The Offices of
David W Barnett

Flat-Fee Planning Programs

You may complete and submit the following form online, or print it out and submit:
by Fax to (866)274-6590 or
by mail to P.O. Box 820304, Fort Worth, Texas 76182.

If you have any questions or need assistance completing the form, please contact us at:
(817)589-7281 in the DFW area or toll-free (866)964-4456 nationwide.

Purchaser's Mailing Address and Information

Your Name
Your Address
City	ST ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYPRGMVI ZIP
Phone	E-Mail

Participant's Mailing Address and Information (If Different)

Participant Name
Your Address
City	ST ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYPRGMVI ZIP
Phone	E-Mail

Available Programs

	The Silver Program Includes the Life-Coaching Session and the Life Handbook	$45 each	Qty 012345678910 or more
	The Gold Program Includes the Life-Coaching Session, the Life Handbook, and a one hour private consultation	$95 each	Qty 012345678910 or more
	The Platinum Program Includes the Life-Coaching Session, the Life Handbook, a one hour private consultation, and a second consultation with a custom-prepared Personalized Life Plan.	$195 each	Qty 012345678910 or more

Special Instructions

Payment may be made by personal check or credit card, payable to Signal Securities, Inc. Please submit this form with your e-mail address. We will process your order and e-mail you an invoice that includes payment instructions. Payment must be received prior to the initial consultation.

Licenses and Registrations

Investment advisory services are offered through:

Grand Arbor Advisors
7624 Bridges Avenue
Richland Hills, Texas 76118
(817) 589-7281

Registered as a Registered Investment Advisor with the Texas State Securities Board.

• General Lines -- Life, Accident, Health and HMO Insurance License in the State of Texas

Professional Designations

• ChFC
  Chartered Financial Consultant
  
  The American College
  Bryn Mawr, PA
  . . . . . . . . . . .
• FLMI
  Fellow, Life Management Institute
• AIRC
  Associate, Insurance Regulatory compliance
• ACS
  Associate, Customer Service
  
  Life Office Managment Association
  Atlanta, GA
  

Memberships

Member, Northeast Tarrant
Chamber of Commerce
Haltom City, Texas
. . . . . . . . . .