Individual Contact Request Form

Please fill out the following information as completely as possible.

Contact information

Client name:

Date of birth:

Phone 1:

Phone 2:

Fax:

Mailing address:

(address where FedEx can be delivered)


City	State	Zip

Email address:

Preferred method of contact:

You must understand the risk of loss associated with trading futures and futures options before investing.

Investment information

Approximate net worth / entity value:


Number of years' experience in the following:
Equities	Bonds	Futures	Alternative investments/hedge funds

Approximate percentage of portfolio in the following:
% Equities	% Bonds	% Futures	% Alternative investments/hedge funds

Investment style

Which of the following best describes you attitude toward your investments over your investment time horizon?

My only goal is capital growth. I am not concerned with the level of fluctuation in my portfolio value.

My only goal is capital growth. I am modestly concerned with the level of fluctuation in my portfolio value.

My primary goal is capital growth and my secondary goal is capital preservation. I am willing to accept a moderate level of fluctuation in my portfolio value.

My primary goal is capital preservation and my secondary goal is capital growth. I am willing to accept a low level of fluctuation in my portfolio value.

My only goal is capital preservation. I am adverse to short-term loss and can accept only minimal fluctuations in my portfolio value.

Check all that apply.

Please send me further information on the FuturesOne Speculative Ag Program. We will strongly consider using the program if we like what we see.

Please send me updates on your performance.

Comments

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When you're done, click the button below to send your request.

Thank you; you will hear from us shortly. Your information will be kept confidential within our office(s). If you have any questions you can reach us toll free at 800-488-5121 or 402-434-2170.