VA Disclosure Form

* Client Name

* Client Address

* Client Phone

* Client Email

Client acknowledges David Lebold is an Investment Advisor Representative with Burgos and Brein Wealth Management, LLC (“BBWM”). BBWM hereby accepts appointment and fiduciary duty of utmost good faith to act solely in the best interests of each client pursuant to the terms and conditions set forth in this Agreement and to comply with impartial conduct standards of:

• Charging no more than reasonable compensation for services provided; and
• Making no misleading statements regarding investments, compensation and conflicts of interest.

Services include preparing a financial plan which may include a review of wills, trusts, investments, taxes, and insurance, and other applicable topics. Please refer to Scope of Services section for details.

Financial Planning Services are offered based on an hourly rate of $350 per hour.The payment is due at the signing of the advisory agreement. All plans will be delivered inside of 30 days. Client may cancel within five (5) days of signing Agreement for a full refund. If the client cancels after five (5) days, any unearned fees will be refunded to the client based on the percentage of work completed. The fee schedule is as follows:

Hourly Fees

* Hour(s)

* Total Fees

Client acknowledges that representatives of BBWM may provide client with various insurance products uponnwhich a commission may be paid to BBWM’s representatives, and such commissions are separate and apart from the fees charged under this Agreement. A conflict exists because of the relationship. This conflict is mitigated by disclosures, procedures, and the firm’s Fiduciary obligation. The client is under no obligation to act upon the investment advisor’s recommendations. If the client elects to act on any of the recommendations, the client is under no obligation to effect the transaction through BBWM.

No assignment of this Agreement by BBWM shall be effective without the prior written consent of Client. Client may terminate the Agreement within five (5) business days of signing, without penalty, and with full refund.

Client acknowledges receipt of Privacy Policy and Form ADV2 of BBWM. For the purposes of this provision, a contract is considered entered into when all parties to the contract have signed the contract or otherwise signified their acceptance, any other provisions of this contract notwithstanding. Client will have five (5) business days to terminate BBWM services without penalty.

This agreement becomes valid upon the signing of the agreement by both parties and is considered complete upon delivery of the recommendations made by Burgos and Brein Wealth Management, LLC to the client.