CLIENT AGREEMENT
XXXXX XXXXXX
Account Number
Branch Account T C FC
- - - - - - - - - - - - -
Before you sign this Agreement, please read it carefully. Instructions for
the completion of this Agreement are contained in the accompanying booklet
entitled "Important New Account Information". After you have completed and
signed this Agreement, please return it in the enclosed postage-paid envelope.
Note: Signatures are MANDATORY in either Sections A and C OR Sections B and
C.
___________________________________________________________________________
Account Title
___________________________________________________________________________
Account Owner's Account Owner's
Name Name
___________________________________________________________________________
Street Apt. City State Zip Code
Address
___________________________________________________________________________
In consideration of Xxxxx Xxxxxx Inc. accepting an account for me (us), I (we)
hereby acknowledge that I (we) have read, understand and agree to the terms
of this Agreement contained in the sections numbered 1 through 11. If this
is a margin account, I (we) further acknowledge that I (we) have read,
understand and agree to the terms of this Agreement contained in the sections
numbered 15 through 17. If this is a joint account, we further acknowledge
that we have read, understand and agree to the terms of this Agreement
contained in the sections numbered 12 through 14. Note: Texas residents with
joint accounts must also execute a Texas Joint Account Supplement agreement
(form 3882).
A. Cash Accounts.
I (We) acknowledged that I (we) have received a copy of this Agreement which
contains a pre-dispute arbitration clause at section 5.
If this is a joint account, all parties must sign.
___________________________________________________________________________
Account Owner's Signature Date Joint Account Owner's Signature Date
___________________________________________________________________________
B. Margin Accounts.
By signing this Agreement, I (we) acknowledge that my (our) securities may be
loaned to you or loaned out to others. I (We) acknowledge that I (we) have
received a copy of this Agreement which contains a pre-dispute arbitration
clause at section 6.
If this is a joint account, all parties must sign.
___________________________________________________________________________
Account Owner's Signature Date Joint Account Owner's Signature Date
___________________________________________________________________________
C. Tax Certification (See Instructions on the last page of this form).
Under penalties of perjury, I certify that the number shown below is my
correct taxpayer identification number or if not, then the number I have
entered below is my correct tax identification number, and that I am not
subject to backup withholding because: (a) I have not been notified by the
Internal Revenue Service (IRS) that I am subject to backup withholding as a
result of failure to report all interest or dividends, or (b) the IRS has
notified me that I am no longer subject to backup withholding (see below), or
(c) I am exempt from backup withholding (see below). Note: You must cross
out (b) above if you are currently subject to backup withholding because of
underreporting interest or dividends on your tax return.
For those exempt from backup withholding, write the word "EXEMPT" here:
___________________________________.
The Social Securitiy Number or The Social Security Number or
Tax Identification Number on Tax Identification Number
Xxxxx Barney's records is: shown to the left is incorrect
The CORRECT number is:
______________________________ ______________________________
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______________________________ ______________________________
Note for joint accounts: The Social Security Number of this account is the
number of the client whose name appears first in the account title. Do not
enter the number of any other account owner.
___________________________________________________________________________
Account Owner's Signature Date Joint Account Owner's Signature Date
___________________________________________________________________________
D. Name Disclosure.
Please indicate your choice as to the release or withholding of your name,
address and securities positions to issuing corporations.
___ NO, I do not want } my name, address and securities disclosed to any
companies, upon their request, in which I own
___ YES, I do want } securitties that are being held for me at Xxxxx
Xxxxxx Inc.
___________________________________________________________________________
E. Money Market Fund Agreement.
Available cash in your account will automatically be invested or "swept" into
the money market fund of your choice. If you do NOT elect to have the
automatic money market fund sweep, please check the "NO" box below, If you
wish to change your choice of money market fund, please contact your Financial
Consultant.
(Note to Wisconsin residents: You must indicate below specifically whether
or not you wish to have a money market sweep for your account)
___ NO, I do not want cash balances in my account to be automatically swept
into a money market fund.
___ YES, I would like the cash balances in my account to be automatically
swept into the fund of my choice.
___________________________________________________________________________
F. Tenancy in Common. DO NOT Complete this Section if You Wish To Establish
A Joint Account With Rights of Survivorship. In the event of the death of
either or any of the undersigned, the interests in the account as of the close
of business on the date of the death of the decedent, or on the following
business day if the date of death is not a business day shall be as follows:
Note: Texas residents with joint accounts must also execute a Texas Joint
Account Supplement agreement (form 3882).
Name of Signature of
Participant____________ or his or her estate ___% Participant___________
