Web Site or Search Engine TV or Radio Advertising Magazine / Newspaper Ad Scottrade BROKERAGE ACCOUNT APPLICATION Select Account Type: (Individual [=] Joint - type: WI ([] Custodial (use minor's SSN) 5 Coverdell ESA eI IRA - type: (C] Investment Club (CD Trust (C) Guardianship/Conservatorship (CJ Non-Corporate Organization ( Estate (F Corporate - type: APPLICANT Title of Account (If applicable, name of corporation/partnershipytrust/etc.) : Me Name First Middle Last | Mea Name First Middte Last Srethdion PO. Box or c/o address not permitted) eee anaes PO. Box or c/o address not permitted) me wo Home Phone Number Work Phone Number Cell Phone Number Home Phone Number Cell Phone Number News Article Friend Referral / Promotion Code I'm an Existing Scottrade Customer () Qualified Plan - type: Partnership - type: ([) Update Account # CO-APPLICANT (IF ANY) Mailing Address (if different from home address, P.O. Boxes may be used) Social Security or Tax ID Number Social Security or Tax ID Number Date of Birth Are you a U.S. Citizen? YES - Skip to "Occupation" Are you a U.S. Citizen? YES - Skip to "Occupation" Non-U.S. Citizens: NO - Complete the section below Non-US. Citizens: NO - Complete the section below Country of Citizenship: Country of Citizenship: Are you a permanent U.S. Resident? Are you a permanent U.S. Resident? ( YES - Alien Registration Number CO YES - Alien Registration Number (1 NO - Indicate your Visa type AND complete and sign (CO NO- Indicate your Visa type AND complete and sign the U.S. Visa Holder Statement (form number SF1039)* the U.S. Visa Holder Statement (form number SF1039)* “if you pian on staying i in the U.S. 183 days or less, contact our International Department = you plan an staying inthe U.S. 183 days or less, contact aur international Department to appt . ply for an account Occupation (CJ Employed (specify occupation) (J Setf-Employed [7] Unemployed [_] Retired ["] Homemaker [“] Student Employer (If self-employed, specify job function) (J) Employed (specify occupation) (J) Self-Employed [_] Unemployed [_] Retired [[] Homemaker ["] Student Employer (If self-employed, specify job function) Please answer the following: oO Yes Oo No |s any applicant employed by or affiliated with a securities firm, @ securities exchange, or FINRA? (if yes, provide name and address of Compliance Dept.) (J) No Is pany a applicant a a ‘contre Y” of “affiliate” of a public company 28 as defined by the SEC? This would generally include 10% shareholders, members of the -making officers. (if yes, provide trading symbol and company) gn political official? Type of Account (Choose A or B): A) Internet Trading (Requires e-mail address) (J Intemet: All securities & proceeds held in account. Trade confirmations and monthly account statements will be To receive paper copies for a fee, check one or both of the fol B) Non-internet Trading (Be advised that non-Intermet Commission Rates will apply.) . ‘ ions: Hold Proceeds OR Mail Proceeds Indicate Instructions: D1) Safekeeping Hold Dividends & Interest OR Mail Dividends & Interest Additional Services: [Marga (IRAs exctided): Sign Margin Agreement below [~] Options: Send me an Options Application & Disclosure Decument [] Transfer Account to Scattrade: Send me the Account Transfer form Under penalties of perjury, | certify that: (1) the number shown on this form is my correct taxpayer identification number (or | am waiting for a number to be issued to me); (2) Lam not subject to backup withholding because: (a) | am exempt from backup withholding, ng. (b ) | have not been notified by the Internal Revenue Service (IRS) that 1 gem Satie? to becieae withholding ne a reault of fahure all interest or dividends, or (c) the IRS has notified me that | am no longer subject to backu withholding; and (3)! am a U.S. person (including a U. nt alien). The IRS does not require my consent to any provision of this document other than certification required to avold backup withholding. Applicants who are subject fo backup withholding must cross out tem (2). BY SIGNING THIS AGREEMENT | ACKNOWLEDGE THAT | HAVE RECEIVED, READ AND AGREE TO ABIDE BY THE TERMS OF THE ACCOMPANYING BROKERAGE ACCOUNT AGREEMENT, WHICH CONTAINS A PRE-DISPUTE ARBITRATION CLAUSE AT SECTION 29. Referred By: (Name and/or Referral Number) to your online account free of c! Mail trade confirmation: each) {"]mait account statements ($2 each) X X Applicant/Authorized Person's Signature Date Co-Applicant/Authorized Person's Signature Date MARGIN PRIVILEGES - SIGN BELOW ONLY IF YOU DESIRE A MARGIN ACCOUNT By signing this agreement | acknowledge that | have received, read and agree to abide by the terms of the accompanying Grokerage Account! Agreement, including te Margin Account section starting at Section 53. X Xx Applicant/Authorized Person's Signature Date Co-Applicant/Authorized Person's Signature Date FOR SCOTTRADE USE ONLY Online Application Entry Registered Rep Registered Principal New Accounts Rep SNAP Approved SF1000/12-09 EFTA00289233