EFTA01237426.pdf

First Private Equity Group 70 Pine Street, New York, N.Y. 10005 FIRST PRIVATE Phone 1-212-937-3623 EQUITY GROUP Fax 1-212-656-1857 Email [email protected] GENERAL INFORMATION EMPLOYMENT CLIENT PROFILE 0 Income 0 Seely ol Princcat Cozensno 0 Growth 0 Tax Freeteteried Net Worth (orectutling 0 Soreuts•on 0 Ode, reeMence) Is Winos piny or an immildan lemay member inhalod with or is oche. party or an Immediate Witty mentor a cieecer. a 10% cepesect by key tecureaS inn. bank. trust 01 i eisiree greater tharehneer, ors polcipMerung execs:We olker of a eteneanitt suably trudge company' ❑Yas ONO 0 Yes 0 No 11 yes. vital hen and position' yos. what Wm and poskeno Intestine, Einem:rim Stocks Bonds Fume. Onions Risk Tolerance Tax Packet None 0 0 0 0 C lox 0 0-15% 0 29-36% Lrolo 0 0 0 0 C Moderate 0 16-26% 0 36%. Moderate 0 0 0 0 C High Extensive 0 0 0 0 ACCOUNT Mitt Trareacias Type: 0 Buy 0 See CI Deposit 0 'bander INFORMATION Selbeed 0 Sorel Dan*, Symbol. Type of Account. 0 Cash 0 Margin 0 °plea Noe or Regbelti0n O Irsfrodual O Partnershp• 0 Corporation • 0 Invastmert Advisor O twestment Mb • 0 Charitable 0 cussen 0 Tenants asCommon 0 TruSI ❑ Our 0 Joint Tenants ARMS MRerenms*• ' Additinial Doane= Flepared CERTIFICATION I hereby Carley mat the information retake on this born is bpi. caret' and complete to MO WSI ol my krowlediat Cerarcaam Stamen( (All poisons must sign 4 Vie is a joie accw'*I X Signature SOMYSO Dale Dale Should you *see a margin or open account. Ouse sign and COM01010 IN MARGIN AGREEMENT/LOAN CONSENT FORM or OPT ION AG REUSE NT. OFFICE USE ACe°4n. OM's) By: 0 °win Agreemeol Gout. ONLY Rep Sputure Delo. Branch Manager &Datum. Date EFTA01237426