Name *

First Name

Last Name

Phone - Primary *

(###)

###

####

Phone - Mobile

(###)

###

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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 (if checked, please answer additional question below)

Trust

IRA (if checked, please answer additional question below)

Partnership

Corporation

Limited Liability Corporation (LLC)

Other

If Account type is "Joint" - Choose one of the following

Joint Tenants with Rights of Survivorship

Community Property

Tenants in Common

If Account type is "IRA" - Choose one of the following

Traditional

Traditional - Inherited

Traditional - Rollover

Roth

Roth - Inherited

Simplified Employee Pension (SEP)

Simplified Employee Pension (SEP) - Inherited

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

Yes

No

Funding Method *

Check (slowest)

Wire Transfer (Fastest)

ACAT (IRA to IRA between Custodians)

Trustee to Trustee (401k to IRA Conversion)