PLEASE FILL IN AS ACCURATELY AS POSSIBLE AND E-MAIL TO

JNCRACIUN@YAHOO.COM



TITLE:

FULL NAME:

ADDRESS:

TELEPHONE:

INVESTOR CLASS: PRIVATE INVESTOR OR CORPORATION

PRIMARY E-MAIL:

SECONDARY E-MAIL:

EXPERIENCE WITH TRADING?  YES, NO.

IF YES, SINCE WHEN:

WHAT SECURITIES DID (DO) YOU TRADE:

HOW DO YOU TRADE? PART-TIME, FULL-TIME, OCCASIONALLY, I NEVER TRADED.

WHAT CAPITAL DO YOU TRADE?

COMMENTS: