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Registered Representative
Confidential Inquiry Form

Please complete this form to help us in our preliminary evaluation of your needs. The more information you provide, the better we will be able to assist you in finding suitable firms that match your experience and criteria. All inquiries will remain strictly confidential.

Personal Information
Phone Number(s)
(Please include any numbers where it is convenient for us to call you.)


Employment/Background Information

(Positive Integer)
Current Business/Production Profile

(trailing 12 months commision)
Licenses and Certifications
(Please select all that apply)
Speciality Percent of
your Business
Equities: %
Fixed Income: %
Mutual Funds: %
Options: %
Annuities: %
Life/Health Insurance: %
Managed Money: %
529 Plans: %
Other (please describe below) %
Investment Management product needs

Retirement Plans
Fixed Income
Complex Options Trading
Mutual Fund Wrap Accounts
Offshore Mutual Funds
IPOs
Fee-Based/Wealth Management products
Private Placement

Other products that you require

(Please use this space to describe any special requirements or concerns that you have)

This profile questionnaire requests specific information from you that will be held confidential by Legent Clearing and by any broker/dealers you select on the profile form to receive your information. Your information will be forwarded only to the firms that you select and will not be distributed to any other firms. Legent Clearing does not endorse or recommend any firm and you understand that any information about a particular firm has been provided by them and not by Legent Clearing. Legent accepts no liability for any decisions you make and for any agreements you enter into with a correspondent of Legent Clearing. Additionally, Legent will not be held liable for any misrepresentation, loss, expenses, damages or any other miscommunication by any correspondent firm, by you, or by any parties representing you.


I have read the above and agree to the terms and conditions.