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<br />Are you (or a member JfYour household) a director, 10% shareholder, or policy-making officer of a publicly traded company? <br />o Yes (j No Jf yes, please specify company name and address: <br /> <br />Do you (or amemberftyour household) have an affiliation with, or work for, a securities fi:rm, bank, trust or insurance company? <br />OYes 6No If yes, please specify company name and address: <br /> <br />I 4. ACCOUNT INSTRUCTIONS <br /> <br />Does any other perso~ve Power of Attorney over this account? <br />OYes ONo If yes, please specify individuals name, (Attach supporting documentation) <br /> <br />Payment and Delivery Instructions: For your convenience, our clearing:firm will hold all securities you purchase in "street namell. <br />Please contact your broker if you wish to have securities transferred and shipped to you. If nothing below is marked, the account will be <br />coded to hold everything. <br /> <br />DividendsJInterest: <br />Sales Proceeds: <br /> <br />Q1kld in Account <br />()1i:old in Account <br /> <br />o Send to Customer <br />o Send to Customer <br /> <br />Duplicate Confirmations and Statements: UfseasonaJ, please specify start and end dates: <br />Name: <br />Address: <br />City, State, Zip <br /> <br />) <br /> <br />Margin and Option Acconnt: If you wish to add margin capabilities and option trading to this account, please indicate below. A <br />completed and signed Margin Account Agreement and/or Option Account Agreement will be required. <br /> <br />Yes, please provide me with the required paperwork: 0 Margin Account 0 Option Trading Account <br /> <br />~1/e.r n Y'Y1R.rJ <br />Cash-Management Services: Any credit balances held in your account will automatically sweep to a Money Market Fund, unless you <br />instruct your broker otherwise. Through our clearing linn, BNY Clearing Services, we are also able to offer the following personal <br />financial services for your account. Please indicate below if you are interested in more infonnation. <br /> <br />o Check-writing privileges <br /> <br />o MasterCard@Platinum debit card <br /> <br />OACH capabilities <br /> <br />Under rule 14b-l (c) of the Securities Exchange Act, Northland Securities Inc. is required to disclose to an issuer the name, address and <br />securities positions of our customers who are beneficial owners of that issuerls securities unless the customer objects. If you object to the <br />disc10spre of such information. please check this box: 0 <br /> <br />By signing below, I acknowledge the following: <br /> <br />] have carefully read and reviewed this entire document. All of the <br />information printed above is true, correct and accurate. I agree to <br />notify Northland Securities Inc. should my investment situation <br />and/or objectives change. <br /> <br />] acknowledge that I have read, understand and agree to be bound <br />by the terms and conditions of the BNY Clearing Customer Account <br />Agreement and Disclosure Document. 1 further acknowledge that 1 <br />have read and understand the pre-dispute arbitration clause located <br />in paragraph 26 of the Customer Account Agreement and <br />Disclosure Document and agree to resolve any disputes arising out <br />o m account b arbitration, <br /> <br />;. <br /> <br />NORTHLAND~SECURITIES <br /> <br /> <br />Investment Executive <br /> <br />Approved By <br />Date <br /> <br />This record is the property of Northland Securities Inc. <br /> <br />Northland Securities. Inc, . 45 South 7th Street. Suite 2500 . Minneapolis, MN 55402 . 1-800-851-2920 . www.northlandsecurities.coID <br />NAlOOl(IOlO2) <br />