Portfolio Management Services Packet

   Capital Investment Group, Inc.
Dear Solicitor Agent:

Thank you for your interest in Capital Investment Counsel and its portfolio management services. Th...
Reset Form
■ NEW ACCOUNT                           ■ UPDATE                                                               ...
CUSTOMER AGREEMENT
1..  In consideration of Capital Investment Group, Inc. (“CIG”) accepting one or more accounts (Account...
Reset Form




                                 Investment Advisory Client Agreement

This Agreement is entered into this ...
4.    COMPENSATION

     a.   Compensation of Counsel for its services as provided by this Agreement shall be paid quarter...
d.   Counsel and its Advisers may acquire or depose of securities in which Client has or may acquire a position.
         ...
a.   All communications by Counsel shall be directed to the address of record provided by the Client. In the
         even...
EXHIBIT A
Fee Schedule:

         Market Value             Option A (Wrap)        Option B (Fee +   Option C (Fee Only)
  ...
Trading Authorization

By entering into this agreement, the below Client authorizes Capital Investment Counsel, Inc. and i...
Letter of Authorization
Dear Sir/Madame:

This letter serves as authorization for Capital Investment Counsel, Inc. (“Couns...
Solicitation Agreement & Disclosure
This Agreement is entered into by Capital Investment Counsel, Inc. (“Counsel”), the So...
Money Management Investment Objectives & Guidelines

                                                (Please print the fol...
Dear Sir/Madame:


This questionnaire is designed to gather pertinent information needed to understand your financial goal...
Client Profile

Last name: _________________________                      First name:_____________________________        ...
General Questions
1.   What is your major reason for investing?
     a. Preserving capital
     b. Education funding
     ...
10. In constructing and managing a portfolio, answer each question on which is most important to you?

    ___ Investing i...
13. Many times portfolio performance comes after planting many seeds and “testing a client’s patience.” We have always fou...
19. If Yes to the prior question, please describe any changes you anticipate to your overall financial circumstances in th...
24. While the value of your investment is expected to increase over the long term, in the short term the value of any port...
Portfolio Management Services Packet
Portfolio Management Services Packet
Portfolio Management Services Packet
Portfolio Management Services Packet
Portfolio Management Services Packet
Portfolio Management Services Packet
Portfolio Management Services Packet
Portfolio Management Services Packet
Portfolio Management Services Packet
Portfolio Management Services Packet
Portfolio Management Services Packet
Portfolio Management Services Packet
Portfolio Management Services Packet
Portfolio Management Services Packet
Portfolio Management Services Packet
Portfolio Management Services Packet
Portfolio Management Services Packet
Portfolio Management Services Packet
Portfolio Management Services Packet
Portfolio Management Services Packet
Portfolio Management Services Packet
Portfolio Management Services Packet
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Portfolio Management Services Packet

  1. 1. Portfolio Management Services Packet Capital Investment Group, Inc.
  2. 2. Dear Solicitor Agent: Thank you for your interest in Capital Investment Counsel and its portfolio management services. The following items are enclosed for your Client’s review and execution, where applicable. In the case of the Solicitation Agreement and Disclosure, you as the Solicitor are required to review and execute. 1. New Account Form and Brokerage Forms – A New Account Form will need to be completed and then executed by the Client. Also, additional required brokerage forms (i.e. trust certifications, IRA Simplifier, etc.) must be completed commiserate with account registration(s) for each account to be managed by Counsel. Additional required brokerage forms can be obtained from the firm’s web site, www.capital-invest.com. 2. Investment Advisory Agreement – The agreement is to be executed by Client and Counsel’s authorized signatory. All blank items and selection options are to be completed by the Client. 3. Trading Authorization Form – The form is to be executed by the Client and Counsel’s authorized signatory. 4. Letter of Authorization – The Letter of Authorization page is to be completed by Clients for their quarterly investment advisory fees to be debited from their brokerage account. 5. Solicitation Agreement and Disclosure – The agreement is to be executed by Client, Solicitor, and Counsel’s authorized signatory. 6. Money Management Investment Objectives and Guidelines – The document is to be completed and executed by the Client with assistance from the Solicitor. 7. Privacy Policy – The privacy policy is to be provided to all prospective Clients. 8. Form ADV Part ll & Schedule F – The information is to be provided to all prospective Clients about Capital Investment Counsel, Inc. We encourage all Clients to read such document closely. 9. Wrap Fee Program Brochure – The brochure is required to be provided to prospective Clients for informational purposes. Unlike Schedule ll, this brochure provides more detailed information about participation in the Wrap Fee Program. We encourage all Wrap Fee Program participants to read such document closely. Once we have received and processed the paperwork, we will mail a copy of the fully executed documents to both you and your client. Please make sure that you send the original documents (numbers 1-6) to: Capital Investment Counsel, Inc. Attn: Kristin Matthews 17 Glenwood Avenue Raleigh, NC 27603 Once again, thank you for your interest in Capital Investment Counsel, Inc. Should you have any questions, please contact Kristin Matthews at (919) 863-2384. Respectfully, Capital Investment Counsel, Inc.
  3. 3. Reset Form ■ NEW ACCOUNT ■ UPDATE NEW ACCOUNT FORM Account Carried By: ACCOUNT NO. AE# DATE ■ STERNE, AGEE & LEACH ■ DIRECT INVESTMENT - (REITS, Mutual Funds, Insurance, Annuities) ACCOUNT NAME - ADDRESS - DISCLOSURES ACCOUNT NAME SOC. SEC. OR TAX I.D. NO. DL NUMBER DATE OF BIRTH JOINT TENANT NAME/MINOR IF CUSTODIAL/TTEE NAME SOC. SEC. OR TAX I.D. NO. DL NUMBER DATE OF BIRTH HOME TELEPHONE NO. BUSINESS TELEPHONE NO. E-MAIL ADDRESS ( ) ( ) MAILING ADDRESS CITY STATE ZIP CODE LEGAL ADDRESS (IF DIFFERENT) CITY STATE ZIP CODE ■ YES ■ NO Are you affiliated with or related to any employee or financial representative of Capital? Specify person and relationship. _____________________________________ ■ YES ■ NO Are you associated with or related to someone who is an employee of a member firm of a stock exchange or NASD or an officer of a bank, trust company, or insurance company? Indicate person, firm, and relationship. __________________________________________________________________________________________ ■ YES ■ NO Are you or a related person a director, a 10% shareholder, or policy-making executive of a publicly traded company? Indicate company’s name and relationship. _____________________________________________________________________________________________________________________________________ ■ YES ■ NO I want my name, address, and security position disclosed to requesting companies in which I hold securities in street or nominee name. (See Section 20.) FOR PERSONAL ACCOUNTS EMPLOYED BY OCCUPATION ANNUAL INCOME NET WORTH LIQUID NET WORTH BUSINESS ADDRESS CITIZENSHIP MARRIED? TAX BRACKET CITY STATE ZIP CODE SPOUSE/JT.TEN/TTEE INCOME SPOUSE/JT.TEN/TTEE OCCUPATION ACCOUNT INFORMATION TYPE OF ACCOUNT TO BE OPENED: ■ CASH ■ MARGIN (FORWARD ADDITIONAL INFORMATION) ■ OPTION (FORWARD ADDITIONAL INFORMATION) ACCOUNT REGISTRATION: INVESTMENT ADVISOR ACCOUNTS ■ INDIVIDUAL (001) ■ IRA (074) ■ NON-PROFIT ORG. (065) ■ TRUST (073) ■ CAPITAL INVESTMENT COUNSEL ■ JTWROS (002) ■ ROTH IRA (074) ■ CUSTODIAN FOR MINOR (010) ■ ESTATE (071) ■ CIC ADVISERS, LLC ■ CORPORATION (003) ■ SIMPLE (076) ■ JT TENANTS IN COMMON (020) ■ DVP/RVP (050) ■ CAPITAL ADVISERS ■ PARTNERSHIP (056) ■ SEP (076) ■ 529 PLAN ■ OTHER ■ OTHER ____________________________________________ INVESTMENT OBJECTIVES, RISK TOLERANCE, AND EXPERIENCE PRIMARY OBJECTIVE & RISK TOLERANCE SECONDARY OBJECTIVE & RISK TOLERANCE INVESTMENT EXPERIENCE Select only one objective and time horizon. Select one objective and risk tolerance (not required). Provide your experience in years. ■ PRESERVATION OF CAPITAL + CONSERVATIVE (A) ■ PRESERVATION OF CAPITAL + CONSERVATIVE (A) Stocks __________ ■ PRESERVATION OF CAPITAL + MODERATE (B) ■ PRESERVATION OF CAPITAL + MODERATE (B) Bonds __________ ■ INCOME + CONSERVATIVE (C) ■ INCOME + CONSERVATIVE (C) Mutual Funds __________ ■ INCOME + MODERATE (D) ■ INCOME + MODERATE (D) ETFs __________ ■ CAPITAL APPRECIATION/GROWTH + CONSERVATIVE (E) ■ CAPITAL APPRECIATION/GROWTH + CONSERVATIVE (E) Variable Insurance __________ ■ CAPITAL APPRECIATION/GROWTH + MODERATE (F) ■ CAPITAL APPRECIATION/GROWTH + MODERATE (F) Variable Annuities __________ ■ CAPITAL APPRECIATION/GROWTH + AGGRESSIVE (G) ■ CAPITAL APPRECIATION/GROWTH + AGGRESSIVE (G) Options __________ ■ SPECULATION + AGGRESSIVE (H) ■ SPECULATION + AGGRESSIVE (H) LPs/REITs __________ TIME HORIZON TIME HORIZON Margin Trading __________ ■ <5 YEARS ■ 5-10 YEARS ■ >10 YEARS ■ <5 YEARS ■ 5-10 YEARS ■ >10 YEARS Other __________ SERVICE INSTRUCTIONS WHEN BUYING SECURITIES: SETTLEMENT INSTRUCTIONS: CASH DIVIDENDS/INTEREST: ■ DELIVER CUSTOMER NAME (1) ■ SEND CHECK ON SETTLEMENT (A) ■ MAIL CHECK (5) ■ HOLD CERTIFICATES (4) ■ PURCHASE/MONEY MARKET FUND (C) ■ HOLD IN ACCOUNT (1) MONEY MARKET ■ PRIME CASH ■ GOVERNMENT ■ TREASURY ■ MUNICIPAL ADDITIONAL INFORMATION INITIAL TRANSACTION ■ BUY ■ SELL ■ DEPOSIT ■ TRANSFER ■ ROLLOVER DESCRIPTION: ______________________________________________________ HOW WAS CUSTOMER INTRODUCED? ■ BANK CUSTOMER ■ PERSONAL ACQUAINTANCE ■ CALL IN ■ SOLICITATION ■ SEMINAR ■ WALK-IN ■ ADVERTISING HOW LONG HAVE YOU KNOWN CUSTOMER? ______________ BANK REFERENCE ____________________________________________________________________________________ NOTES INCLUDING RELATED/OTHER ACCOUNTS TO BE LINKED FOR BREAKPOINTS (Account Name/Account Number/Location): ________________________________________ __________________________________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________ INTERNAL