AUTHORIZATION TO BANK TO RELEASE ACCOUNT INFORMATION TO FINANCIAL ADVISER

[DATE, ex. Wednesday, June 11, 1998]

[NAME, BANK AND ADDRESS, ex.

John Smith

XYZ Bank

1234 First Street

Suite 567

Anycity, Anystate 85245]

Dear [NAME, ex. John Smith],

You are hereby authorized to release to [NAME OF INDIVIDUAL OR COMPANY] all banking information requested by [him / her / it] relating to our Account No. [ACCOUNT NO., ex. 12345678].

This shall be your good and sufficient authority for so doing.

Sincerely,

[YOUR NAME, ex. Jill Jones]