ACCESS REQUEST AND INFORMATION FORMAccess Request and Information Form • January 5th, 2017
Contract Type FiledJanuary 5th, 2017This Access Request and Information Form (“Access Request Form”) is being executed pursuant to the Eris Exchange Connection Agreement, Eris Exchange Third Party Connection Agreement, or Eris Exchange Clearing Firm Agreement (the “Agreement”) between ERIS EXCHANGE, LLC., a Delaware Limited Liability Company with its principle place of business at 227 West Monroe Street, Suite 2070, Chicago, Illinois 60606, (“Eris Exchange”) and (“Company”). Any capitalized terms not defined herein shall have the meaning set forth in the Eris Exchange Connection Agreement or Third Party Connection Agreement.