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Fee Disclosure Form

Investment Fee Agreement

Date*
MM slash DD slash YYYY
Client Name(s)*
First Name Last Name Age
Account Info*
Account Type Account Owner How is it being funded? Approximate Value? Annual Fee % Fee Paid by Acct? Y/N
Risk Tolerance*
Client Name Risk Willingness Score Risk Ability Score Client Name Risk Willingness Score Risk Ability Score Joint Tolerisk? Y/N
Advisor Notes*
Investment Model*
Hidden
Advisor Signature & date
Hidden
COO Signature & date