T ContneDrolivering Firm Address: 345 PARK AVE 26TH FLOOR NY.NY10154 Con ' (Required): Ccotra/Detivenng Fern Email: Account Type (select one) Olnckyidual — (Non IRA) ElJoint OTrust SCorp/Business OUGWVUTMA ['Estate O Traditional or Rollover IRA K Roth IRA ['Beneficiary IRA El Beneficiary Roth