Mutual Fund Class C Share Disclosure Form

Mutual Fund Class C Share Disclosure Form

CLIENT NAME: ACCOUNT #: REP CODE: PROCESS METHOD:

DIRECT

PERSHING

The following form must be completed for all purchases of Class C shares.

Investment(s) Purchased

Solicited

Unsolicited

Mutual Fund Family/Fund Name

Approx. Value

$

$

Purchase Date

$

$

$

Time Horizon for the Investment:

Less Than 5 Years

Material Facts (The reason(s) class C shares were chosen)

5 or More Years

Annual Fees

% %

% % %

Client Acknowledgements (please initial all):

____ ____ I understand I may incur a contingent deferred sales charge on my purchase(s) if liquidated within one year of the purchase date.

____ ____ I understand Class C shares frequently have higher annual fees than other class shares offered by the mutual fund company. As such, for longer holding periods, total costs may exceed other share classes.

____ ____ I understand I may be eligible for reduced up-front sales charges and lower annual fees for a Class A purchase of the same mutual fund, if my purchase qualifies for a breakpoint, as defined by the fund.

____ ____ In the event I contemplate purchasing Class A shares of the same mutual fund family in the future, I understand the mutual fund company may not aggregate such amounts in calculating sales charges for future Class A share purchases of the same mutual fund family.

____ ____ I understand Class C shares are generally considered shorter-term investments.

____ ____ I received a prospectus for this investment.

I, the undersigned, understand and agree to the above information.

Client:

Name

Signature

Date

Joint Party(ies):

Name

Signature

Date

Registered Representative:

Name

Signature

Date

Registered Principal:

Name

Signature

Date

Securities offered through Capital Investment Group, Inc. or Capital Investment Brokerage, Inc.

v.06/18

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