My account is self-directed and I, alone, am responsible for the selection, due diligence, management, review, and retention of all investments in my account. I
agree that the Custodian and Administrator are not a fiduciary for my account, as the term is defined in the IRC, ERISA, or any other applicable federal, state, or
local laws and this payment does not constitute a prohibited transaction as defined in IRC 4975. I acknowledge and confirm that I have received, read and
understand each of the disclosures for my account(s) and direction(s) of investment, and consent and agree to the terms and conditions contained therein. I direct
American IRA, LLC to execute the payment of the above-referenced expenses for the benefit of my account. I agree to hold American IRA, LLC harmless from any
liability for any loss, damage, injury or expense which may occur as a result of the execution of this payment authorization form, a facsimile, electronic or other
form of this request may be submitted if acceptable to the custodian. I understand that American IRA, LLC will have a reasonable amount of time to complete my
instructions. I understand that if my request would cause my account to drop below the required minimum account cash balance, the request will not be
processed. American Ira, LLC may contact me for verbal confirmation of my expense payment instructions, which may cause delays if I cannot be reached at the
phone number listed on file.
By my signature below, I confirm that I have read and consent to the terms of this document and I further acknowledge that I have read and consent to the terms
of the New Account Application, Custodial Agreement (Form 5305, 5305-A, 5305-RA, 5305-SA, 5305-SEP, 5305-C or 5305-EA, as application, “collectively referred
to as “5305” or 401K Plan Agreement (“Sponsored Plan”) as applicable, Fee Schedule, Account Disclosure Statement and any other documents that govern my
Custodial Account or Sponsored Plan, as such documents are currently written, or as they may be amended from time to time, (the “Documents”), which are
incorporated by reference herein. (In the event of a conflict between the Documents and the 5305 and/or Sponsored Plan applicable to my Custodial Account,
the 5305 or Sponsored Plan shall govern).