ACCOUNT REACTIVATION FORM

Account Number ________________________________

Name of Account Owner _______________________________________

Account Type (please check which applies)

_____ Individual
_____ LLC
_____ Partnership
_____ Joint
_____ Trust
_____ Corporation
DormanAccounts.com Username (required for reactivation) ________________________
E-Mail Address _______________________________________
Home Address ____________________________________________________________
____________________________________________________________
Telephone Number ____________________________________________________
Occupation/Source of Income ________________________________________________
Date of Birth ______________________________________________________
Estimated Annual Income ________________________________
Estimated Net Worth __________________________________________
Estimated Liquid Net Worth __________________________________________
Deposit Amount _______________________________________

ACKNOWLEDGMENT:

I was provided, understand, and accept all of the terms in the required Risk Disclosures
and Customer Agreement. Futures and options trading contains substantial risk and is not for every
investor. An investor could potentially lose all or more than the initial investment. Risk capital is money
that can be lost without jeopardizing ones financial security. Only risk capital should be used for
trading and only those with sufficient risk capital should consider trading. Past performance is
not necessarily indicative of future results.

I have considered the financial risks involved in futures and options trading and I wish to proceed with
reactivating my trading account.

Dorman Trading Compliance may request additional information and/or supporting documentation.

Name: _______________________ Name (if Joint): _______________________

Signature: ___________________ Signature (if Joint): ___________________

Print out and sign by hand with a pen. Print out and sign by hand with a pen.

Date: ___________________ Date (if Joint): ___________________