Contact Information:
*First Name
Mr.
Ms.
*Last Name
Firm Name
*Address
*City
*State
*Zip Code
*Phone
*Email
*Expected/Anticipated Approval Date for Advisor
Anticipated Activities of
Firm:
Anticipated amount of assets under
management by your firm within 120 days after registration as
an investment adviser
Select One
$0 to $10 Million
$10 to $25 Million
$25 to $100 Million
> $100 Million
What state will
be the main location of your firm’s offices?
Will
your firm or its investment advisor representatives have offices
in other states? (For purposes of answering these questions,
please consider an investment advisor representative as an
individual that provides recommendations regarding securities
or markets, makes investment decisions, solicits investment
advisory clients or supervises anyone doing such.)
Select One
Yes
No
N/A
If yes, please list
How many investment adviser representatives
(including yourself) will be affiliated with your firm?
List the states that your firm will
have 5 or more clients within 120 days of registration as an
investment adviser
Does your firm or any of its anticipated
investment adviser representatives have a disciplinary history
such as a censure, suspension, disbarment or fine, with a regulator?
Select One
Yes
No
N/A
If yes, please explain
Are you, your firm or any of its
anticipated investment adviser representatives currently subject
to an inquiry, investigation or enforcement proceeding by a regulatory
authority?
Select One
Yes
No
N/A
If yes, please explain
Are you, your firm or any of its
anticipated investment adviser representatives subject to a pending
customer complaint, arbitration or lawsuit?
Select One
Yes
No
N/A
If yes, please explain
Will your firm also be registered
as a broker-dealer?
Select One
Yes
No
N/A
Will your firm serve as a commodities
pool operator or commodities trading advisor?
Select One
Yes
No
N/A
Will your firm advise or operate
a hedge fund?
Select One
Yes
No
N/A
Will your firm advise a registered investment company?
Select One
Yes
No
N/A
Will you,
your firm, or an affiliated firm serve as general partner of
a limited partnership or managing member of a limited liability
company offered to clients?
Select One
Yes
No
N/A
If yes, please explain
Will your firm
pool client investments?
Select One
Yes
No
N/A
Will you, your firm or its investment
adviser representatives offer any of the following services:
List the products
that will be subject to investment advice from your firm:
Will your firm
charge a performance fee (other than an asset under management)
based on the profits of the account?
Select One
Yes
No
N/A
Will any of the
investment adviser representatives of your firm also be affiliated
with a broker-dealer as a registered representative?
Select One
Yes
No
N/A
If yes, please list
What exams and/or
professional designations have the investment adviser representatives
of your firm successfully completed?
If your investment
adviser representatives do not hold the appropriate licenses
or professional designations will these investment adviser
representatives take the Series 65 exam?
Select One
Yes
No
N/A
Are you or any
of your firm’s anticipated investment adviser representatives
subject to a non-solicit, non-compete or confidentiality agreement?
Select One
Yes
No
N/A
If yes, please explain
Will your firm
use third-party solicitors?
Select One
Yes
No
N/A
Will your firm
or its investment adviser representatives serve as a solicitor
for a third-party money manager?
Select One
Yes
No
N/A
What firm will
serve as the custodian of your firm’s clients’ assets?
Will your firm
conduct financial planning?
Select One
Yes
No
N/A
If yes, please
describe and specify the approximate range for financial planning
fees
Will
your firm sponsor a wrap fee program?
Select One
Yes
No
N/A
(In basic terms,
a wrap fee program is a program under which a client is charged
a specified fee not based directly on transactions in a client
account for investment advisory services and execution of client
transactions. Typically, fees such as custodial fees, transaction
charges, and commissions are not billed separately, but included
in the overall management fee charged to the client. Programs
where an advisor charges an asset management fee, but the custodian’s
fees are billed separately are not generally considered wrap
fee programs.)
How
did you learn of our services?
Select One
Email Newsletter
Google Ad
MSN Ad
Other Internet Search Engine
Investment News Ad
Financial Planning Ad
Conference Speaker
Direct Mail
Referral
Other
These questions have been answered to the best
of my knowledge, and I understand that this information will
be used to develop a specific proposal and quote for my firm.
In the event that my circumstances or plans change, I understand
that a revised proposal and quote for our services may be necessary
to reflect the increased complexity or work associated with the
engagement.
