Client Name
Date
Page 14
For Individual Clients:
CLIENT’S SIGNATURE
NAME OF WITNESS
(Print first, middle & last name)
(Print first, middle & last name)
Signature
Signature
Note: If this Agreement is to be used by a member of a SRO, or is affiliated with an
organization that requires certain terms and conditions in agreements with clients or
disclosure of compliance with certain practices, codes of conduct (or similar documents),
consideration must be given to ensuring compliance with such requirements.