Account Application Form

Account Information

Account Registration

Select the type of registration you want on your Account

Individual Joint Tenants with Right of Survivorship (If one owner dies, his/her interest passes to the surviving owner(s)) Tenants in Common (If one owner dies, his/her interest passes to his/her estate (50/50, unless otherwise noted)) Other (Contact Ashford Wells Group to obtain additional documents that must accompany this application. Certain restrictions may apply.)

Account Holder

Mr Mrs Ms Dr

Last name

First name

Middle name

Email address(es)

Date of birth (mm/dd/yyyy)

Home address

City

State, Province

Country

Postal, Zip Code

Postal address (if different than above)

Home phone (if applicable) (Country code-Area code-Number)

Mobile phone (Country code-Area code-Number)

Other phone (if applicable) (Country code-Area code-Number)

Fax (optional) (Country code-Area code-Number)

Country of citizenship

Country of residence (if other than above)

Additional Account Holder

(If applicable)

Mr Mrs Ms Dr

Last name

First name

Middle name

Email address(es)

Date of birth (mm/dd/yyyy)

Home address

City

State, Province

Country

Postal, Zip Code

Postal address (if different than above)

Home phone (if applicable) (Country code-Area code-Number)

Mobile phone (Country code-Area code-Number)

Other phone (if applicable) (Country code-Area code-Number)

Fax (optional) (Country code-Area code-Number)

Country of citizenship

Country of residence (if other than above)

Securities industry regulations require that we request the following information:

(for account holder)

Employed Self-Employed Retired Unemployed

Employer/Business name

Nature of business

Business address

City

State, Province

Country

Postal, Zip Code

Business phone (Country code) (City/Area code) (Number)

Occupation/Position

Years with employer

Marital Status

Single Married Divorced

Number of dependents

Securities industry regulations require that we request the following information:

(for additional account holder)

Employed Self-Employed Retired Unemployed

Employer/Business name

Nature of business

Business address

City

State, Province

Country

Postal, Zip Code

Business phone (Country code) (City/Area code) (Number)

Occupation/Position

Years with employer

Marital Status

Single Married Divorced

Number of dependents

Is any member of your household a control person (Example: A person who can exercise power or has a controlling interest in a company) in a publicly traded corporation?

Yes No

If YES, please specify the corporation:

Investment Profile

(Account Holder)

Investment Knowledge

None Limited Good Extensive

Investment Experience

Common Shares

None Limited Good Excellent

Preferred Shares

None Limited Good Excellent

Bonds

None Limited Good Excellent

Money Marke

None Limited Good Excellent

New Issues

None Limited Good Excellent

Mutual Funds

None Limited Good Excellent

Options

None Limited Good Excellent

Commodities/Futures

None Limited Good Excellent

Venture Situations

None Limited Good Excellent

Trading Experience (years):

Equities

Bonds

Currencies

Commodities /Futures

Derivatives

Investment Knowledge

None Limited Good Extensive

Investment Experience

Common Shares

None Limited Good Excellent

Preferred Shares

None Limited Good Excellent

Bonds

None Limited Good Excellent

Money Marke

None Limited Good Excellent

New Issues

None Limited Good Excellent

Mutual Funds

None Limited Good Excellent

Options

None Limited Good Excellent

Commodities/Futures

None Limited Good Excellent

Venture Situations

None Limited Good Excellent

Trading Experience (years):

Equities

Bonds

Currencies

Commodities /Futures

Derivatives

Investment Goal

Capital Preservation Income Growth Speculation

Investment Objective Definitions: Capital preservation: The objective of capital preservation is to protect your initial investment by choosing investments that minimize the potential of any loss of principal. The long-term risk of capital preservation is that the returns may not be adequate to offset inflation. Income: The primary objective of an income strategy is to provide current income rather than long-term growth of principal. Growth: The objective of a growth strategy is to increase the value of your investment over time with recognizing a high likelihood of volatility. Speculation: A speculator's objective is to assume a higher risk of loss in anticipation of potentially higher than average gain by taking advantage of expected price changes

Does anyone other than the account holder(s) have trading authorization over the account?

Yes No

If yes, please complete and mail Power of Attorney form to add an individual as having trading authority

I /We am/are of legal age to enter in this agreement. I hereby request that Ashford Wells Group open an account in the name(s) listed as account holder(s) on this application. I/We the undersigned agree to provide instructions as an authorized signatory to Ashford Wells Group via phone, fax, email or any other method deemed appropriate by Ashford Wells Group without instructions being duly confirmed in writing. Therefore, this signed document allows Ashford Wells Group to process transactions sent via any of the above mentioned mediums without liability in any form to Ashford Wells Group or its employees.

I understand there are fees associated with establishing, maintaining, engaging in transactions, and transferring assets out of this account. I further acknowledge that securities products purchased or sold in a transaction with Ashford Wells Group are subject to investment risks, including possible loss of the principal invested. I understand that Ashford Wells Group does not provide tax, legal or accounting advise.

Signature of Primary Account Owner

Signature of Co-Account Owner

FOR ASHFORD WELLS GROUP ONLY

Approved By

Date Approved (mm/dd/yyyy)

Print Name of Approver

Source Code

Indexing Code

Branch Office and Account Number

ACCOUNT APPLICATION FORM

Account Information

Account Registration

Account Holder

Additional Account Holder

Securities industry regulations require that we request the following information:

Securities industry regulations require that we request the following information:

Investment Profile

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