REVENUE SERVICE—Required Information (W-9 Form): Under penalties of perjury, I certify (1) that the Taxpayer I.D. Number shown above is my correct taxpayer identification number; and (2) that I am not subject to backup withholding either because I have not been notified that I am subject to backup withholding as a result of a failure to report all interest or dividends, or the Internal Revenue Service has noti- fied me that I am no longer subject to backup withholding. (Internal Revenue Service regulations require you to strike out the language certifying that you are not subject to backup withholding due to notified payee under reporting if you have been notified that you are subject to this type of withholding, and you have not received a notice from the Internal Revenue Service advising you that backup withholding has terminated.) (3) I am a U.S. person (including a U.S. resident alien). BANK CUSTOMER ACKNOWLEDGEMENT: IN CONSIDERATION OF CAPITAL INVESTMENT GROUP, INC. (CIG) ACCEPTING FOR THE UNDERSIGNED ONE OR MORE ACCOUNTS, THE UNDER- SIGNED HEREBY ACKNOWLEDGES THAT CIG IS AN INDEPENDENT REGISTERED SECURITIES BROKER/DEALER, AND THAT ALL SECURITIES SERVICES PROVIDED TO THE UNDERSIGNED BY CIG OR ITS DESIGNATED CLEARING AGENT(S), ARE SOLELY THE RESPONSIBILITY OF CIG OR ITS DESIGNATED CLEARING AGENT(S), ARE NOT FDIC INSURED, AND ARE NOT BEING PROVIDED BY, AND ARE NOT THE RESPONSIBILITY OF THE SUBSCRIBING INSTITUTION ON WHOSE PREMISES CIG’S OFFICES ARE LOCATED. _____________ INITIALS In consideration of your accepting one or more accounts, I hereby affirm that the information above is correct and I have read and understand and agree to the terms set forth in the Customer Agreement on the reverse of this application. By signing this form, I acknowledge I have or will receive a copy of the New Account Form with Customer Agreement. THIS AGREEMENT CONTAINS A PREDISPUTE ARBITRATION CLAUSE IN SECTION 10 ON THE REVERSE SIDE. X —————————————————————————————————————————— X —————————————————————————————————————————— Customer Signature Date Joint Party(ies) Signature Date X —————————————————————————————————————————— X —————————————————————————————————————————— Registered Representative Signature Date Registered Principal Date Compliance Department: 17 Glenwood Avenue, Raleigh, NC 27603 919-831-2370
  4. 4. CUSTOMER AGREEMENT 1.. In consideration of Capital Investment Group, Inc. (“CIG”) accepting one or more accounts (Account) of the undersigned (whether designated as Customer, by name, number or otherwise) and CIG agreeing to act as agent of the undersigned account for the purchase and sale of securities, options, or other property (collectively referred to as “property”) and in consideration of the carrying as clearing agent for CIG of the under- signed’s account in certain circumstances by Sterne Agee & Leach, Inc. (“SALI”), the undersigned agrees with CIG and SALI as follows: 1. That throughout this Customer Agreement I/Me/We/Us refer to the undersigned and You/Your refer to CIG or SALI as applicable, their respective subsidiaries, officers, directors, affiliates, agents and/or employees. 2. Authority & Ownership: I have the requisite legal capacity, am authorized to enter into this agreement and have obtained all necessary authorizations from third parties, where necesssary, to open accounts and effect securities, transactions under this agreement. 3. Clearing Relationship: For certain transactions, SALI will act as clearing agent for CIG and, unless SALI receives from the undersigned prior written notice to the contrary, SALI will accept from CIG, without any inquiry or investigation: (a) orders for the purchase or sale of securities or other property in the undersigned’s account on margin or otherwise, and (b) any other instructions concerning the undersigned’s account or property therein. The undersigned understands and agrees SALI shall have no responsibility or liability whatsoever to the undersigned for any acts or omissions of CIG or any other broker, its officers, employees or agent. SALI will not give investment advice to the undersigned or to CIG. CIG is not affiliated with or controlled by or employed by SALI. SALI has no duty to supervise or monitor trading by the undersigned or CIG in the accounts carried by SALI. It is further understood any of the foregoing provisions while relating to instructions given to SALI by the undersigned or actions by SALI on the undersigned’s behalf may in fact be given to SALI by CIG who the undersigned acknowledges and agrees in acting on the undersigned’s behalf. Conversely, notices to the undersigned may in fact be given to CIG and may be considered as having been given to the undersigned. SALI will send the undersigned written confirmation of trades in the undersigned’s account(s) cleared by SALI and monthly statements of all activity in undersigned’s account(s). 4. Transaction Handling: (a) All transactions under this agreement shall be subject to and handled in accordance with all then applicable federal and state laws, rules and regulations promulgated thereunder, the constitution, rules, regulations, customs and usages of the exchange, association, market or clearinghouse, including, but not limited to, rebates for order flow. (In accordance with Securities and Exchange Commission Rule 11Ac1-3 and amendments to Rule 10b-10 under the Securities and Exchange Act of 1934, all securities firms are required to periodically notify their clients of the existence of certain fee income. As a clearing firm, SALI receives remuneration in the form of rebates for routing equity securities orders to designated broker dealers or third markets for execution. These rebates range from 1/4 of one cent to two cents per share for over the counter securities and up to one cent per share for certain listed securities. New York Stock Exchange or American Stock Exchange listed securities orders in excess of 5000 shares are routed to the floor of the exchange where the securities are traded, and SALI does not receive a rebate for such orders. In those situations where you have not directed your order otherwise, your order is routed by automated computer systems and trading procedures to market centers, including other broker dealers, where, based on experience, they combine price, speed and size to provide you with what we believe are the best executions. All orders are executed at prices equal to, or better than, the displayed national best bid/offer prices. Generally, compensation is passed on to CIG. (b) In all transactions between CIG and the under- signed, it is understood CIG is acting as a broker, except when CIG discloses in writing at or before the completion of a particular transaction, it is acting as dealers for its own account or as brokers for another party. (c) Sale Transactions: It is understood and agreed that the undersigned, when placing with you any sell order for a short or long account, will designate it as such and hereby authorizes you to mark such order as being “short” or “long” respectively. Any sell order which the undersigned shall designate as being for a long account as above provided, is for property then owned by the undersigned and, if such proper- ty is not then deliverable by you from any account of the undersigned, the placing of such order shall constitute a representation by the undersigned that delivery will be made by the settlement date for the transac- tion. In the event the undersigned fails to deliver negotiable securities pursuant to a sell order, you are authorized to borrow or purchase securities to cover the undersigned’s position and charge any loss and costs incurred to the undersigned’s account. In addition, it is agreed that if you fail to receive payment for securities purchased by the undersigned, you may, without prior demand or notice, sell securities held in any of the undersigned’s accounts, and any loss therefrom will be charged to my account. 5. Amendments and Termination: (a) This agreement shall be deemed modified to the extent necessary to conform with any changes in such laws, rules, regulations, constitutions, customs and usages, and as modi- fied, shall remain in full force and effect. Except as hereinabove expressly provided, no provision of this agreement shall in any respect be waived, altered, modified or amended unless such waiver, alteration, modifi- cation or amendment be committed to in writing and signed by the Treasurer, General Counsel, or Compliance Officer of your firm and SALI, if applicable. (b) This agreement shall continue in force until terminated by the undersigned by notice in writing directed to you at the address shown above. Notwithstanding any such termination, this agreement shall continue in effect as to all transactions entered into or business effected prior to such termination and to all matters pertaining thereto. You have the right to terminate this agreement at any time by written notice to the undersigned. 6. Liens & Settlement: (a) All monies and property which you may at any time be carrying for the undersigned, or which may at any time be in your possession for any purpose, including safekeeping, shall be subject to a general lien for the discharge of all obligations of the undersigned to you, irrespective of whether or not you have made any advances in connection with such property, and irrespective of the number of accounts the undersigned may have with you. (b) The undersigned agrees to settle all transactions when due and, at any time upon your demand, to discharge in whole or in part, obligations of the undersigned to you, and in the event of a closing of any account of the undersigned to pay you the deficiency, if any. No oral agreement or instructions to the contrary shall be recognized or enforceable. In the event the under- signed shall fail or refuse to make any payment to you when due, and any action or proceeding is brought to collect such amount, then the undersigned agrees to pay interest and the costs of collection, including a reasonable attorney’s fee. (c) You are hereby authorized at your discretion, should the undersigned die or should you for any reason whatsoever deem it necessary for your protection, to sell any of the property which may be in your possession, or to purchase on behalf of, and for the account of the undersigned, any property which the account(s) may be short, or cancel any outstanding orders in order to close out the account(s), in whole or in part, in order to close out any commitment made on behalf of the undersigned. Such sale, purchase, or cancellation may be made according to your judgment and may be made, at your discretion, on the exchange or other market where such business is then usually transacted or at public auction or at private sale, without advertising the same and without notice to the undersigned or to the per- sonal representatives of the undersigned, and without prior tender, demand or call of any kind upon the undersigned or upon the personal representatives of the undersigned, and you may purchase the whole or any part thereof free from any right of redemption, and the undersigned shall remain liable for any deficiency; it being understood that a prior tender, demand or call of any kind from you, or prior notice from you, of the time and place of such sale or purchase shall not be considered a waiver of your right to sell or buy any property held in the account, or owed you by the undersigned, at any time as hereinbefore provided. 