Fee Waiver Request

Please use this form for all request to waive the service fee to a customer. This form must be filled out in its entirety for final approval from Michael Kumpulanian. You should not communicate to the customer the fee has been waived until you get approval via email. For New Account waivers, send completed form and approval with the account set up form.
  • Date Format: MM slash DD slash YYYY
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  • Required for Existing Accounts
  • Required for Existing Accounts
  • Required for Existing Accounts
  • Required for Existing Accounts
  • Required for Existing Accounts
  • Required for Existing Accounts