NEW ACCOUNT APPLICATION AND AGREEMENT PLAN LEVEL ACCOUNTS

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1 Mid Atlantic Capital Corporation The Times Building 336 Fourth Avenue Pittsburgh, PA Fax: General Information: NEW ACCOUNT APPLICATION AND AGREEMENT PLAN LEVEL ACCOUNTS Name of Plan Tax ID Number Note: If the Trustee maintains multiple plans with Mid Atlantic Capital Corp, please complete Schedule A listing each individual Plan name covered under this applilcation. Type of Plan (401(a), 401(k), 403(b), or 457) Name of Third Party Administrator (If applicable) I. Account Registration Name of Plan Trustee (or Custodian, if Plan is organized as a custodial account) Telephone Number Street Address or Post Office Box Facsimile Number Street Address address City State Zip code II. Wire Instructions (for distributions and/or redemptions) Bank Name Bank ABA Number Reference Account Name and Number

2 III. Transacting Persons We act as trustee for the above-referenced plan (or, if the plan is organized under Section 403(b) or Section 457 of the Internal Revenue Code of 1986, as amended, as custodian (either a Trustee ), and have entered into this Account Application and Agreement ( Agreement ) to authorize you to act as broker of record for the plan and to receive execution and settlement services with respect to the plan s investment in mutual funds or other investment products for the plan referenced herein. Each person providing a signature below is executing this Agreement on behalf of the plan referenced herein and has the authority under the plan s governing instruments to so execute this Agreement, and execution of this Agreement has been duly authorized in accordance with the governing instruments of the plan and does not violate any agreement with, or require the approval of, any other person. IV. Representations and Acknowledgements In connection with the services that we provide to the plan, we: (i)(a) are a bank, as defined in Section 3(a)(6) of the Securities Exchange Act of 1934, as amended ( Exchange Act ), and are excluded from the definition of broker, as defined in Section 3(a)(4) of the Exchange Act, or (b) are another financial institution, entity or person that is excluded from the definition of broker by rule or order of the Securities and Exchange Commission; (ii) have the power and authority under the plan documents or other agreement and applicable law to perform services to the plan and receive fees therefor; and (iii) will not be in violation of any covenant of the plan documents or other agreement, order of any court, or applicable law if we enter into this Agreement for purposes of providing services to the plan. We acknowledge that, if any of the foregoing representations become untrue for any reason, that we will promptly contact you at the address and telephone number noted above. V. Authorization of Agent (If Applicable) By inserting the name of the third party administrator (the TPA ) in the General Information section above, we are advising you that the TPA and their employees have been duly authorized to act on behalf of the plan referenced herein to convey instructions to you or any of your agents or perform any other necessary activities and receive any necessary information for purposes of clearing and settling transactions on behalf of the plan and maintaining plan records related thereto. These instructions may include, but not be limited to: cash disbursement directions, transfers between accounts, fee deductions, trade instructions, deposit information, plan registration changes, and any other instructions needed to service the account. You may rely on any instructions or other communications that you reasonably believe are provided by the proper persons or person duly appointed or authorized by the us for the benefit of the Plan. You shall have no duty to advise any person of the investment, tax or other consequences resulting from that person s actions or inactions, or of your own actions in following the directions of such person, or your failing to act in the absence of such directions We understand that you shall have no liability to us, a plan participant, or plan custodian for the performance or nonperformance of services of any TPA or other third party service provider. We understand that you shall in no event be liable to us, any plan participants, or plan custodian for any special, incidental, indirect, punitive, exemplary or consequential damages. VI. Fee Disclosure We understand that certain fee payments are available to you in connection with plan investments in the mutual funds that have been made available to the plan. We understand that the exact types and amounts of fees payable to you and other service providers to the plan will depend on the mutual funds in which plan assets are invested. We understand that you may receive commissions or dealer concessions up to 5% of the amount invested or 12b-1 fees up to 1.0% of the plan s fund account balances. Service fees, sub-administrative fees, and sub-transfer agency fees up to.25% of the plan s fund account balances may be available to you or other service providers to the plan. We understand that we may enter into a separate side letter or agreement with you to direct you to collect such fees and pay all or a portion of them to the plan s service providers or to pass them through to the plan, as we shall direct. We understand that more precise information about these fees is available upon our written request to you.

