Personal Information Date of Birth: Investment Information Investment Amount $10,000 or less $10,000-$50,000 $50,000-$100,000 $100,000 or more Current Employment Status Employed (full/part time) Self-Employed Retired Other Annual Income Less than $25,000 $25,001 - $99,999 $100,000 - $499,999 $500,000 + Liquid Net Worth Less than $50,000 $25,001 - $99,999 $100,000 - $499,999 $500,000 - $999,999 $1,000,000 + Amount Currently Invested less than $25,000 $25,001 - $99,999 $100,000 - $499,999 $500,000 - $999,999 $1,000,000 + Source of Funds Savings Salary Inheritance Investment Income Investment Objective Capital Appreciation Income Generation Wealth Preservation Speculation Risk Tolerance Low Moderate High Very High Accredited Investor Status Yes No Investment Experience None Less than 2 years 2-5 years More than 5 years Declaration: I have read and agree to the terms and conditions. I certify that the information provided in this account application form is accurate and complete to the best of my knowledge. I acknowledge that I have read, understood, and agreed to the terms and conditions of the investment firm, and I agree to abide by them. Submit
