IAR Onboarding Intake

Advisor Information:

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Submission Date

Full Legal Name(Required)

First Middle Last Suffix

Social Security Number(Required)

Date Of Birth(Required)

Cell Phone Number(Required)

Personal Email(Required)

Legal Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Business Address, if different from Home Address

Street Address Address Line 2 City State ZIP Code

This is the address(s) for any "office" locations you plan or will be meeting clients, or conducting business.

What is your CRD number?(Required)

Do you intend on using a DBA?(Required)

What is the name and website of your DBA?(Required)

Are you dual registered with a Broker Dealer?(Required)

What is the name and CRD of your Broker Dealer?

Do you have OUTSIDE business activities?(Required)

Outside businesses such as financial, Investment, Insurance or Securities Related Outside Business Activities. This includes ALL outside business associations and activities full, part-time, or voluntary.

Please list ALL outside activities, see description below for items to include.(Required)

Please provide the following FOR EACH outside activity. 1. Is it Financial, Investment, Insurance or Securities Related? 2. Address: 3. Description of business: 4. Hours/ Month: 5. Relationship: 6. Contact Person Information: 6. Insurance Carrier (if applicable).

Criminal or Civil Litigation Attesation(Required)

Please set forth below the charge, the date of the charge and the disposition or status. You must attach a copy of the charging document and the court order showing the disposition of the case.(Required)

Attach a copy of the charging document and the court order showing the disposition of the case.(Required)

Max. file size: 2 GB.

Do you have disclosable events not disclosed on your current U4? (Please ask if you are not certain an event is disclosable prior to completing)(Required)

NOTE: It is your obligation to make sure Bison Wealth is fully aware of all disclosable events.

Please list all disclosable events not disclosed on your current U4.(Required)

Do you have any pending complaints?(Required)

Yes

Please list pending complaints in the last 10 years and outcomes:(Required)

Do you have any pending litigation?(Required)

Yes

Does not apply to me

Please list any pending litigations in the last 10 years and outcome:(Required)

Anticipated Resignation Date from Current Firm?(Required)

RIA only Book Of Business/AUM Information

If you have a current book of business, what is your estimated RIA AUM? If also registered with a BD, please list that in the separate BD section below.

Who are your current custodian(s)?

Approximately how many accounts? (Please separate by custodian)

Please list the account registration types, i.e. layered trust, IRA, Business, Individual, etc.

Do any of these accounts hold A shares that you received a commission for in the last 36 months?

Yes

Broker Dealer BOB, if applicable

What is your estimated BD AUM, if applicable?

Approximately how many accounts? (Please separate by custodian)

Who are your current custodian(s)?

System Information

Will you be bringing your own device? If so, please list the computer model, device name, and operating system version (e.g. Windows 11 Home). You can find this information in the System/About section of your computer.(Required)

What cyber protection software (or service) do you currently use?(Required)

What is your current CRM?(Required)

What is your current Portfolio Management/Reporting system?(Required)

If joining as a DBA, please upload logo.

Accepted file types: jpg, jpeg, png, gif.

Billing Information

Intended Fee Schedule?(Required)

Current billing cycle?

Investment Management Information

What Model Portfolios do you utilize?

My Own Models

Money Managers

Open to new options

Other

Please describe, in detail, the other model portfolios used.

Please list the Money Managers that you utilize.

Please indicate you approximate percentage of ETFs that make up your business.:

Please indicate you approximate percentage of INDIVIDUAL BONDS that make up your business.:

Please indicate you approximate percentage of STOCKS that make up your business.:

Please indicate you approximate percentage of MUTUAL FUNDS that make up your business.:

Please indicate which other investments you utilize:

***NOTE: to multiselect press the shift key and select all that apply.

Please provide, in detail, the "other" investments you utilize.

By checking this box you are consenting the the outlined: Obligations To Prior Employers; Compliance With Securities And Privacy Laws(Required)

We are honored by your consideration of our offer to affiliate as an investment advisor representative of Bison Wealth, LLC (“Bison Wealth”). As you consider affiliating with our firm, please be advised that Bison Wealth’s policies regarding the protection of client non-public personal information require our strict adherence with state and federal securities laws, including, without limitation, Regulation S-P and similar privacy laws and rules. To that end, please avoid sharing with us any non-public client information or data, including, without limitation, client names, account numbers, account balances or holdings, tax identification numbers, and the like, unless and until you have received the consent from the underlying client(s) for the release of such information and have been authorized by your prior employer to do so. By agreeing to become licensed as an investment advisor representative of Bison Wealth, you represent and warrant that, (1) you will not possess, as of your start date with the firm and during your employment with the firm, any material, tangible, confidential or proprietary information, including documents, files, disks, or other materials, belonging to your former employer or its affiliates; (2) as of your start date with the firm, you have not solicited any employees or clients of your former employer or its affiliates to change their association with or otherwise materially alter or reduce their relationship with your former employer or its affiliates; and (3) you are not subject to any restrictive covenant, notice of termination requirement, non-competition or non-solicitation provision with any former employer or any agreement that prevents your affiliation with the Firm and that you have conducted a reasonable review of copies of all agreements you may have entered into with your former employer to ensure that this is correct. By accepting an affiliation as an investment advisor representative of Bison Wealth, you further agree to indemnify, defend, and hold harmless the firm, its affiliates, and their respective principals, officers, directors, members, and employees from all losses, damages, liabilities, and expenses (including attorneys’ fees and court costs) arising from or related in any way to your breach of any obligations to any of your former employers. Thank you for your interest in joining our growing team. If you have any questions or concerns, please contact us at 404-841-2224 or compliance@bisonwealth.com .

Please upload your valid government ID.(Required)

Max. file size: 2 GB.

Signature(Required)

By signing, I state that the information contained herein is true and complete. I understand that failure to fully disclose the information requested herein may be grounds for termination.