Register

First Name, MI, Last Name: *

Investment Consultant:

At which SMITH HAYES branch do you do business?

Lincoln
Omaha
Columbus
Other

E-mail address:*

Additional email addresses:

Phone:*

( ) -

Which of your accounts does this authorization apply to?

All of my accounts
Specific accounts

Agreement:
I consent to receive documents by any and all electronic media. This consent applies to all documents of which the FINRA and /or SEC requires delivery.

This consent is valid until I revoke it. I understand that I have the option to receive documents on paper. I may revoke this consent at any time by notifying SMITH HAYES Financial Services Corporation in writing.

I understand that at this time the electronic documents are in addition to mailed paper documents, and that this form authorizes SMITH HAYES to provide electronic documents upon my request.

I understand that at any costs I incur in association with electronic delivery (such as internet service) are my responsibility.

If my e-mail address changes, I agree to inform SMITH HAYES immediately. I understand that I will have to sign a new consent form to receive documents at any e-mail address not listed on this form.

I agree to the above terms.

Note: Fields marked by an asterisk (*) are required.