7. Credit Investigations: You may exchange credit information about me with others. You may request a credit report on me (1) if the purpose is to establish or maintain my margin and/or option account, (2) if I have chosen to settle transactions by check, (3) to comply with government agency or court orders, or (4) if I give my permission. If I ask, you will tell me the name and address of the consumer reporting agency that fur- nished the report. You may request a new credit report at any time without telling me. 8. Margin Loans and Option Transactions: I understand and agree that margin loans, if any, provided to me will be made under a separate Margin Agreement and that I will comply with all requirements which SALI and CIG may impose with respect to such loans. I will not request that any transactions be effected on Margin and/or in Options prior to executing the aforementioned Margin Agreement and/or Options Agreement. 9. Joint Accounts: (a) The undersigned jointly and severally agree that each of them shall have authority on behalf of the joint account to buy, sell (including short sales) and otherwise deal in, through you as brokers, property, on margin or otherwise; to receive on behalf of such account demands, notices, confirmations reports, statements of account and communications of every kind; to receive on behalf of such account agreements relating to any of the foregoing matters and to terminate or modify same or waive any of the provisions thereof; and generally to deal with you on behalf of such an account as fully and completely as if one of us alone were interested in said account, all without notice to the other or others interested in such account. (b) You are authorized to follow the instructions of any of the undersigned in every respect concern- ing such account and to make deliveries to any of the undersigned, or upon any of our instructions, of any or all securities in such account, and to make payments to any of the undersigned, or upon any of our order, of any or all monies at any time or from time to time in such account as any of us may order and direct, even if such deliveries and/or payments shall be made to one of us personally, and not for such account. You shall be under no duty or obligation to inquire into the purpose or propriety of any such demand for delivery of securities or payment of monies, and; you shall not be bound to see to the application or disposition of the said securities and/or monies so delivered or paid to any of the undersigned. (c) The liability of the undersigned with respect to said account shall be joint and several. The undersigned further agree, jointly and severally, that all property SALI may at any time be holding or carrying for any one or more of the undersigned, shall be subject to a lien in your favor for the discharge of the obligations of such account to you, such lien to be in addition to, and not in substitution of, the rights and remedies you otherwise would have. (d) In the event of the death of either or any of the undersigned, the survivor or survivors shall immediately give you written notice thereof, and you may, before or after receiving such notice, take such proceeding, require such papers, retain such portion of and/or restrict transactions in the account as you may deem advis- able to protect you against any tax, liability, penalty or loss under any present or future laws or otherwise. The estate of any of the undersigned who shall have died shall be liable and each survivor shall continue liable jointly and severally, to you for any net debit balance or loss in such account in any way resulting from the completion of transactions initiated prior to the receipt by you of the written notice of death of the decedent or incurred in the liquidation of the account or the adjustment of the interests of the respective parties. (e) Any taxes or other expenses becoming a lien against or being payable out of such account as a result of the death of any of us, or through the exercise by any of our estates or representatives of any rights in such account, shall be chargeable against the interests of the survivors as well as against the interest of the decedent. This provision shall not release the decedent’s estate from any liability provided for in this agreement. 10. PREDISPUTE ARBITRATION AGREEMENT: This agreement contains a predispute arbitration clause. By signng this agreement, the parties agree as followsA: (a) Arbitration is final and binding on the parties. All parties to this agreement are giving up the right to sue each other in court, including the right to a trial by jury, except as provided by the rules of the arbi- tration forum in which a claim is filed. (b) The parties are waiving their right to seek remedies in court, including the right to jury trial. Arbitration awards are generally final and binding; a party’s ability to have a court reverse or modify an arbi- tration award is very limited. (c) Pre-arbitration discovery is generally more limited than, and different from, court proceedings. The ability of the parties to obtain documents, witness statements and other discovery is generally more limited than in court proceedings. (d) The arbitrators’ award is not required to include factual findings or legal reasoning and any party’s right to appeal or to seek modification on rulings by the arbitrators is strictly limited. The arbi- trators do not have to explain the reason(s) for their award. (e) The panel of arbitrators will typically include a minority of arbitrators who were or are affiliated with the securities industry. (f) The rules of some arbitration forums may impose time limits for bringing a claim in arbitration. In some cases, a claim that is ineligible for arbitration may be brought in court. (g) The rules of the arbitration forum in which the claim is filed, and any amendments thereto, shall be incorporated into this agreement. (h) No person shall bring a putative or certified class action to arbitration, nor seek to endorse any pre-dispute arbitration agreement against any person who has initiated in court a putative class action; or 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; or (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. Any and all controversies arising out of or relating to this agreement or the conduct of the parties hereto which can be lawfully submitted to arbitration, should be submitted to arbitration in accordance with the rules, then existing, of the NASD. The award of the arbitrators, or a majority of them, shall be final, and judgment upon the award may be entered in any state or federal court having jurisdiction. This clause binds the undersigned to submit to arbitration all claims including those which could otherwise be brought in a judicial forum and those which could be jointed to other non-arbitrable claims. 11. Communications: (a) Communications may be sent to the undersigned at the address of the undersigned, or at such other address as the undersigned may hereafter give you in writing, and all communications so sent, whether by mail, telegraph, messenger or otherwise shall be deemed given to the undersigned personally, whether actually received or not. (b) In the event of a change in name or address, I agree to promptly notify you in writing of any change to my name or address. 12. Confirmation of Transactions: Confirmation of orders and statements of the accounts of the undersigned shall be deemed to have been accepted by the undersigned if not objected to in writing within ten days after forwarding by you to the undersigned by mail or otherwise. 13. Prospectus & Offering Statement Delivery: I have received a copy of the prospectus or offering statement for any mutual fund, variable contract, REIT, 529 plan, and/or limited partnership, including oil and gas partnerships, purchased or established in connection with this application. I agree that I understand the prospectus or offering statement provided to me. 14 Privacy Policy: As a valued customer, the privacy of the information with which you provide us, to assist you in reaching your financial goals, is of utmost importance. Therefore, we offer the following Privacy Policy for Capital Investment Group, Inc., Capital Investment Brokerage, Inc., Capital Investment Counsel, Inc., CIC Advisers, LLC and their affiliates collectively known as “Capital Investment Companies.” (Capital Investment Group, Inc. and Capital Investment Brokerage, Inc., are “introducing” broker/dealers whose custmer accounts are carried by either SALI and/or Fiserv Securities, Inc., clearig firms that provide certain back office functions and custodial and processing services.) PLEASE NOTE: CAPITAL INVESTMENT GROUP, INC., CAPITAL INVESTMENT BROKERAGE, INC., CAPITAL INVESTMENT COUNSEL, INC., CIC ADVISERS, LLC AND THEIR AFFILIATES, DO NOT SELL YOUR NONPUBLIC PERSONAL INFORMATION. (a) We collect your nonpublic personal information from the following sources: Information we receive from you on applications, and other forms; Information we receive from you in writing, in person by tele- phone, electronically, or by any other means; Information about your transactions with Capital Investment Group, Inc. or Capital Investment Brokerage, Inc., or our affiliates, SALI, Fiserv Securities, Inc., financial insti- tutions or others, and; Information we receive from the Internal Revenue Service, consumer reporting agency, or other such entity. (b) We disclose your nonpublic personal information to affiliates and non-affili- ated third