By completing this form, you authorize Smart Capital Fund to deduct a monthly service fee equivalent to 25% of trading profits, billed upon deposit of funds. This authorization will remain in effect until canceled in writing. You may cancel this authorization at any time by notifying us in writing. Cancelation will not affect any charges already incurred.

Monthly Service Fee: 25% of Profits
Charged upon deposit of monthly funds.

Client InformatioN

Account Holder Name

First Name

Last Name

Email

Phone

(###)

###

####

Billing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Checking Account Information

Bank Routing Number

Checking Account Number

Authorization Agreement

I authorize Smart Capital Fund to debit my checking account for a monthly service fee of 25% of profits, billed upon deposit of funds.

Approved

DISCLAIMER

I understand that this payment information will be stored securely and used for future transactions related to my account with Smart Capital Fund.

I understand that I may cancel this authorization at any time by contacting Smart Capital Fund. This agreement will remain in effect until written notice of cancelation is received.

Authorization & Agreement for Monthly Service Fee

Client InformatioN