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Table of
Contents 10237 Yellow Circle Drive Minnetonka, MN 55343 X X Applic (Date)
Co-Applicant’s Signature (Date) Page 2 of 2 America Inc. (01/28/13) Account
Application Account Number: (Con Office Use Only: ACCT.#: CONS. ACCT #: L
FIRST NAME: REP NO. REP LAST NAME: 4. Investor Information Investment
Objectives (Check all that apply): Capital Preservation Investing low-risk
investments, such as government-issued bonds and c deposit, resulting in
relatively low current income and often l opportunity for capital
appreciation. Income: Focus is on gen income, but with moderate risk of
principal and little or no op appreciation Growth: Investing in securities
designed to gene capital appreciation, that are subject to greater
fluctuations in and offer little or no current income. Speculation: Investing
i hope of achieving exceptional capital appreciation, but whose fluctuate
widely, and thus have a higher than average potenti principal. Risk Tolerance
(Check only one) Low (Conservation preserve my invested principal in this
account, with minimal means this account does not generate significant income
or c and may not keep up with inflation. Moderate: I am willing t to my
invested principal and tolerate some volatility to seek h understand I could
lose a portion or all of the money invested (Aggressive): I am willing to
accept high risk to my invested volatility, to seek higher than average
returns over time, and lose all or a substantial amount of the money
invested. Financial Primary Applicant: Check Here If Co-Applicants Are
Combining Information Investment Experience (# of Years) Estimated A
Estimated Net Worth 1 Estimated Liquid Net Worth 2 Tax Bra Bonds Mutual Funds
Municipal Treasuries REITs Variable A Limited Partnerships Under $25,000
$25,000 - $50 $75,000 $75,001 - $100,000 $100,001 - $175,000 $175,001 -
$250,001 - $500,000 Over $500,000 Under $50,000 $50,000 $100,001 - $150,000
$150,001 - $250,000 $250,001 - $500,0 $999,999 $1,000,000 - $2,000,000 Over
$2,000,000 Under $ $100,000 $100,001 - $150,000 $150,001 - $250,000 $250,00
$500,001 - $750.000 $750,001 - $1,000,000 Over - $1,000,0 28% 33% 35% 39.6%
Financial Information – Co-Applicant Investment Experience (# of Years)
Estimated Annual Incom Worth 1 Estimated Liquid Net Worth 2 Tax Bracket
Stocks Mutual Funds Municipal Bonds REITs Variable Annuities Li Under $25,000
$25,000 - $50,000 $50,001 - $75,0 $100,000 $100,001 - $150,000 $150,001 -
$250,000 $250,00 $500,000 Under $50,000 $50,000 - $100,000 $100,001 - $15
$250,000 $250,001 - $500,000 $500,001 - $999,999 $1,000,0 Over $2,000,000
Under $50,000 $50,000 - $100,000 $100,00 $150,001 - $250,000 $250,001 -
$500,000 $500,001 - $750,0 $1,000,000 Over - $1,000,000 10% 15% 25% 28% 33%
35% Worth is the value of all assets minus all liabilities. 2 Liquid portion of
Net Worth that can be easily converted into cash, e securities, short-term
cds, cash. 5. Account Agreement (Pleas Certification of Taxpayer ID Number
(Substitute W-9): Under perjury, you certify that (1) the number shown on
this form is taxpayer identification number and (2) you are not subject to
withholding because (i) you are exempt from backup withhold have not been
notified by the Internal Revenue Service (IRS) subject to backup withholding
as a result of a failure to report dividends, or (iii) the IRS has notified
you that you are no long backup withholding and (3) you are a U.S. person
(including alien). Arbitration Agreement: The customer agrees, and by c for
the customer, American Investors Group, Inc. agrees that which may arise
between us concerning any transaction or th performance, or breach of this or
any other agreement between securities, whether entered into prior, on or
subsequent to the be determined by arbitration. Any arbitration under this
agree conducted pursuant to the Federal Arbitration Act before the Regulatory
Association, or FINRA, in accordance with the rules then prevailing at the
organization. Both parties agree that (i) arbitration is fi al and binging on
the parties. (ii) The parties are waiving their right to seek rem including
the right to jury trial. (iii) Pre-arbitration discovery limited than and
different from court proceedings. (iv) The arbitrator’s award is not required
to include factual findings or legal reasoning and appeal or seek
modification of rulings by the arbitrators is str trictly limited The panel
of arbitrators will typically include a minority of a or are affiliated with
the securities industry. FOR BROKER U Name: X X Registered Representative
Signature (Date) Principal’s Signature Note: Please see Exhibit B for
state-specific suitability standards
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