Name *

First Name

Last Name

Phone - Primary *

(###)

###

####

Do you anticipate needing these funds for any expenditures in the next year? *

Yes

No

When investing your money, which one do you care about most? Choose ONE. *

Maximizing Gains

Minimizing Losses

Both Equally

Which of these three hypothetical return profiles most appeals to you? Choose ONE. *

Expected Return +7.5%, Range of Probable Returns In Any Given Year -3% to +11%

Expected Return +12.05%, Range of Probable Returns In Any Given Year -12% to +25%

Expected Return +18.50%, Range of Probable Returns In Any Given Year -20% to +50%

The securities markets are often volatile. If your entire investment portfolio lost 10% of its value in a month during a market decline, what would you do? Choose ONE. *

Sell All Of Your Investments

Sell Some

Keep All

Buy More

What type of account do you wish to open? Choose ONE. *

Individual

Joint

Trust

IRA (Traditional, SEP, Inherited, etc.)

Partnership

Corporation

Limited Liability Corporation (LLC)