements pertaining to any and all investments entered into with DHHA contemporaneously with or subsequent to the date of this Agreement. The provisions of this Agreement shall be continuous. Should any term or provision of this Agreement be deemed or held to be invalid or unenforceable, the remaining terms and provisions shall continue in full force and effect. This Agreement, all the terms herein, and all controversies described in Paragraph 5 shall be governed and construed in accordance with the laws of the state the client resides in where the transaction occurred. Your failure to insist at anytime upon strict compliance with any term of this Agreement, or any delay or failure on your part to exercise any power or right given to you in this Agreement, or a continued course of such conduct on your part shall at no time operate as a waiver of such power or right, nor shall any single or partial exercise preclude any other further exercise. All rights and remedies given to you in this Agreement are cumulative and not exclusive of any other rights or remedies which you otherwise have. I understand that DHHA shall not be liable for loss caused directly or indirectly by government restrictions, exchange or market rulings, suspension of trading, war, strikes, power failures, computer failures or other conditions, commonly known as acts of God, beyond DHHA s reasonable control.. This agreement represents our entire understanding with regard to the matters specified herein. No other agreements, covenants, representations, or warranties, express or implied, oral or written, have been made by any party to any other party concerning the subject matter of this agreement.

4 Investments are not insured by the FDIC, the Federal Reserve Board or any other agency, and are subject to investment risk, including the possible loss of principal. Securities possess certain inherent risks, including market risk. Upon a sale or redemption, you may receive more or less than invested. Verification of Account Holders To help the government fight the funding of terrorism and money laundering, my name and the names of all other authorized individuals on this account will be verified by searching the Treasury s Office of Foreign Asset Control s Specially Designated Nationals and Blocked Persons list and my government ID with be gathered and verified. Note for Direct Participation Program Clients: Pursuant to FINRA Rule 2810(b) (3) (D), I have been advised of all pertinent facts relating to the illiquidity and lack of marketability of direct participation programs. Investment Risk Disclosure: The undersigned is aware of the degree of risk involved with investments and has given the Investment Advisor Representative named below, information to demonstrate that this account and the trading anticipated in connection therewith is not unsuitable for the undersigned in light of the undersigned s investment objectives, financial situation and needs, experience and knowledge. Complaint Information Disclosure: Any client complaints shall be directed to Dan H. Hill at D.H. Hill Advisors, Inc., 1543 Green Oak Place, Suite 100, Kingwood Texas, 77339; Telephone (832) The undersigned acknowledge(s) that the information set forth herein has been reviewed and is accurate as of the date of signature. I represent and warrant to DHHA that all information furnished to DHHA in connection with the opening of the Account and all documents supplied by me in this regard, including financial statements, are true, complete and correct. DHHA is entitled to rely on this information until it receives written notice of any change. I agree to promptly notify DHHA of any significant change in the information provided by me or of any other significant change in my financial circumstances or investment objectives that might affect my Account and agree to provide DHHA with such additional information as DHHA may request from time to time. I agree to hold DHHA harmless from any damages resulting from advice or selected investments if my circumstances and/or objectives change since the rendering of such advice or the choosing of said investments or resulting from material facts about my situation which were not disclosed to DHHA. I further agree to consult with DHHA at least annually to provide updated information, if any, about my financial circumstances and investment objectives. By signing below, the client acknowledges that he has read and understands this document, and that he has received a copy of this document and a copy of D.H. Hill s Privacy Pledge and Notification. NOTE: THIS AGREEMENT CONTAINS A PRE-DISPUTE ARBITRATION CLAUSE WHICH IS LOCATED AT PARAGRAPH 5 ON PAGE 3. Title of Account: Joint (if applicable) Investment Advisor Representative Signature Investment Advisor Representative Number D. H. Hill Advisors, Inc. Office Use Only: Manager Signature

5 D.H. HILL D.H. Hill Advisors, Inc Green Oak Place, Suite 100 Kingwood, TX Ph Fax: IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING AN ACCOUNT WITH D.H. HILL ADVISORS, INC. To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. D.H. Hill Advisors, Inc. falls under the definition of financial institution. What this means to you: When you wish to open an account with D.H. Hill Advisors, Inc. we will ask for your name, address, date of birth and other information which will allow us to adequately identify you. We may also ask to see your driver s license, passport or other appropriate identifying documents and make copies of same. Thank you for your assistance in this matter of greatest importance as we all make every effort to combat terrorism, the funding of terrorism and other illegal laundering schemes. I acknowledge that I have received and read a copy of the above notice regarding opening an account with D.H. Hill Advisors, Inc.