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METROPOLITAN INVESTMENT SECURITIES Document
Number
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SUBSCRIPTION AGREEMENT Investor Number
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[ ] METROPOLITAN MORTGAGE & SECURITIES CO., INC. [ ] New Account
[ ] SUMMIT SECURITIES, INC. [ ] Change Account
[ ] WESTERN UNITED HOLDING COMPANY Information
000 X. 0xx Xxx. Xxxx 000000, Xxxxxxx, XX 99201-5041
If you need assistance in filling out this form, call us toll free at
0-000-000-0000, in Spokane (000) 000-0000.
Type of Account [ ] SEPARATE PROPERTY [ ] GUARDIAN [ ] CORP/PARTNERSHIP Interest Options:
[ ] CUSTODIAN [ ] XXX [ ] TRUST [ ] TENANTS IN COMMON [ ] Account Payments [ ] mo
[ ] JOINT TENANT WROS [ ] COMMUNITY PROPERTY [ ] UTMA/UGMA Withholding [ ] quarterly [ ] semi-
annual
% OR compound
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$
---------- [ ] semi
[ ] annual
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[ ] Investment [ ] Investment [ ] Discount Investment Interest Term Installment Term
Advisor Debentures or Debentures or Amount (Months) Payments [ ]mo AND Amortization Term
[ ] Registered Rep Certificates Certificates 60-120 mos.
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[ ] Preferred Stock Investment Amount Payment of Dividends
Series [ ] Cash
---------- [ ] Automatic Reinvestment
Issue Date The ISSUE DATE for Debentures/certificates (only) shall be the postmark date on mailed transmittals of
funds and complete paperwork to the Issuer's office in Spokane, WA, or in all other cases, the date of
actual receipt of funds and complete paperwork by the Issue at its Spokane offices.
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Registrant's First Name (if Trust, provide full name and year of the Trust) Middle Last
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Additional names (If joint Account, "AND" status, or other individual, i.e. Trustee
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Physical Address Required (State of Domicile) City State Zip
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[ ] Please issue all distributions in the "OR" status __________ Initial Home Phone No. Marital Status (check one)
__________ Initial ( ) [ ] Single [ ] Married [ ] Widowed
[ ] Divorced
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[ ] Male Date of Birth Date of Birth for JT Work Phone No. [ ] U.S. Citizen [ ] 1078 Attached
[ ] Female ( ) (Resident Alien)
[ ] W-8 Attached (Non-Resident Alien)
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Social Security No. or Tax ID No. Social Security # [ ] Joint Tenant Check the box if you are subject to
Backup Withholding
[ ] under the provisions of Section
3406(a)(1)(c) of the Internal
Revenue Code. (see reverse)
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Mail to Other [ ] Duplicate Statement [ ] Checks Bank Account No. / ACH Info (Attach deposit slip)
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Address City State Zip
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[ ] XXX Beneficiary [ ] XXX/POD Address Relationship Percent Birthdate Social Security #
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[ ] XXX Beneficiary [ ] XXX/POD Address Relationship Percent Birthdate Social Security #
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[ ] XXX Beneficiary [ ] XXX/POD Address Relationship Percent Birthdate Social Security #
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[ ] TRADITIONAL XXX [ ] SEP XXX [ ] EDUCATION XXX [ ] XXXX XXX [ ] CONVERSION XXXX XXX
[ ] NEW CONTRIBUTION: Tax Year Amount $ Tax Year Amount $
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[ ] DIRECT ROLLOVER (Qualified Plan) $ [ ] REINVESTMENT $ [ ] CONVERSION YEAR
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[ ] DIRECT TRANSFER (from XXX) $ [ ] ROLLOVER $ [ ] CONVERSION AMOUNT $
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OFFICE USE ONLY
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SUBSCRIBER'S SIGNATURE & DATE DATE RECEIVED DATE POSTMARKED COMMENTS
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SUBSCRIBER'S SIGNATURE & DATE INVESTMENT REP. SIGNATURE & DATE, REP # PRINCIPAL SIGNATURE & DATE
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WHITE-OFFICE COPY YELLOW-CUSTOMER COPY
Page 2
SUBSCRIPTION AGREEMENT -- CONFIDENTIAL
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Metropolitan Investment Securities, Inc., is required by the National Association of Securities Dealers, Inc. (NASD) to obtain
certain information about your financial situation and needs, investment objectives and investment experience. The following
information will be kept strictly confidential and used only to determine suitability of investments, subject to examination by the
NASD and other regulatory authorities.
