DESIGNATION OF ACCOUNTANT 1) Broker-dealer Name: __________________ __________________ _________________________ Address: __________________________________ _________________________ Telephone Number: __________________________________ _________________ SEC Registration Number: ____________________________ _________________ 2) Accounting Firm Name: __________________ __________________ _________________________ Address: __________________________________ _________________________ Telephone Number: _____________________________________ ______________ 3) Audit date covered by the agreement: ____________________________________ (month / day / year) 4) The contractual commitment to conduct the brokers or dealers annual audit: ( ) is for the annual audit for the fiscal year ending __________________________. ( ) is of a continuing nature, providing for successive yearly audits. If this commitment is not of a continui ng nature, it will be necessary to file this form each successive year. Accountants Signature: _______ ___________________________ ________________ Print Accountants Name _____________________ __________________ __________ Title: _____________________________________ __________________ __________ Date: ______________________ __________________ _________________________ IN-1493 RDA 897 American LegalNet, Inc. www.USCourtForms.com