PRIVATE ACCOUNT CONSULTANT MANAGEMENT SERVICES
CLIENT PROFILE FORM

The Client Profile Form questionnaire provides us with the necessary information to develop an investment portfolio and asset allocation strategy for your specific investment goals, time horizon and tolerance for risk, while still complying with the provided Consultant Agreement. We like to keep a record of your experience, knowledge and objectives in connection with all forms of investments. All information given is for internal use only and will be dealt with in a strictly confidential manner.

NAME/ACCOUNT HOLDER:

BROKERAGE FIRM: Fidelity Interactive Brokers Other Discount Brokerage Firm ACCOUNT#:

INVESTMENT OBJECTIVES:

Investment Period (check one):

I am looking for (check one or more):

Regular income

Automatic reinvestment

Capital growth

Capital preservation

Diversification

MY INVESTMENT EXPERIENCE:

PERSONAL HOLDINGS:

What approximate percentage of your total net worth was acquired through the following source(s):

What approximate percentage of your net worth is considered invested in the following area(s):

EDUCATION:

How many total years of formal education have you received (i.e. high school equals 12 years):

12 years

14 years

16 years

18 years

Other (please specify)

RISK TOLERANCE:

Our first and primary objective at JOHN MOIR is to generate profits for our clients; however, there are and will be times when adjustments in market conditions are more difficult to anticipate than others. Therefore, please specify the percentage of total equity loss exposure that is an acceptable level of tolerance for you in each of the specified periods. (Note: The percentages provided in no way revises the information outlined in the Consultant Agreement for the Private Consultant Management Services, but simply gives us an idea of your level of risk tolerance) :

PERSONAL DECLARATION:

The undersigned, collectively called Client, am providing the above data in this Client Profile Form as being an accurate reflection of investment objectives, experience, education, and personal holdings percentages. Also, the provided risk tolerance information reflects the Clients most desirable levels of tolerance, but in no way changes or adjusts the risks disclosed within the Consultant Agreement for the Private Account Consultant Management Services. The funds for this investment are liquid funds of the Client and are not borrowed funds.

SIGNATURE OF THE CLIENT SIGNATURE OF THE CLIENT Date

PRIVACY AGREEMENT BETWEEN CLIENT AND JOHN MOIR

The undersigned, collectively called Client, agree to keep private the private account consultant management services entered into between the Client and JOHN MOIR, hereinafter, the Consultant. The brokerage firm with custody of the Clients’ accounts, Fidelity Interactive Brokers Other Discount Brokerage Firm , hereinafter the Broker, that will be processing the trades entered, will have the current and future understanding that the account is in the Clients name and the Client is the authorized trader for the account. The Client agrees to explain this private account consultant management services to any employee or family member that may answer the phone, which represents the number provided to the Broker. Even though all trades will be done on-line through the Internet with the Broker, they will, periodically, call providing a fill for a position and request to speak with the authorized trader on the account, which is the Client. Simply remind the Broker that all trades and fills will and are being made and received on-line and no phone calls are necessary. By entering into this privacy agreement, it enables the Consultant to enter trades through the Internet on the Clients’ behalf with a limited power of attorney without having access to the Clients funds. The Client is the only person authorized to request funds from the account and any checks or bank wire transfers will only be sent to the Clients name and address on file with the Broker.

SIGNATURE OF THE CLIENT SIGNATURE OF THE CLIENT Date