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Sources of Annual Income (as a Percentage of Total Income)
EMPLOYMENT COMPENSATION % INVESTMENT INCOME % ESTIMATED ANNUAL INCOME $
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Other Income Source (please specify) RISK TOLERANCE: [ ] High [ ] Medium [ ] Low
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Investment Objective (if more than one, give order of importance, 1 highest, 2, 3, etc.)
INCOME CAPITAL APPRECIATION OTHER
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LIQUIDITY PRESERVATION OF CAPITAL
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Previous Investment Experience
[ ] INVESTMENT REAL ESTATE [ ] COMMODITIES & OPTIONS [ ] STOCK [ ] MUTUAL FUNDS [ ] CDs
[ ] MONEY MARKET [ ] BONDS & DEBENTURES [ ] ANNUITIES [ ] OTHER (please specify)
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Investments (including this investment) Approximate Current Other Investments Types Amount/Values
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Estimated Liquid Net Worth - Cash, Equity Securities, Money Market Balances, etc.
OVER $
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Estimated Net Worth - Excluding Primary Residence, Furnishings and Primary Automobile (including MIS Investments)
OVER $
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Please provide any other information you deem relevant to your financial status, investment objectives, or investment experience.
Attach additional sheets if necessary.
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[ ] Check here if you are employed by a registered Broker/Dealer, Bank, Have you ever advised anyone else with regard to
Investment Advisor or Insurance Company financial investments?
[ ] YES [ ] NO
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Employer Type of Business Title
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Employer Address City State Zip
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Length of Time Employed If less than two years or if retired, provide previous employer and occupation
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This
subscription agreement, including the terms on the reverse side hereof, contains the entire agreement between MIS and
subscriber for the purchase of the described security. The undersigned certify that I/We have full authority and legal capacity to
purchase the above securities. I/WE ACKNOWLEDGE RECEIPT OF A COPY OF THE PROSPECTUS RELATING TO THE SPECIFIED SECURITIES PRIOR TO
EXECUTION OF THIS
SUBSCRIPTION AGREEMENT. I/WE CONSIDER THE INVESTMENT APPROPRIATE FOR MY/OUR INVESTMENT PORTFOLIO, CONSIDERING
MY/OUR OTHER SECURITY HOLDINGS, INVESTMENT OBJECTIVES, AND FINANCIAL SITUATION AND NEEDS. I/WE HAVE HAD THE OPPORTUNITY TO DISCUSS
MY/OUR FINANCIAL SITUATION, INVESTMENT OBJECTIVES AND NEEDS WITH MY/OUR INVESTMENT REPRESENTATIVE. Under the penalties of perjury,
I/We certify that the information pertaining to Social Security No., Tax ID No. and backup withholding is true, correct and
complete.
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SUBSCRIBER'S SIGNATURE DATE SUBSCRIBER'S SIGNATURE DATE
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FOR XXX ACCOUNTS. CONSENT OF SPOUSE MAY BE REQUIRED IN COMMUNITY PROPERTY STATES IF PERSONS OTHER THAN OR IN ADDITION TO SPOUSE ARE
DESIGNATED BENEFICIARY.
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SIGNATURE OF SPOUSE DATE
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INVESTMENT REPRESENTATIVE'S APPROVAL AND RECEIPT. Based on the above information and my discussion with the Subscriber(s) regarding
their other securities holdings, investment objectives, financial situation and needs, I believe that the purchase of these
securities is suitable for the above signed Subscriber(s). I acknowledge receipt of the amount of this subscription in the following
form(s):
[ ] CHECK [ ] METROPOLITAN / SUMMIT SECURITIES CERTIFICATE NUMBERS
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INVESTMENT REPRESENTATIVES SIGNATURE REP NUMBER DATE STATE OF SALE
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MIS APPROVAL. BY SIGNING BELOW, THE UNDERSIGNED SUPERVISOR OF METROPOLITAN INVESTMENT SECURITIES CONCURS WITH THE BELIEF OF
SUITABILITY AND APPROVES THE PROPOSED INVESTMENT.
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AUTHORIZED SIGNATURE / ISSUER / MIS DATE
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WHITE-OFFICE COPY YELLOW-CUSTOMER COPY
BROKERAGE ACCOUNT
PRE-DISPUTE
ARBITRATION AGREEMENT
I AM AWARE OF THE FOLLOWING:
(A) ARBITRATION IS FINAL AND BINDING ON THE PARTIES.
