About Us

Employment Status*
Employed Company Owner Student Self-Employed Retired Not Employed

Company Name

Company Address

Are you affiliated with or employed by a stock exchange or member firm of an exchange or FINRA, or a municipal securities broker- dealer?*
Yes No

Are you a director, 10% shareholder or policy-making officer of a publicly held company?*
Yes No

Annual Income from All Sources: (Exclude income from spouse or joint account holder.)*
Below 100,000 100,000 - 199,000 200,000 - 349,000 350,000 - 599,000 600,000 - 999,999 1,000,000 Plus

Liquid Net Worth: (Exclude the value of your residence and other non-liquid assets.)*
Below 100,000 100,000 - 199,000 200,000 - 349,000 350,000 - 599,000 600,000 - 999,999 1,000,000 Plus

Total Net Value of All Assets: (Total assets minus total liabilities.)*
150,000-349,999 350,000 – 599,999 600,000 – 999,999 1,000,000 Plus

Investment Knowledge*
None Limited Good Extensive

Risk Tolerance*
Aggressive Moderate Conservative

Investment Target*
Income Growth Speculation

Investment Objectives
Income: Seek preservation of capital while generating Income from investments
Hedging: Seek to minimize potential loss of principal
Speculation: Seek to maximize total return potential while taking on a higher degree of risk through investments in a broad spectrum of securities.