Referral Partner Form

Section 1 of 6

Professional Background

First Name *

Last Name *

Professional Title: *

Other Professional Title:

Please specify

License Number: *

We will verify your professional credentials and review your disclosures (if any) with your state licensing authority. If not professionally licensed, enter N/A.

State: *

Professional Associations:

Examples: AICPA, State Bar Association, etc.

Years of Experience in Your Field: *

Section 2 of 6

Client and Referral Information

Primary Client Base: *

Describe the types of clients you typically serve (e.g., small business owners, high-net-worth individuals, family-owned businesses).

How often do you refer clients to other professionals for services like business valuations, financial planning, legal or tax advice? *

Frequently (monthly)Occasionally (a few times a year)Rarely (once a year or less)Never

Do you currently have referral partners for business valuation services? *

YesNo

If yes, please briefly describe your current referral process.

Section 4 of 6

Collaboration and Communication

How would you prefer to collaborate with Northern Pacific Asset Management for referrals?

Direct client introduction via emailScheduled meetings or callsSecure document sharing (e.g., ShareFile)Other

What is your preferred method of communication for updates and ongoing collaboration? *

EmailPhoneVideo conferencing (e.g., Teams, Zoom)In-person meetings (when possible)

Is there anything else you’d like to share about your practice or how you envision a partnership with Northern Pacific Asset Management?

Section 5 of 6

Contact Information

Company / Firm Name:

Email Address: *

Phone Number: *

Best Time to Contact You: *

Address *

Website Address:

LinkedIn Page:

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Have documents ready for your meeting? Upload tax returns, estate documents, statements, or any files you'd like your advisor to review in advance.

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Section 6 of 6

Consent & Submission

Review the disclosures below, provide your electronic signature, and submit.

Data Protection & Privacy

At Northern Pacific Asset Management, LLC., we deeply value the trust you place in us by sharing your personal and confidential information. This statement is a concise overview of our comprehensive Privacy Policy, tailored to the context of your interaction with this form.

Key Aspects of Our Privacy Approach:

1. Personal Information Handling

In line with our Privacy Policy, we collect personal information such as contact details, financial and commercial information, internet or electronic activity data, and other identifiers. This information is essential for offering and providing our services, operating our business, and ensuring compliance with legal obligations.

2. Purposeful Data Utilization

The information you provide is used to understand and meet your financial needs, facilitate transactions, improve our services, and maintain the security of our networks and systems. We do not sell your personal information for third-party promotional purposes.

3. Data Security Measures

Secured with AES-256-bit encryption. Your data is transmitted directly to Northern Pacific Asset Management.

4. Disclosure and Sharing of Information

Consistent with our Privacy Policy, we may disclose personal information to service providers, business partners, and governmental authorities as necessary for business operations, legal compliance, and service provision.

5. Your Privacy Rights

You have rights regarding your personal information, including the right to access, update, and request deletion. Our practices align with federal and state laws, including the California Consumer Privacy Act (CCPA), ensuring your right to non-discrimination in services.

6. Ongoing Updates and Transparency

Our Privacy Policy may be updated periodically. We commit to keeping you informed of any significant changes and encourage you to review the policy regularly.

For a full understanding of how we manage and protect your personal information, we encourage you to review Osaic Wealth, Inc. detailed Privacy Policy.

If you have any questions or concerns regarding the handling of your data, please do not hesitate to contact our customer service team. Trust and transparency are the pillars of our relationship with you.

Thank you for your trust in Northern Pacific Asset Management, LLC.

Legal Disclosure

This form is provided for informational purposes only and does not constitute investment, legal, or tax advice. The information you provide will be used to facilitate your advisory discussion and does not create or modify any advisory agreement. All investments involve the risk of potential investment losses and no strategy can assure a profit. Please consult with a qualified professional for specific legal, tax, or accounting advice. Northern Pacific Asset Management and Osaic Wealth do not provide tax or legal advice.

I consent to the collection and use of my personal and financial information as described in the Data Protection & Privacy disclosure above and the Osaic Privacy Policy.I confirm that the information provided in this form is accurate to the best of my knowledge and understand it will be used to prepare for my advisory meeting.

Electronic Signature (Type Full Name) *

Date *

Thank You!

Your referral partner form has been submitted successfully. Our team at Northern Pacific Asset Management will review your information and reach out to schedule a meet & greet.

A confirmation will be sent to the email you provided. If you need to make changes, please contact your advisor directly at (832) 559-3771.