(B) THE PARTIES ARE WAIVING THEIR RIGHT TO SEEK REMEDIES IN COURT,
INCLUDING THE RIGHT TO JURY TRIAL.
(C) PRE-ARBITRATION DISCOVERY IS GENERALLY MORE LIMITED THAN AND
DIFFERENT FROM COURT PROCEEDINGS.
(D) THE ARBITRATORS' AWARD IS NOT REQUIRED TO INCLUDE FACTUAL
FINDINGS OR LEGAL REASONING AND ANY PARTY'S RIGHT TO APPEAL OR
SEEK MODIFICATION OF RULINGS BY THE ARBITRATORS IS STRICTLY
LIMITED.
(E) THE PANEL OF ARBITRATORS WILL TYPICALLY INCLUDE A MINORITY OF
ARBITRATORS WHO WERE OR ARE AFFILIATED WITH THE SECURITIES
INDUSTRY.
I AGREE THAT ALL CONTROVERSIES THAT MAY ARISE BETWEEN US CONCERNING ANY ORDER OR
TRANSACTION, OR THE CONTINUATION, PERFORMANCE OR BREACH OF THIS OR ANY OTHER
AGREEMENT BETWEEN US, WHETHER ENTERED INTO BEFORE, ON, OR AFTER THE DATE THIS
ACCOUNT IS OPENED, SHALL BE DETERMINED BY ARBITRATION BEFORE A PANEL OF
INDEPENDENT ARBITRATORS SET UP BY EITHER THE
NEW YORK STOCK EXCHANGE, INC., OR
NATIONAL ASSOCIATION OF SECURITIES DEALERS, INC., AS I MAY DESIGNATE. IF I DO
NOT NOTIFY YOU IN WRITING WITHIN FIVE (5) DAYS AFTER I RECEIVE FROM YOU A
WRITTEN DEMAND FOR ARBITRATION, THEN I AUTHORIZE YOU TO MAKE SUCH A DESIGNATION
ON MY BEHALF. I UNDERSTAND THAT JUDGMENT UPON ANY ARBITRATION AWARD MAY BE
ENTERED IN ANY COURT OF COMPETENT JURISDICTION.
NO PERSON SHALL BRING A PUTATIVE OR CERTIFIED CLASS ACTION TO ARBITRATION, NOR
SEEK TO ENFORCE ANY PRE-DISPUTE ARBITRATION AGREEMENT AGAINST ANY PERSON WHO HAS
INITIATED IN COURT A PUTATIVE CLASS ACTION; WHO IS A MEMBER OF A PUTATIVE CLASS
WHO HAS NOT OPTED OUT OF THE CLASS WITH RESPECT TO ANY CLAIMS ENCOMPASSED BY THE
PUTATIVE CLASS ACTION UNTIL:
(I) THE CLASS CERTIFICATION IS DENIED;
(II) THE CLASS IS DECERTIFIED; OR
(III) THE CUSTOMER IS EXCLUDED FROM THE CLASS BY THE COURT.
SUCH FORBEARANCE TO ENFORCE AN AGREEMENT TO ARBITRATE SHALL NOT CONSTITUTE A
WAIVER OF ANY RIGHTS UNDER THIS AGREEMENT EXCEPT TO THE EXTENT STATED HEREIN.
TRANSFER FEES
PLEASE NOTE THAT THERE WILL BE A $25 SERVICE CHARGE PER TRANSACTION FOR ANY
TRANSFER OR EXCHANGE OF CERTIFICATES.
NATIONAL ASSOCIATION OF SECURITIES DEALERS (NASD) PUBLIC DISCLOSURE PROGRAM
The NASD Public Disclosure Program provides an investor brochure describing the
program. Inquiries for this brochure can be made via NASD Regulation's toll-free
telephone listing (0-000-000-0000), or the NASD Regulation's Internet site
(xxxx://xxx.xxxxx.xxx).
AGREEMENT
Subscriber subscribes for and tenders the stated investment amount as full
payment of the investment described. This investment is not insured by the
United States Government, any state government, nor any agency thereof. If this
is an investment for investment certificates or investment debentures, any
indenture relating to the investment contains statements of the rights of the
holders of the investment, MIS and the trustee named in the indenture. MIS
agrees to issue a Receipt evidencing the investment to the designated persons
upon acceptance hereof and payment in full.
