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Personal Info

Full Name:
Residential Address:
Business Address:
Business Tel:
Business Fax:
Civil Status:
Date of Birth:
Name & Address of Employer:
Nature of Business:
Name of Spouse:

Business Status and Affiliates

Are you associated with another broker or dealer?
Yes      No     If yes: Name of broker:
Are you an officer or director of a listed company?
Yes      No     If yes: Name of company:
Stock Certificate(s) to be placed in:
My Name      Summit Capital Management
Source of Funds:
Business      Employment      Savings      Inheritance      Donation     

Additional Requirements

For CORPORATE ACCOUNTS, please indicate names of personnel authorised to transact business on behalf of the company.
Full Name:

Do you require a duplicate copy of your confirmation to be sent to another person?
Yes      No
 If yes: Full Name:

Terms and Conditions

I represent that I have read, understand and agree to the Terms and Conditions governing this account. I agree to be bound by such Terms and Conditions as currently in effect and as may be amended from time to time without prior notice to me. I warrant that all the information I have entered on my application is correct to the best of my knowledge and belief. If there is a change in the future, I agree to promptly notify Summit Capital Management in writing.

You must agree to the Terms and Conditions by ticking the box