Client Profile

Financial Information:
Annual Income*
Estimated Net Worth*
(Total worth of all assets, excluding residence)
Investment Objectives

Preservation of CapitalIncomeLong-Term GrowthSpeculation (High degree of risk. Not needs-based)
Risk Tolerance

Capital PreservationConservativeModerateAgressive

Additional Question
Are you or your spouse a director, 10% shareholder, or executive who makes policy at a public company ?

YesNo
If yes,

Please provide the information for the company(s) in which the client is a director, policy-making executive, or 10% shareholder:
Company Name/Stock Symbol
Are you, or your spouse, or any other immediate family members, including parents, in-laws, and siblings that are dependents, employed by or associated with the securities industry (for example, Investment Advisor, Sole Proprietor, Partner, Officer, Director, Branch Manager or Broker at a Broker-Dealer Firm or Municipal Securitites Dealer) or a financial regulatory agency, such as FINRA or the New York Stock Exchange? If yes, and if this entity requires that you obtain its approval to open this account, please select the Yes checkbox:

YesNo

Beneficiary Designation

If more than one Beneficiary is designated, be sure that the total percentage share adds up to 100 %
Primary Beneficiary #1*
SSN*
DOB*

MonthDayYear
Date
% Share *
Relationship*

SpouseOther
Primary Beneficiary #2
SSN
DOB

MonthDayYear
Date
% Share
Relationship

SpouseOther
No Contingent Beneficiares

I do not want to designate continent beneficiaries
Contingent Beneficiary #1
SSN
DOB

MonthDayYear
Date
% Share
Relationship

SpouseOther
Contingent Beneficiary #2
SSN
DOB

MonthDayYear
Date
% Share
Relationship

SpouseOther
Additional Information
Should be Empty:

Client Profile Form