Agent Multiple Employment Agreement {S.A. 16}

S.A. 16 (7/07) AGENT MULTIPLE EMPLOYMENT AGREEMENT _________________________________________________________ (Print/Type Agent's name and CRD Number) Pursuant to the requirements of 21 VAC 5-20-95 of the Virginia Administrative Code, an agent may be employed by more than one registered broker-dealer. In order to comply with the provisions of the regulation, each broker-dealer identified below consents to the multiple employment of the agent and agrees to be responsible for the employment activity of the agent on behalf of each undersigned broker-dealer. __________________________________ Broker-Dealer Name/CRD# (Type/Print) By: _____________________________ Signature __________________________________ Name of Signer (Type/Print) _________________________________ Title of Signer (Type/Print) __________________________________ Date __________________________________ Broker-Dealer Name/CRD# (Type/Print) By: _____________________________ Signature __________________________________ Name of Signer (Type/Print) _________________________________ Title of Signer (Type/Print) __________________________________ Date American LegalNet, Inc. www.FormsWorkFlow.com