parties: Capital Investment Group, Inc., Capital Investment Brokerage, Inc., Capital Investment Counsel, Inc. and CIC Advisers disclose to affiliates and non-affiliated third parties, nonpublic personal infor- mation only in connection with our servicing of, or conducting business on behalf of, your account. Such disclosures may be provided to affiliates and non-affiliated third parties (i) as required or necessary to carry out fully and properly the securities business conducted by Capital Investment Group, Inc., Capital Investment Brokerage, Inc., Capital Investment Counsel, Inc., and CIC Advisers LLC; (ii) as required by law or legal process, or; (iii) with your consent. We may disclose all of the information we collect, as described above. (c) Former Clients: We do not disclose any nonpublic personal information about our customers or former customers to anyone, except as permitted by law or legal process, or with your consent. (d) Confidentiality and security of nonpublic person interest: We restrict access to nonpublic personal information about you to those employees that need to know that information to provide products or services to you. We maintain physical, electronic and procedural safeguards to guard your nonpublic personal information; and Capital Investment Group, Inc., Capital Investment Brokerage, Inc., Capital Investment Counsel, Inc., and CIC Advisers reserve the right to change this Privacy Policy at any time. 15. Client Status: The undersigned, if an individual, represents unless you are notified in writing to the contrary, the undersigned is of full age and is not an employee of any exchange, or of any corporation of which any exchange owns a majority of the capital stock, or a member of any exchange, or of a member firm or member corporation registered on any exchange, the NASD or any member firm thereof, or of a bank, trust company, insurance company or of any corporation, firm or individual engaged in the business of dealing either as broker or as principal, in securities, bills of exchange, acceptances or other forms of commercial paper. The undersigned has an interest in the account or accounts of the undersigned with you. The undersigned agrees to notify you promptly in writing of any changes in the foregoing representations. 16. Force Majeure: You shall not be liable for loss caused directly or indirectly by war, natural disasters, government restrictions, exchange or market rulings, suspension of trading mechanical or communications mal- functions or other conditions beyond your control. 17. Governing Laws & Regulations: (a) For accounts carried by SALI, this agreement and its enforcement shall be governed by the State of Alabama. For all other accounts, this agreement and its enforcement shall be governed by the applicable jurisdiction. (b) In the event any provisions of this agreement shall be deemed invalid or unenforceable for any reason, such provision shall be deemed ineffective, but the remainder of this agreement shall continue in full force and effect. 18. Telephone Conversations: For the protection of the undersigned, as well as that of SALI and CIG, the undersigned hereby authorizes SALI and CIG, at its discretion, and without prior notice to the undersigned, to monitor and/or record any and all telephone conversations which the undersigned may have with employees of SALI and CIG and/or its affiliate companies. 19. Business Continuity Plan: Capital Investment Companies, consisting of Capital Investment Group, Inc., Capital Investment Brokerage, Inc., CIC Advisers, LLC, and Capital Investment Counsel, Inc., has developed a Business Continuity Plan on how we will respond to events that significantly disrupt our business. Since the timing and impact of disasters and disruptions is unpredictable, we will have to be flexible in responding to actual events as they occur. With that in mind, we are providing you with this information on our business continuity plan. Our goal is to quickly recover business operations after a significant business disruption and respond by safeguarding our employees and property, making a financial and operational assessment, protecting the firm’s books and records, and allowing our customers to transact business. In short, our business continuity plan is designed to permit our firm to resume operations as quickly as possible, given the scope and severity of the significant business disruption. The Business Continuity Plan anticipates inter- nal and external business disruptions. Internal disruptions affect only our firm’s ability to communicate and do business, such as fire in our building. External disruptions prevent the operation of the securities mar- kets for a number of firms, such as a terrorist attack, a city flood, or a wide-scale, regional disruption. In light of potential internal and external business disruptions, our business continuity plan addresses: data back up and recovery; all mission critical systems; financial and operational assessments; alternative communications with customers, employees, and regulators; alternate physical location of employees; critical supplier, contractor, bank and counter-party impact; regulatory reporting; and assuring our customers prompt access to their funds and securities if we are unable to continue our business. Significant business disruptions can vary in their scope, such as only our firm, a single building housing our firm, the business district where our firm is located, the city where we are located, or the whole region. Within each of these areas, the severity of the disruption can also vary from minimal to severe. In a disruption to only our firm or a building housing our firm, if access to our building is not permitted, we will transfer our operations to an alternative building location currently leased by our company. In a disruption affecting our business district, city, or region, we will partner with our clearing agents whereby they will assume transaction processing and assur- ance of customer access to funds and securities. Should you be unable to contact your representative and our Main Office cannot be contacted within a reasonable amount of time, you can contact the custodian of your funds and securities. If your funds and securities are held at a clearing agent, you can contact Sterne, Agee & Leach at (800) 264-4863. All other entities serving as custodian of your funds and securities can be contacted directly at the phone number listed in previously provided prospectuses or on the internet. Please be advised that business continuity plans are subject to change in light of technology and changes in business risk. 20. Direct Shareholder Communications: In an effort to provide for improved communications between companies which issue securities and shareholders who own those securities, the Securities and Exchange Commission adopted Rule 14b-1(c). The purpose of this Rule is to allow companies to communicate directly with non-objecting beneficial owners. Under Rule 14b-1(c), unless you object, SALI will be required to provide your name, address and securities position to each requesting company in which you hold securities. For your protection, the Rule prohibits the requesting company in which you hold securities from using the information provided for any purposes other than communicating directly to you. The SEC Rule directs SALI to contact each shareholder to determine a “yes” or “no” response, whether you authorize them to provide your name, address, and securities position to requesting companies. If you tell us “no,” we will not provide this information to requesting companies. If you tell us “yes” or if you choose not to respond to this survey, we will be obligated to provide your name, address, and your securities position to requesting companies. Under the rule, your “yes” or “no” will apply to all securities registered in “nominee” or “street name” SALI holds for you now, or to any such securities they may hold in the future. SALI will continue to follow your instructions with respect to all securities held for you until such instruction is amended by you. REQUIRED TO BE COMPLETED ONLY IF THE NEW ACCOUNT FORM IS NOT IN TRIPLICATE FORM: I, the undersigned, have read, understood, and agree to the terms set forth in the Customer Agreement, including the PREDISPUTE ARBITRATION CLAUSE IN SECTION 10. X —————————————————————————————————————————— X —————————————————————————————————————————— Customer Signature Date Joint Party(ies) Signature Date X —————————————————————————————————————————— X —————————————————————————————————————————— Registered Representative Date Registered Principal Date
  5. 5. Reset Form Investment Advisory Client Agreement This Agreement is entered into this ____ day of _____________ between Capital Investment Counsel, Inc., a North Carolina corporation hereafter referred to as "Counsel" and _________________________, hereinafter referred to as "Client". In consideration of the promises, covenants, and undertakings set forth herein, the parties agree as follows: 1. DEFINITIONS a. Client Assets. The term "Client Assets" shall mean equities, government securities, investment company securities, ETFs, corporate debt instruments, mortgage backed securities, municipal securities, options, warrants, cash and cash equivalents, as well other types of investments over which Counsel is charged with providing Portfolio Management Services as described in paragraph 2.b. below. b. Client Accounts. The term "Client Account" shall mean an account maintained with a registered broker/dealer, bank, or trust company designated by client, in which the Client Assets are deposited. 2. SERVICES OF COUNSEL a. Portfolio Review Service. Counsel will analyze the Client’s present financial situation, needs and objectives and may recommend as guidelines, an Investment Policy Statement, which, subject to Client approval, will govern Counsel’s management of Client Assets as provided in paragraph 2.b. below. Counsel may recommend changes for Client approval to the Investment Policy Statement from time to time. The Investment Policy Statement and subsequent modifications thereof, if any, may not be in writing. b. Portfolio Management Service. Counsel will administer the day-to-day investment of the Client Assets in accordance with the Investment Policy Statement or other guidelines as may be modified from time to time. Client hereby grants discretion and authority to Counsel unless otherwise instructed in writing, to dispose of, exchange, invest, or reinvest the Client Assets in stocks, bonds, as well as cash and money market instruments and to reinvest dividends, capital gains and any other income earned by or gain realized on disposition of any of the Client Assets. Such income or gain shall be deemed a part of the Client Assets when it is earned or realized. 