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_____________________________________________________
In order to explore opening a managed account, please complete the form below to the
best of your ability.  A representative will contact you to address any issues that you
have indicated in the question or comment field.
* Required field.
First Name*:
Last Name*:
Address:
City:
State*:
Zip Code:
Home/Work Phone*:
Your email address*:
Ex:  name@domain.com
Our Targeted Annualized Returns  For This Account Are at least
20%-30%.   Are You Willing To Accept This?
Yes
No
Are  you willing to accept significant volatility in this account in order to
achieve the above targeted returns?
Yes
No
Are  you willing to accept 1 - 3 years as a reasonable time period for our
investments/trading strategy to potentially prosper?
Yes
No
Total Net Worth (including your primary residence)
$500,000 - $1,000,000
$50,000 - $100,000
$5,000,000 - $10,000,000
$100,000 - $500,000
$1,000,000 - $5,000,000
Over $10,000,000
Total Existing Stock Holdings
$500,000 - $1,000,000
$50,000 - $100,000
$5,000,000 - $10,000,000
$100,000 - $500,000
$1,000,000 - $5,000,000
Over $10,000,000
Total Existing Bond Holdings (including Cash and Cash Equivalents)
$500,000 - $1,000,000
$50,000 - $100,000
$5,000,000 - $10,000,000
$100,000 - $500,000
$1,000,000 - $5,000,000
Over $10,000,000
Phone
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Contact You:
Best Way To
Contact You:
Email
Questions or
Comments:
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