To register for Premier Trust e-Statement:

E-Statement Authorization

To register for Premier Trust E-Statement delivery:

1. Complete all fields.

2. Sign the authorization form.

3. FAX (702-507-0755) or mail the form to us at:

Premier Trust, Inc.

4465 S. Jones Blvd.Las Vegas, NV 89103If you have questions about the application process, please contact us at 702-507-0750.

Account Information

Account Name:Acct. No.

Account Name:Acct. No.

Account Name:Acct. No.

Your Name:

Account Relationship:

Mailing Address:

Home/Contact Phone:

E-Mail Address:

E-Statement Disclosure

By enrolling in E-Statements, you have requested, and Premier Trust, Inc. (the Trust Company) has agreed, to notify you via the e-mail address you provide to the Trust Company, notice that your account statements are electronically available through the Trust Companys Portfolio Review website. The Trust Company will send, electronically to the same e-mail address, a message containing a notice of how to view available information by accessing the Trust Companys Portfolio Review website. By receiving your statement electronically, you acknowledge you will not receive a hard copy of your account statement. Your electronic statement will provide a review of assets, summary statement of activity, and statement of transactions activity for the statement period, and reports displaying a Market Value Chart, Portfolio % Chart, and Portfolio Review.

By enrolling, you agree to the terms stated above, and that you are able to meet the minimum requirements for printing or retaining the information that is provided to you. You understand that you have a duty to exercise reasonable promptness in examining the electronic statement, and to notify the Trust Company of any questionable transactions by contacting us at 702-507-0750. You agree to receive a copy of our privacy policy electronically. You agree to notify us if your e-mail address changes. Should you decide to cancel this method of statement delivery, you may do so by calling our office at 702-507-0750.

I agree to the aforementioned terms and conditions and wish to sign up for E-Statements.

Date___________________ Signature_________________________________________

Authorized Signer