I understand that DBSI may, in its sole discretion, decide not to accept any order. I acknowledge that DBSI will rely upon the aforementioned representation. Print Client Name Print Client Advisor Name Client Signature Client Advisor Signature Account Number Pmt Branch Supervisor Name Branch Supervisor Signature Date ‘MAIS6657 021318 060415 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0079137 CONFIDENTIAL SDNY_GM_00225321 EFTA01380644