Submission Of Claim Against Broker To Arbitration

1. Parties. The undersigned are Customer and Broker with respect to a securities account maintained by Broker to Customer.

2. Matters Submitted to Arbitration. The parties agree to submit to arbitration the following claims or disputes relating to Customer's securities account:

[brief descriptions].

3. Terms of Arbitration. All matter submitted to arbitration under this Agreement shall be subject to arbitration in accordance with the Securities Arbitration Rules of the American Arbitration Association, except as otherwise provided in this Agreement.

Arbitration shall be before a panel of three Arbitrators. Customer shall designate, by written notice to the Broker, one Arbitrator from a list of prospective arbitrators prepared by the American Arbitration Association. Within [number] days of receipt of such notice, Broker shall select a second Arbitrator from the said list and notify Customer of Broker's selection. Within [number] days thereafter, these two Arbitrators shall select a third Arbitrator from the said list. If they fail to select a third Arbitrator, then the third Arbitrator shall be designated by the American Arbitration Association. If either party fails to designate an Arbitrator, then the claim or dispute shall be submitted to arbitration before a panel of three Arbitrators chosen by the American Arbitration Association.

4. Place of Arbitration. All matters submitted to arbitration under the terms of this Agreement shall be heard in [court, state].

5. Final Award. The award in the arbitration proceeding shall be final and binding on the parties, and judgment on such award may be entered in any court having competent jurisdiction.

6. Fees and Expenses. The Arbitrators are authorized to award either party a sum to compensate the party for the time and expense of the arbitration if they determine that arbitration was demanded without reasonable cause. In such event, the Arbitrators may also assess the costs of the arbitration proceeding against the party that demanded arbitration. In all other cases, the costs of the arbitration proceeding shall be assessed against the party against whom the arbitration award is determined, or against both parties if the determination is against both.

[dated]

[signature]

Customer

[signature]

Broker

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