Board Member or Owner Information
Please complete the form below. Information provided will be used to open new investment accounts and will not be shared with anyone outside Headwater Investments.
Name
*
First Name
Middle Name or Initial
Last Name
Position on Board/in Company
Your Legal Address (Cannot be a PO Box)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Your Mailing Address is Same as Legal Address
*
Yes
No
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Your Preferred Phone
*
Please enter a valid phone number.
Preferred Phone is my:
Cell
Home (landline)
Work
Other
Cell Phone
*
Please enter a valid phone number.
Your Preferred Email
*
example@example.com
Preferred Email is my:
Home
Work
Other
Date of Birth
*
-
Month
-
Day
Year
Social Security Number
*
Are you a U.S. Citizen?
*
Yes
No
Country of Citizenship
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Are you retired?
*
Yes
No
Company
Job Title
Back
Next
Non-Profit or Corporate Account Information
To be completed by a Board President, Treasurer or other Business Owner
I want to complete non-profit or corporate account information
*
Yes
No
Legal Organization Name
*
Other Entity Name / Doing Business As
Legal Address (Cannot be a PO Box)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address is Same as Legal Address
*
Yes
No
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Organization Taxed As:
*
C-Corp
S-Corp
LLC
Partnership
Sole Proprietorship
Non-Profit
Tax ID Number (TIN or EIN)
*
Upload Files
Please upload the Articles of Incorporation, Bylaws, and all statements of the accounts you will be transferring to Headwater and/or other information you wish to share.
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