3 We also understand that you may receive credit earnings or interest on the cash in the plan s account awaiting investment, which earnings credit or interest you may retain as additional compensation. We understand that any such cash balances are payable on demand. VII. Delivery of Certain Communications We acknowledge that certain communications, such as periodic account statements and immediate or periodic trade confirmations, are delivered to us by agents acting on your behalf. We understand that we will be asked to consent to receive such communications in an electronic format if you or your agents determine to deliver them by electronic means by separate notice. In that regard, we understand that we have the opportunity to receive daily cash balances online rather than in cash account statements that would be mailed on a periodic basis. We understand that our daily cash balances can be made available to us via a password-protected Website maintained by you or your agents, and that cash balances for the day will be available at 6:00 pm (EST) online at a protected location containing our daily cash balances. We understand that we must contact you in writing if we do not wish to receive these statements online. By executing this Agreement below, we consent to receiving daily cash balance information online rather than via mail delivery of periodic cash account statements. We understand that we may revoke our consent to receive daily cash balances via online at any time by written request to you. VIII. Recording and Arbitration Acknowledgement We understand that telephone calls to Mid Atlantic Capital Corporation may be recorded and hereby consent to such recording. THIS ACCOUNT IS GOVERNED BY THE ATTACHED PRE-DISPUTE ARBITRATION AGREEMENT OF WHICH WE ACKNOWLEDGE RECEIPT AND UNDERSTANDING. Name of Trustee Authorized Officer / Title Signature Authorized Officer / Title Signature

4 Mid Atlantic Capital Corporation NEW ACCOUNT APPLICATION AND AGREEMENT PLAN LEVEL ACCOUNTS Schedule A Please list the full name and tax i.d. number of all benefit plans covered by this agreement for which Mid Atlantic Capital Corporation will provide cash custodian services. Additional Schedule A s may be completed as needed.

5 Pre-Dispute Arbitration Agreement This Agreement contains a predispute arbitration clause. By signing an arbitration agreement, the parties agree as follows: (A) (B) (C) (D) (E) (F) (G) All parties to this agreement are giving up the right to sue each other in court, including the right to a trial by jury, except as provided by the rules of the arbitration forum in which a claim is filed. Arbitration awards are generally final and binding; a party s ability to have a court reverse or modify an arbitration award is very limited. The ability of the parties to obtain documents, witness statements and other discovery is generally more limited in arbitration than in court proceedings. The arbitrators do not have to explain the reason(s) for their award. The panel of arbitrators will typically include a minority of arbitrators who were or are affiliated with the securities industry. The rules of some arbitration forums may impose time limits for bringing a claim in arbitration. In some cases, a claim that is ineligible for arbitration may be brought in court. The rules of the arbitration forum in which the claim is filed, and any amendments thereto, shall be incorporated into this agreement. We agree that all controversies that may arise between us (including, but not limited to controversies concerning any account, order or transaction, or the continuation, performance, interpretation or breach of this or any other agreement between us, whether entered into or arising before, on or after the date this account is opened) shall be determined by arbitration in accordance with the rules then prevailing of the New York Stock Exchange, Inc., or NASD as we may designate. If we do not notify you in writing within five (5) days after we receive from you a written demand for arbitration, then we authorize you to make such a designation on our behalf. We understand that judgment upon any arbitration award may be entered into in any court of competent jurisdiction. No person shall bring putative or certified class action to arbitration, nor seek to enforce any pre-dispute arbitration agreement against any person who has initiated in court a putative class action; who is a member of a putative class action who has not opted out of the class with respect to any claims encompassed by the putative class action until: (i) (ii) (iii) the class certification is denied; the class is decertified; or the customer is excluded from the class by court. Such forbearance to enforce an agreement to arbitrate shall not constitute a waiver of any rights under this agreement except to the extent stated herein.

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