3. RESPONSIBILITIES OF CLIENT a. The Client agrees to complete the following items before Counsel’s obligation to provide Portfolio Management Services begins. 1. Complete the Client Questionnaire, Money Management Questionnaire, or similarly named document(s), if provided, and any other documents required to be completed. 2. Establish and deposit the Client Assets in the Client Account or identify the Client Account to Counsel. Counsel may recommend an affiliated broker/dealer, Capital Investment Group, Inc. or Capital Investment Brokerage, Inc., through which the Client Account may be established and Client Assets are to be deposited. If the Client requests another registered broker/dealer for their Client Account and Client Assets to be deposited, the Client should provide the name of the broker/dealer, the name of any broker/dealer representative, address, and phone number. 3. Client shall complete all forms and procedures required by the custodian and/or broker/dealer to authorize Counsel to direct and effect transactions involving the Client Assets and the Client Account in accordance with this Agreement. 4. Review, consider, and approve Investment Policy Statement or similar guidelines, whether provided in writing or not, upon which Counsel can rely in managing the Client Assets. b. Client shall promptly advise Counsel if Client’s financial condition, needs, investment objectives, risk tolerance, or other information changes as required for the management of the Client Assets at any time during the term of this Agreement. v. 0808
  6. 6. 4. COMPENSATION a. Compensation of Counsel for its services as provided by this Agreement shall be paid quarterly in advance in accordance with the then current fee schedule. Counsel may make amendments to the fee schedule at its discretion as provided in paragraph 4.f. Counsel reserves the right to waive or negotiate any fee on a case by case basis. b. All Clients are subject to a minimum annual fee of $500. c. Client shall pay the fees pursuant to the Option selected or as otherwise provided by Exhibit A. d. Fees shall be calculated based upon the fair market value of the Client Assets under management by Counsel as of the last business day of the month preceding the quarter to be billed, and the resulting amount, divided by four, shall be the amount due Counsel for the next quarterly period. e. Counsel reserves the right to change the fees charged to Client for the services provided under this agreement upon 30 day advance notification to the Client. f. Additional information concerning Counsel’s Wrap Program is found in Form ADV supplement Schedule H and Client acknowledges that Client has received and read same. 5. FEE PAYMENT By signing this Agreement and a separate Letter of Authorization or similar documentation required by the custodian and/or broker/dealer, the Client authorizes Counsel and its agents to invoice the custodian of the Client Assets for the fees, and the Client authorizes the custodian to pay such fees directly to Counsel. Cash balances or equivalents will first be used to pay for services to be provided by Counsel per the terms of this Agreement. Counsel will send to Client an invoice (concurrent with its submission to the custodian) showing the amount of the fee, the market value of the assets on which the fee is based, and the manner in which it was calculated. Should Client elect to pay fees directly to Counsel, Client may remit the invoiced amount by check within 30 days of the invoice date. 6. TERMINATION OF AGREEMENT a. This Agreement shall be in force until either party gives thirty days prior written notice of termination. Since fees are billed quarterly in advance, Counsel will refund to Client after termination a pro-rata share of the fees computed on a daily basis for the quarter. Client’s death shall not terminate this Agreement or the authority granted to Counsel hereunder until Counsel has received written notification or other notification deemed satisfactory to Counsel of said death. b. If the Form ADV Part ll and accompanying schedules was received less than 48 hours before the Client signed the Agreement, the Client has the right to cancel this Agreement without penalty within five business days of executing the Agreement. Upon written request, Counsel will provide the Client with a copy of its most current Form ADV Part II and accompanying schedules. 7. FEE PAYMENT DISCLOSURES a. The Portfolio Management Services are composed chiefly of American stocks, bonds and government securities listed on the New York or American Stock Exchanges or are traded in the over-the-counter market. b. Counsel is one of several affiliated companies operating under Capital Investment Companies. Counsel may recommend affiliated broker/dealers, Capital Investment Group, Inc. (“CIG”) and Capital Investment Brokerage, Inc. (“CIB”), through which Client Assets will be deposited or transactions will be made. Counsel Advisers may be shareholders of Counsel, CIG and/or CIB. c. Advisers with Counsel are registered brokers with one or both of the above-named affiliated broker/dealers. In the capacity of a registered representative of a broker/dealer, an Adviser may receive a commission or remuneration in the execution of any transactions through such affiliated broker/dealers. For any mutual fund positions maintained in a Client Account through one of Counsel’s affiliated broker/dealers, a Counsel Adviser may receive 12b-1 or service fees in addition to any compensation above noted in paragraph 4. v. 0808
  7. 7. d. Counsel and its Advisers may acquire or depose of securities in which Client has or may acquire a position. Counsel will give priority to execution of the Client’s trades in such cases. Client hereby consents to Counsel and its Advisers buying and selling securities for their own accounts. e. When executing transaction orders, Counsel with the broker-dealer may engage in bunching of client transactions or may individually purchase or sale securities on an individual Client Account basis. f. Nothing in this Agreement shall limit or restrict the right of any director, officer, or employee of Counsel to serve as a director, officer or employee of any other entity engaged in a financial business, or to engage in any other business, or to render services of any kind to any other corporation, firm, individual or association. g. Unless otherwise agreed by the Client, Counsel will not be sharing Portfolio Management Service fees from Client Accounts with one or more investment advisory firms, sub-advisers, or third party without disclosing such arrangements to the Client. 8. LIMITATION ON RESPONSIBILITIES OF COUNSEL Counsel’s responsibility under this Agreement is to render the services contracted for hereunder in good faith, and in compliance with all the fiduciary obligations imposed upon Counsel under Section 206 of the Investment Advisors Act of 1940. Counsel shall not be responsible for any action of the Client in declining to follow any advice or recommendation. Client and Counsel or its Advisers are not partners or joint venturers and nothing herein shall be construed so as to make them partners or joint venturers or to impose any liability as such on either of them. 9. OWNERSHIP OF ASSETS a. Client represents the Client is the owner of cash and securities under which Counsel will conduct Portfolio Management Services. Client attests that Client Assets have not been borrowed from a third party or subject to any liens. If such assets become subject to any lien or similar matter, Client will provide immediate written notification to Counsel. b. Should Client seek to grant authority to direct or control any assets in a Client’s Account beyond the terms of this Agreement either to Counsel or a third party, then an executed Power of Attorney or other appropriate agreement will be required to be received and approved by Counsel. 10. INDEMNIFICATION In the absence of fraud, willful misconduct, or willful negligence on the part of Counsel, Client agrees not to hold Counsel responsible for losses or recommendations given, taken, or not taken with respect to Client Assets. Counsel shall not be responsible of any act or omission of Client. None of the above preceding statements waives the rights of the Client under the Investment Advisers Act of 1940. 11. NON-EXCLUSIVE AGREEMENT It is understood that Counsel renders Portfolio Management Services for numerous clients. Nothing contained in this Agreement shall be deemed to impose upon Counsel any obligation to purchase or sell or to recommend the purchase or sale to any Client any security, which Counsel may purchase or sell for or recommend to the account of any other client. Client agrees that transactions in a security may not be executed for all Client Accounts at the same time or same price. More so, Client recognizes that portfolio positions may differ among various clients due to timing, client objectives, market conditions, and other reasons. 12. CONFIDENTIALITY OF CLIENT INFORMATION a. Except as otherwise required by law, necessary to provide services described herein, or disclosed in its privacy policy, Counsel will keep confidential all information concerning identity, financial affairs, and investments of the Client and Client Account (s). b. All recommendations and advice furnished by Counsel are personal in nature and will not be discussed with anyone, except when authorized to do so by the Client. Should a Client wish to have such information communicated to a third party (i.e. CPA, attorney, etc.), Client shall provide written notice of such intention. 13. COMMUNICATIONS v. 0808
