FISN Purchase Order - Fixed Rate, Structured & Exchangeable<br/>Corporate Securities


FISNA Division of Landolt Securities, Inc.	1-800-351-4494

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PURCHASE ORDER
FISN Division of Landolt Securities, Inc.
Account Holders Only

I currently maintain an account with the FISN Division of Landolt Securities, Inc. I want to indicate my interest in purchasing the following investment. I realize that this Purchase Order is contingent upon availability and price of the security, suitability considerations and settlement funding for the account.

The FISN Division will determine if the indicated investment has sufficient quantity to meet the order, verify the current price and assess the suitability of the investment, based upon the account investment profile. The FISN Division will contact me to review all aspects of the security, confirm suitability, and set the payment date and method for settlement.

I understand that this Purchase Order is an "Indication of Interest" and does not commit me to a purchase any investment until I confirm it with the FISN Division of Landolt Securities, Inc. I understand that an "Indication of Interest" does not mean that the FISN Division can or will fill my order. All orders must be confirmed with and by the the FISN Division Account Executive to complete the transaction.

Fixed Rate, Structured & Exchangeable
Corporate Securities

Fixed Term	Annual Interest Rate	Issuer Credit Rating	Exchangeable Stock At Maturity	Prospectus (Terms & Conditions)	Closing Date	Downside Protection	Interest Payment
No Current Issue

* A red asterisk indicates a required field.

ACCOUNT INFORMATION
*PURCHASE AMOUNT ($1,000 Units)	,000.00
Account Ownership Title:
*Account Number:
FISN Account Executive:
CONTACT INFORMATION
Purchase Order Contact:
Contact Telephone Number:
*Contact Email Address:
*Confirm Email Address:

Note: Purchase Requests can only be accepted for established, active accounts. If you do not currently have an open account or wish to purchase investments in a new ownership title, please contact the FISN Division at 1 (800) 351-4494. Or, you can get started now by opening an account online (single or joint accounts only) before you call us.