I currently maintain an account at First Internet Securities Network (FISN), the broker dealer division of FISN, Inc. I want to indicate my interest in purchasing the following item. I realize that this Purchase Order is contingent upon availability and price of the security, suitability considerations and settlement funding for the account.

FISN will determine if the indicated investment has sufficient quantity to meet the order, verify the current price and assess the suitability of the investment, based upon the account investment profile. FISN will contact me to review all aspects of the security, confirm suitability, and set the payment date and method for settlement.

I understand that this Purchase Order is an "Indication of Interest" and does not commit me to a purchase any investment until I confirm it with FISN. I understand that an "Indication of Interest" does not mean that FISN can or will fill my order. All orders must be confirmed with and by the FISN Account Executive to complete the transaction.

Note: Purchase Requests can only be accepted for established, active accounts. If you do not currently have an open account or wish to purchase investments in a new ownership title, please contact FISN at 1 (800) 351-4494. Or, you can get started now by opening an account online (single or joint accounts only) before you call us.