  8. 8. a. All communications by Counsel shall be directed to the address of record provided by the Client. In the event of an address change, Client is required to provide written notification of such address change. b. In the event of any material change to the charter or by-laws of a corporation, trust, ERISA-eligible plan, or similar Client Account affecting the control, objectives, notifications, or covenants of such Client Account, the Client agrees to promptly provide in writing notification of such changes in addition to amended trust, plan, or other documents reflecting such change. Such changes include, but are not limited to, individuals named as trustees, powers of attorney, or fiduciaries. c. Account statements will be furnished no less than quarterly to Client by the custodying broker/dealer. Records of all transactions are maintained by the broker/dealer. 14. ERISA ACCOUNTS For Employee Retirement Securities Act of 1974 (ERISA) accounts, Client will assume all liabilities and obligations to comply with ERISA laws and standards including but not limited to bonding, voting proxies, insurance coverage, authorizations, tax returns, notifications and disclosures, whether regulatory in nature or not. 15. COMMUNICATIONS PROXY VOTING Counsel does not assume responsibility for proxy voting since it manages accounts under limited discretion. Client agrees to assume this responsibility by signing this contract. 16. ASSIGNMENT Neither party may assign this Agreement without the prior written consent to the other party. 17. GOVERNING LAW AND SEVERABILITY a. It is agreed by Client and Counsel the laws of the State of North Carolina shall govern the validity of this contract and any of its terms or provisions. b. It is understood by the parties hereto that if any term, provision, duty, obligation, or undertaking herein contained is held by the courts to be unenforceable, illegal, or in conflict applicable laws and regulations, the validity of the remaining portions shall not be affected, and the rights and obligations of the parties shall be construed and enforced as if such invalid or unenforceable provision was not contained herein. 18. ACKNOWLEDGEMENT OF FORM ADV PART ll AND SCHEDULES The Client’s signature below acknowledges the Client has received and read the Form ADV Part ll and accompanying documents as required by the Securities and Exchange Commission. 19. USE OF SOLICITOR AGENTS AND CLIENT ACKNOWLEDGEMENT Counsel, on occasion, may utilize solicitors to obtain accounts. In the event a Client agrees to have Portfolio Management Services rendered by Counsel after the Client has been referred to Counsel by a solicitor, Client agrees and understands such solicitors may receive a solicitation fee, which is based on a fraction of quarterly fees billed by Counsel. This fee is not in addition to any fees above stated but rather a portion of the fees the Client has agreed to per execution of this Agreement. By executing this Agreement, Client acknowledges Client has received and read the Solicitation Agreement and Disclosure or similar document, if any, provided by Counsel. IN WITNESS THEREOF, the parties hereto agree to the above provisions as evidenced by the below signatures and dates. CLIENT: COUNSEL: _____________________________________________ ___________________________________ Client Signature Date Authorized Signatory Date _____________________________________________ ___________________________________ nd 2 Client Signature Date v. 0808
  9. 9. EXHIBIT A Fee Schedule: Market Value Option A (Wrap) Option B (Fee + Option C (Fee Only) Commission) For accounts held outside CIG/CIB Up to $500,000 2.000% 1.250% 1.750% $500,000 to $1,500,000 1.750% 1.000% 1.500% $1,500,001 to $3,000,000 1.500% 0.750% 1.250% Above $3,000,000 Negotiable Negotiable Negotiable Choose Option (Please initial): Rate*: * Please combine related accounts for total billed asset breakpoint Please note special requirements below: v. 0808
  10. 10. Trading Authorization By entering into this agreement, the below Client authorizes Capital Investment Counsel, Inc. and its Advisers to purchase, sell, deposit, or exchange securities, on margin or not, for the Client account(s) on a discretionary basis. This shall not authorize the Advisor to receive any securities or property held in Client’s account. By entering into this Agreement, the Client is not surrendering ownership of the cash and securities comprising the Client’s account(s). More so, Counsel and its Advisors may not remove cash and securities from the Client’s account(s), unless agreed upon in a Letter of Authorization or like-document for the payment of fees in connection with advisory services. The Client has the authority at its discretion to place limitations and/or restrictions on the management of their portfolio, which could include, but is not limited to, restricting the type or class of securities purchased in their account or restrict exposure to certain types or classes of securities. The Client should be aware that excessive restrictions might affect Counsel and its Advisers’ ability to provide the services agreed upon between the parties. All such limitations and/or restrictions must be given to Counsel or its Advisers in writing and may be amended to by the Client in writing. All such restrictions and/or limitations and any amendments thereof will take effect when received by Counsel. / / Client Signature Client Name (Print) Date / / nd 2 /Joint Client Signature (if applicable) Client Name (Print) Date / / Capital Investment Counsel Signatory Signatory Name (Print) Date v. 0506
  11. 11. Letter of Authorization Dear Sir/Madame: This letter serves as authorization for Capital Investment Counsel, Inc. (“Counsel”) and its agents to debit my investment account(s) held at Sterne, Agee & Leach, Inc. or any other broker/dealer utilized to custody assets. Such account(s) are serviced under an Investment Advisory Agreement or similar service agreement established with Counsel. My account(s) will be debited quarterly in accordance to my Investment Advisory Agreement or similar agreement. With regards to this authorization: 1. Proceeds from the debit shall pay for investment advisory fees and service costs per the terms of the Investment Advisory Agreement or similar service agreement. 2. The agreement shall remain in force until the earlier: 1) termination of the Investment Advisory Agreement or similar service agreement by either party; or 2) written notification by the Client indicating they no longer wish to have their account(s) debited for investment advisory fees and service costs which Client has previously agreed upon have been received by Counsel. 3. The following account(s) are to be debited for investment advisory fees. (If a client has multiple accounts to be serviced under an Investment Advisory Client Agreement or similar service agreement and wishes for investment advisory fees and transaction costs to be debited out of one account, list only that one account.) Account Number Account Name Brokerage Firm/Custodian The undersigned understands and agrees to the above provisions. / / Client Signature Client Name (Print) Date / / nd 2 /Joint Client Signature (if applicable) Client Name (Print) Date / / Capital Investment Counsel Signatory Signatory Name (Print) Date INTERNAL USE ONLY (DO NOT COMPLETE) Billing Rate: Miscellaneous: v. 0506
  12. 12. Solicitation Agreement & Disclosure This Agreement is entered into by Capital Investment Counsel, Inc. (“Counsel”), the Solicitor, and the Client. The named parties agree to and the Client acknowledges the following: 1. The Solicitor has referred Client to Counsel for portfolio management services pursuant to terms of the Investment Advisory Agreement. On occasion, the Solicitor may refer other clients to the Adviser for portfolio management services. For introducing the client to Counsel, Counsel has agreed to pay the Solicitor(s) % for the length of time the referred client’s account is managed by Counsel or the representative remains registered with an affiliated broker/dealer of Capital Investment Companies, whichever is shorter. The agreement will not result in fees charged to the client above those Counsel normally charges its non-referred clients or those stated in its publicized fee schedule. Referral clients represent business Counsel would otherwise not have received. 2. The Solicitor represents it is registered as an investment adviser under the Investment Advisers Act of 1940, an investment adviser employed by Counsel or another investment adviser, meets appropriate qualifications and/or is registered under the appropriate laws of the corresponding federal and state jurisdictions. Solicitor further represents that Solicitor will not solicit referral clients on behalf of Counsel in any other jurisdiction without first notifying Counsel, obtaining Counsel’s prior written approval and taking such steps as may be necessary to ensure that Solicitor may lawfully solicit clients on behalf of Counsel and under the laws of such jurisdiction. Solicitor represents neither it nor any of its agents is a person: (a) subject to an order of the SEC under Section 203(f) of the Investment Advisers Act of 1940; (b) who has been convicted within the previous ten years of any felony or misdemeanor involving conduct specified in Section 2039 (e) (2) (A) – (D) of the Act; or (c) who has been found by the SEC to have engaged, or has been convicted of engaging, in any of the conduct specified in paragraphs (1), (4) or (5) of section 203(e) of the Act; or (d) is subject to an order, judgment or decree described in Section 203(e) (3) of the Act. 3. Solicitor agrees they are responsible for administering the relationship with the Client. In this capacity, the Solicitor is responsible for: 1) Performing duties under this Agreement in a manner consistent with the instructions of Counsel, the Investment Advisers Act of 1940, and the rules under that Act; 2) Obtain Client information deemed necessary in offering portfolio management services and complying with legal statutes, firm policy, and regulatory acts; and 3) Address all initial and subsequent communications with the Client. 4. Solicitor is permitted to advise Client about other financial services and products, if permitted under law, outside of this Agreement or Investment Advisory Agreement entered into by Client with Counsel. If a dispute arises between Client and Solicitor concerning products and services outside the scope of this Agreement or the Investment Advisory Agreement, Client and Solicitor agree to indemnify and hold harmless the Adviser, its agent, or any of its employees for such events. 5. By executing the Agreement, the Solicitor agrees it has provided and Client agrees they have received a current copy of the Part ll and accompanying schedules of Counsel's Form ADV, the Client agrees they have received a copy of this Agreement. More so, Solicitor agrees and Client acknowledges the Solicitor has disclosed any affiliations between the Solicitor, their broker/dealer (if applicable), and Counsel Frequently, the Solicitor is registered with a broker/dealer affiliated with Counsel (Capital Investment Group, Inc. or Capital Investment Brokerage, Inc.) through common ownership. 6. I, the undersigned, understand and agree to the above information. / / Client Signature Client Name (Print) Date / / nd 2 /Joint Client Signature Client Name (Print) Date / / Solicitor Solicitor Name (Print) Date / / Co-Solicitor (if applicable) Solicitor Name (Print) Date / / Counsel Authorized Signatory Signatory Name (Print) Date V 0608
