Common use of Dealer Information Clause in Contracts

Dealer Information. If opening your account through a Broker/Dealer or Registered Investment Advisor, please have them complete this section. Dealer Name Representative’s Last Name, First Name DEALER HEAD OFFICE REPRESENTATIVE’S BRANCH OFFICE Address Address City, State, ZIP City, State, ZIP Telephone Number Rep Telephone Number Rep ID Number Email Address Rep Email Address Branch ID Number Branch Telephone Number (if different than Rep Phone Number)

Dealer Information. If opening your account through a Brokerbroker/Dealer or Registered Investment Advisordealer, please have them complete this section. Dealer Name Representative’s Last Name, First Name DEALER HEAD OFFICE REPRESENTATIVE’S BRANCH OFFICE Address Address City, State, ZIP Zip City, State, ZIP Zip Telephone Number Rep Telephone Number Rep ID Number Email Address Rep Email Address Branch ID Number Branch Telephone Number (if different than Rep Phone Number)Rep’s ID

Dealer Information. If opening your account through a Brokerbroker/Dealer or Registered Investment Advisordealer, please have them complete this section. Dealer Name Representative’s Last Name, First Name DEALER HEAD OFFICE REPRESENTATIVE’S BRANCH OFFICE Address Address City, State, ZIP Zip City, State, ZIP Zip Telephone Number Rep Telephone Number Rep Rep’s ID Number Email Address Rep Email Address Branch ID Office Telephone Number Branch Telephone Number (if different than Rep Phone Number)ID

Dealer Information. (If opening your account through a Brokerbroker/Dealer or Registered Investment Advisordealer, please have them complete this section). Dealer Name Representative’s Last Name, First Name DEALER HEAD OFFICE REPRESENTATIVE’S BRANCH OFFICE Address Address City, State, ZIP Zip City, State, ZIP Zip Telephone Number Rep Telephone Number Rep Rep’s ID Branch Number Branch Number Email Address Rep Email Address Branch ID Office Telephone Number Branch Telephone Number (if different than Rep Phone Number)ID