REFERRING PARTY  APPLICATION FORM

it is compulsory to answer the question with *

 

* TITLE:

* REFERRING PARTY NAME:

* DIRECTOR NAME:

* ADDRESS:

 

 

* STATE/REGION:

* ZIP CODE:

* COUNTRY:

* PHONE NUMBER:

* E-MAIL:

* Fax Number:

 How do you describe yourself as introducing broker or market participant?

 Beginner - Starting to explore opportunities and gather Information

 Intermediate - Have begun to build business, obtain clients, or establish website

 Advanced - I have an existing business with clients currently trading

 

What is your estimated trading volume per month?

USD

What other information can you provide us about your existing business and goals with Washington Prime Plus Inc.?

Any other questions or comments you may have?