  13. 13. Money Management Investment Objectives & Guidelines (Please print the following information) Answering the following questionnaire will help Capital Investment Counsel, Inc. understand and assist you in accomplishing your investment objectives. It is critical that you provide all of the requested information so that our capacity to achieve your expectations is not inhibited. Date: ___ /_ __/__ _ Name: ______________________________________________________ __ Type of Account: ___ Personal Account (taxable) ___ * Pension ___ Joint Account (taxable) ___ * Profit Sharing ___ Custodian for Minor ___ * 401 (k) ___ IRA ___ * Foundation/Endowment ___ *Trust * For these type accounts copies of legal documents will be needed. {If there is more than one account, please note which account you are referring to when you answer the following questions - if the answer(s) would be different for each separate account} v. 0506
  14. 14. Dear Sir/Madame: This questionnaire is designed to gather pertinent information needed to understand your financial goals and objectives, analyze your current financial position, and recommend a financial strategy, which will satisfy your needs and serve as a guide in attaining your goals. Our belief is that long-term success is dependent not only on the development and implementation of planning strategies, but also on continually monitoring and revising planning strategies as changes in your circumstances and in the general economic and investment environment occur. This can be accomplished through an ongoing review, which will allow you to maintain control of your financial life. The extent to which the process is successful depends largely on your commitment to meeting your objectives. Although this process will require time and effort on your part, we have attempted to streamline it as much as possible. This questionnaire is used to gather data concerning your personal and family information, economic assumptions, goals and objectives, investment preferences and retirement information. The information you furnish in this questionnaire will be held in strict confidence - See attached Privacy Notice. This questionnaire is designed to be comprehensive in nature, therefore certain sections or questions may not apply in your particular situation - do not worry if you do not understand all questions and/or how to answered the questions. This is not a test - you will not be graded on how you answer! Respectfully, Capital Investment Counsel v. 0506
  15. 15. Client Profile Last name: _________________________ First name:_____________________________ MI: _____ Date of Birth: ____/____/____ Social Security No.: __ ___-___ __-____ Occupation ________________________ Spouse last name: ________________________ First name: __________________________ MI: _____ Date of Birth: ____/____/____ Social Security No: __ -___ __-_ _ Occupation _____________________ _ Home Address Mailing Address (if different) Contact Numbers Street 1 ___________________________ Street 1/Box Home Phone Street 2 ____________________________ Street 2 Work Phone City___________________________ _ City __________________________ Mobile Phone State _____________________ State _____________________ Fax Zip Code_____________________ Zip Code_____________________ E-mail ______________________ Children/Dependents Date of Birth Children/Dependents Date of Birth __________________________ ___/___/___ __________________________ ___/___/___ __________________________ ___/___/___ __________________________ ___/___/___ _________________________ ___/___/___ __________________________ ___/___/___ __________________________ ___/___/___ __________________________ ___/___/___ _________________________ ___/___/___ __________________________ ___/___/___ _________________________ ___/___/___ __________________________ ___/___/___ Annual Income Net Worth Liquid Net Worth Previous Investment Experience: Stocks Bonds How did you hear about us? Advertisement Referral Walk-In Other If referred, by whom? Do you have your Wills up to date? Yes No Date it was last reviewed: _____________________ What is your anticipated retirement age? (Client) _____________ (Spouse) ______________ What is the total amount of life insurance coverage you currently have? (Client) _______________ (Spouse)______________ What other financial areas can we help you with? Children’s Education Planning Personal Investing Estate Planning Tax-Free Income Financial Independence Company Buy/Sell Retirement Plan Administration Insider Buy/Sell Real Estate Investing Other: Mutual Funds ______________________________________ v. 0506
  16. 16. General Questions 1. What is your major reason for investing? a. Preserving capital b. Education funding c. Retirement d. Wealth accumulation e. Other: ____________________ _ 2. Your present investments are: a. Mostly real estate, stocks and mutual funds b. Mostly bonds, annuities and treasuries c. Mostly CDs and money market accounts 3. Emergency funds and other cash available: a. More than six months expenses b. Three to six months’ expenses c. Less than three months expenses 4. What are your feelings about the U.S. economy? a. Optimistic b. Unsure c. Pessimistic 5. Please state your present investment knowledge and experience level: a. Very knowledgeable b. Some investment knowledge/experience c. Little knowledge/experience 6. How would you describe your attitude toward risk for the money you will be investing in your investment program? a. I am extremely safety conscious. b. I realize there are risks in investing, but I try to minimize them whenever I can. c. I do not mind taking some risks as long as I can earn a reasonable return. d. I think higher risk investing may be appropriate, but only for a portion of my portfolio. e. I am comfortable with higher risk investing for its higher reward potential. 7. Historically, inflation has had a major impact on the value of a dollar’s spending power. Over the last 10 years, the spending power of $100 has declined to $55. With this in mind, how do you feel about the risk of inflation eroding the value of your investments? a. With the way prices have risen in the last 10 years, I am very concerned. b. I know prices are rising, but I am not overly concerned. c. These days, inflation is low enough not to be a serious problem. d. I am not concerned about inflation over the near term, but over the long term I am concerned. Designing Your Portfolio 8. Which of the alternatives in each question is most important to you? Please mark your answer for each of the following comments ___ Higher returns (high fluctuation in values) OR ____ Consistent returns (less fluctuation in value) Please comment: ____________________________________ ____ Income returns OR ____ Capital appreciation returns Please comment: ________________________________________ ____ Minimum down years OR ____ Outperforming the market Please comment: ______________________________________ _ 9. What is your understanding of investment risk and investment results? _________________________________________________________________________________________ _____________________________________________________________ _________ ___________________________________________________________________________ _______ v. 0506
  17. 17. 10. In constructing and managing a portfolio, answer each question on which is most important to you? ___ Investing in quality companies OR Chasing less quality companies going for quick return ___ Buying stocks on a discounted basis OR ___ Chasing a stock at all time highs hoping it will go higher ___ Having small quick returns OR ___ Having big returns over an extended period ___ Having long-term gains tax OR ___ Having short-term gains and paying regular tax rates on the gain ___ Expecting a portfolio to mature out OR ___ Having patience to let it mature out in 3-6 years with a bigger return in 1-2 years with a smaller return ___ Investing into the market overtime OR ___ Investing in the market all at one time 11. Suppose that a substantial portion of your investment portfolio is invested in stocks. If the stock market were to experience a prolonged down market, losing 45 percent of its value over an 18 month period, what would you do (assuming your stocks behaved in a similar fashion)? a. _____ Sell all the stocks in your portfolio. You are afraid that the market is in a downturn and you cannot afford the decrease in value. b. _____ Sell half of the stocks in your portfolio. You think that the market may rebound, but you are not willing to leave all of your investment exposed to further loss. c. _____ Hold the stocks in your portfolio. You understand that your investment may be subject to short-term price swings and are comfortable “weathering the storm.” d. _____ Buy more stocks for your portfolio to take advantage of their low price. You are comfortable with market fluctuations and assume that the stocks will regain their previous value or increase in value. 12. Which of the Investment Objectives described below best describes your investment preferences? We divide a client’s investment objectives into four categories: Growth, Growth & Income, Balanced and Income. The following table defines these classifications in more detail and describes the risk and return expectations. a. Growth b. Growth & Income c. Balanced d. Income (a) Growth Maximum capital growth with no (b) consideration for Growth & Income income. Increased price volatility. Up to Growth of principal 100% in equities and with minor emphasis on income. Less 20% in cash. volatility. Invest up to R 90% in equities, 30% E in bonds and 20% in (c) cash. T Balanced U R (d) Consistent returns, N Income income oriented, modest capital growth. Conservative, current Invest up to 70% of Income oriented. assets in equities, 60% Safety of principal is in bonds and 20% in the main concern. cash. Invest up to 100% in bonds, 35% in equities and 20% in cash. RISK / VOLATILITY v. 0506
  18. 18. 13. Many times portfolio performance comes after planting many seeds and “testing a client’s patience.” We have always found that performance will take care of itself if an investor continues to accumulate quality companies on a discounted basis and continues to average into the market. The determining factor ultimately for your success depends on your level of patience. Tell me about your patience, your timetable and your expectations: _________________________________________________________________________________________ _____________________________________________________________ ___________________________________________________________________________ 14. Your Individual Risk Profile: We want you to be comfortable with the level of risk exposure in your investment portfolio. Please give the following questions careful consideration since investment risk means different things to different people. Your answers will help us determine the level of risk exposure that is appropriate for you. Below are five hypothetical portfolios*, each representing an initial $100,000 investment. After one year, the dollar value of each portfolio will equal one of the two values shown--either low or high. Assuming there is an equal chance of achieving either result, indicate which portfolio represents the maximum risk/return trade-off you would be willing to accept. Value of Hypothetical Portfolio After One Year: Portfolio may be as low as: But may also be as high as: Change Change Risk Portfolio A* $100,000 0% $105,000 5% Conservative Portfolio B* $95,000 -5% $115,000 15% Moderately Conservative Portfolio C* $90,000 -10% $125,000 25% Moderate Portfolio D* $85,000 -15% $135,000 35% Moderately Aggressive Portfolio E* $75,000 -25% $150,000 50% Aggressive Portfolio (Check one): (a)_____ (b)_____ (c)_____ (d)_____ (e)_____ *These portfolios are strictly hypothetical and are intended only as an illustration to determine your tolerance of risk. The returns stated are not based on historical returns and should in no way be construed as an indication of expected future performance. 15. For your bond portion: Indicate the objectives (more than one) of your bond portfolio: a. Manager’s discretion b. Maturity: ___ 1-4 years ___ 5-10 years ___ 11-15 years __ _ 15+ years c. Current Yield d. Yield to Maturity e. Aggressive Trade f. Quality Ratings g. Tax Free h. Conservative Hold 16. Amount of cash to keep in a money market account: a. Manager’s discretion b. 5% or less c. 5% to 10% d. 10% to 20% e. Other: _____________________ 17. Do you anticipate making additional contributions or taking regular or irregular withdrawals from this (these) account(s) in the foreseeable future? a. Yes If yes, (deposit/withdrawal) how often? ________________Amount: $_________ b. No 18. Do you anticipate any changes in your overall financial circumstances in the foreseeable future? a. Yes b. No v. 0506
  19. 19. 19. If Yes to the prior question, please describe any changes you anticipate to your overall financial circumstances in the foreseeable future? _________________________________________________________________________________________ _______________________________________________________________ ____________________________________________________________________________ 20. Are there any particular stocks that you want added, sold and/or not purchased in your account? (i.e. tobacco, alcohol, gambling or pharmaceutical stocks, etc.) _________________________________________________________________________________________ ______________________________________________________________ ____________________________________________________________________________ 21. The movement and directions of the stock market, as well as individual stock positions, often dictate various actions. From the following list of actions, it is assumed the advisor has the discretion to do the following actions based on his professional judgment, current circumstances and what he deems appropriate in order to help maximize your portfolio. For the following situations, if any of the described actions are a concern to you, please circle it and describe at the bottom of the question what you would want done: a. Investing the initial amount in your account(s): From prior history, it is felt that investor’s portfolios have done best by gradually investing the money over time as market conditions dictate versus investing it all at one time. b. Advisor needs to raise cash from the portfolio: Advisor takes profits from stock previously purchased and/or sells off the more aggressive positions and preserves the higher quality ones even if a loss needs to be taken. c. For a current stock holding, if the company’s financial situation is deteriorating and its stock price is going down: If it is felt another position offers better upside potential at this point, the Advisor may take a loss and reposition if he feels it is warranted. d. For a current stock holding, if the stock’s price were to fall after advisor purchases it originally: Advisor may average down if it is felt the stock fundamentals have not changed and it still offers good upside potential. e. If your portfolio needs to be repositioned due to changing market conditions: Advisor may consolidate several positions if a higher quality company were to be added to the Advisor’s buy list, even if it means taking a loss; and/or, after holding a position for a significant length of time and it is felt another position offers better upside movement, the Advisor is free to sell and repurchase another position even if it means taking a loss. f. At year-end (for taxable accounts), if there is positive capital gains from the portfolio and the client would have to pay capital gains tax for the current year: Advisor may sell positions at losses to reduce capital gains tax for the investor. Provide comments to any circled item above (a-f), indicating what you would have wanted done in the situation: _________________________________________________________________________________________ ______________________________________________________________ ____________________________________________________________________________ 22. What do you expect the stock market to do over the next several years? a. Decrease by _____% per year b. Stay flat c. Increase by _____% per year 23. I expect my Money Manager to have the following abilities: a. Generally be able to guess and “time” short-term market turning points and re-orient my portfolio accordingly. He should exercise a high degree of timing judgment and anticipation in selling investments at higher prices in hopes of being able to buy them back at lower prices. OR b. Position my portfolio with the appropriate asset mix (i.e. stocks, bonds, cash equivalents, etc.) to meet my long- term objectives and alter the mix based on my changed objectives and/or a changed longer-term outlook. He should generally sell individual investments only when they are no longer considered good long-term holdings. v. 0506
  20. 20. 24. While the value of your investment is expected to increase over the long term, in the short term the value of any portfolio will fluctuate. This up and down movement in value is called volatility. Keeping your investment objectives in mind, you expect your portfolio volatility to be: a. Greater volatility than the stock market b. About the same volatility as the stock market c. Slightly less volatility than the stock market d. Less volatility than the stock market and about the same as the bond market e. Less volatility than the stock and bond markets 25. What is your idea of an ideal money manager? What do you expect of us (service, insight, leadership, etc.), as your advisor? How can we deliver the service you expect? _________________________________________________________________________________________ _____________________________________________________________ _________ ____________________________________________________________________________ 26. After completing this questionnaire, are there any material facts that have not been addressed? If so, please describe. _________________________________________________________________________________________ ______________________________________________________________ ____________________________________________________________________________ 27. For accounts being transferred in with existing positions, we usually evaluate each position to determine if it meets our investment parameters. If it does, we will keep it. If it does not, we will liquidate it and reposition you with stocks on our buy list. Are there any positions you currently hold that you do not want liquidated? Is there anything we need to know about a particular position (for instance – very low cost basis, came from inheritance, gift, do not sell, etc.)? We will be glad to use your correct cost basis if you can provide it to us. If not, we will use the current market value as the new cost basis for all positions that have been transferred to us (this could ultimately produce inaccurate reporting data for tax returns in the future). (Client assumes all responsibility (managing, following, directing, etc.) for positions transferred in with hold, do not sell instructions and/or a particular position a clients wants to keep and follow. ) _________________________________________________________________________________________ ______________________________________________________________ ____________________________________________________________________________ 28. How do you expect this asset management process and method to meet your investment objectives? _________________________________________________________________________________________ ______________________________________________________________ ____________________________________________________________________________ To the best of my ability, I have answered the foregoing questions based on my investment objectives and expectations. I will notify the Advisor immediately of any changes in my above-stated investment objectives. Client hereby acknowledges a Power of Attorney has been signed and that the money manager is authorized to proceed without a completed Investment Policy Statement. _______________________________________ Client Signature _______________________________________ nd 2 Client/Joint Client Signature v. 0506

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