Form S.a. 15 Investment Advisor Representative Multiple Employment Agreement

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S.A. 15 (7/07)
INVESTMENT ADVISOR REPRESENTATIVE MULTIPLE EMPLOYMENT
AGREEMENT
_________________________________________________________
(Print/Type Representative’s name and CRD Number)
Pursuant to the requirements of 21 VAC 5-80-250 of the Virginia Administrative Code, a
representative may be employed by more than one registered investment advisor. In order to
comply with the provisions of the regulation, each investment advisor identified below consents to
the multiple employment of the representative and agrees to be responsible for the employment
activity of the representative on behalf of each undersigned investment advisor.
______________________________________
Investment Advisor Name/CRD# (Type/Print)
By: _____________________________
Signature
__________________________________
Name of Signer (Type/Print)
_________________________________
Title of Signer (Type/Print)
__________________________________
Date
______________________________________
Investment Advisor Name/CRD# (Type/Print)
By: _____________________________
Signature
__________________________________
Name of Signer (Type/Print)
_________________________________
Title of Signer (Type/Print)
__________________________________
Date

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