Subscriber does hereby acknowledge that he/she has obtained such independent tax
or legal advice regarding the effect of this investment as he/she deems
necessary and that he/she is not relying upon Metropolitan Investment
Securities, Inc. or their agents or employees for such advice. Such parties are
hereby released from any claim for damages in the event of the failure of this
transaction to accomplish the tax or legal purposes intended by Subscriber.
This
Subscription Agreement contains the entire agreement between MIS and
subscriber for the purchase of the described Security. This
Subscription
Agreement shall not be binding upon MIS until it is accepted by an officer of
MIS. Receipt, acceptance, negotiation or deposit by MIS of any security, draft,
check, note or cash shall not constitute acceptance of this
Subscription
Agreement. If it is not accepted, Subscriber shall be entitled to the return of
all monies paid without interest thereon. When accepted, this
Subscription
Agreement shall be irrevocable by both the Subscriber and MIS. Notwithstanding
the foregoing sentence, XXX investments are revocable in accordance with the XXX
custodial agreement.
IMPORTANT TAX INFORMATION
You (as a payee) are required by law to provide us (as payer) with your correct
taxpayer identification number. Accounts that have a missing or incorrect
taxpayer identification number will be subject to backup withholding at a 31
percent rate on interest, dividends and other payments. If you have not provided
us with your correct taxpayer identification number, you may be subject to a
penalty imposed by the Internal Revenue Service.
If the account is in more than one name, give the Social Security Number of the
actual owner of the account or, if joint fund, either person. For Custodian
account of a minor (Uniform Gift to Minor's Act), give the name and the Social
Security Number of the minor. A grantor or revocable trust needs the name and
Social Security Number of the grantor. Partnerships need to state the names of
the partners and its Employer Identification Number. Other trusts must provide
the correct legal name of the trust and the Employer Identification Number.
INDIVIDUAL RETIREMENT ACCOUNT
SUPPLEMENTAL DISCLOSURE STATEMENT
Subscriber has requested Metropolitan Mortgage & Securities Co., Inc.
(Metropolitan) to act as custodian of his or her XXX (the "Plan") under which
some or all of the assets of the plan will be invested in debentures or other
securities issued by Metropolitan.
Neither the representative, Metropolitan, Summit, Western nor Metropolitan
Investment Securities, Inc. is acting as an investment advisor or other
fiduciary with regard to investment decisions of the plan. All decisions with
respect to purchases of securities by the plan are to sole responsibility of
subscriber as fiduciary for the plan. Subscriber approves the purchase of
Metropolitan, Western and Summit Securities by and on behalf of the plan and
acknowledges receipt of the foregoing information prior to the plan's purchase
of Metropolitan, Western and Summit Securities.
INDIVIDUAL RETIREMENT ACCOUNT
ADOPTION AGREEMENT AND BENEFICIARY DESIGNATION
(Under Section 408(a) of the Internal Revenue Code)
The Agreement is entered into between the Owner (subscriber) and Metropolitan
Mortgage & Securities Co., Inc. (called "Custodian") having its principal place
of business at 000 X. 0xx Xxx. Xxxx. 000000, Xxxxxxx, Xxxxxxxxxx 00000.
A. Owner desires to provide for his or her retirement and for the support
of his or her beneficiaries upon his or her death and, to accomplish
these purposes, desires to establish an Individual Retirement Account
(called "XXX") as described in Section 408(a) of the Internal Revenue
Code of 1954, as amended, or any successor statue (called "the Code").
B. Owner does hereby accept the Metropolitan Mortgage & Securities Co.,
Inc. Sponsored Custodian Individual Retirement Account Plan (called
"the Plan"), the terms of which are incorporated herein by this
reference, for the exclusive benefit of owner and his or her
beneficiaries.
C. Owner acknowledges receipt of a copy of the Plan document and agrees to
be bound by the terms and provisions thereof. Owner further
acknowledges receipt of a copy of the Disclosure Statement applicable
to the Plan.
D. BENEFICIARY DESIGNATION. I hereby designate the beneficiary or
beneficiaries as indicated on the reverse hereof under my Plan revoking
all prior designations made by me. This designation is subject to all
the terms, conditions and provisions of the Plan and shall become
effective when received by the Custodian of said Plan prior to my
death. I shall have the right to change this designation at any time
during my lifetime by filing a new designation with the Custodian. If
none of the named beneficiaries is living upon my death this
designation shall be of no effect, and the provision of the plan shall
apply.
