Authorization Form

ADVISOR AUTHORIZATION FORM

I/We hereby authorize you to provide Integrated Investment Strategies, Inc. with information they may request regarding our finacial information. I/We repectfully request that you cooperate with the associates of Integrated Investment Strategies, Inc. to the best of your abilities.

I/We have engaged Integrated Investment Strategies, Inc. to analyze our financial data, and to maintain and update this information for our use and the use of our financial advisors.

This letter shall be effective upon receipt and shall remain in effect until further notice. When you send information in response to Integrated Investment Strategies, Inc. requests, please send us a copy of your letter listing the information you have provided.

A photographic, facsimile or carbon copy of this authorization bearing the signature(s) of the undersigned may be deemed to be equivalent to the original hereof and may be used as a duplicate original.

If you have any questions regarding this authorization, please contact us.

 

Signature:_________________________________________________

Name (printed):_________________________________________________

Date:_______________________

Signature:_________________________________________________

Name (printed):_________________________________________________

Date:_______________________

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