Confidential Fact Sheet

Please complete as much information as possible in the form below to assist us in understanding your clearing needs. Your responses are strictly confidential. You will be contacted within 48 hours by a Legent Clearing sales professional.

( * indicates required field)

General Information

Firm Name:
Address:
Address:
City:
State:
Zip Code:
Country:
Firm's Website URL:
Primary Contact:
Title:
Email Address:
Telephone:
Fax:
Optional Contact:
Title:
Email:
Telephone:
Fax:
Promotion Code:

Principal Business Characteristics

(Please indicate the percentage for all that apply)

Retail:	% of business	Type:
		Number of RRs:
		Number of Branches:
		Total # of Customer Accounts:
		Total # of IRA Accounts:
Institutional:	% of business
Hedge Fund:	% of business
Prime Brokerage:	% of business
RIA:	% of business
Other:

Trading Activity & Volumes

% Agency:		% Fixed Income:
% Principal:		% Mutual Funds:
% Equities:		% Options:
Other:
% Foreign:		% Commission:
% Domestic:		% Fee-based:
Ave# Trades/Month:		Ave Shares/Trade:

Financial Information

Customer Balances		Firm Account Information
Debt Balances:	$	Annual Gross Commissions:	$
Credit Balances:	$	Net Capital:	$
Money Funds Balances:	$	Debit Balances:	$
Short Balances:	$	Credit Balances:	$
Money Funds Used:		Short Balances:	$
Miscellaneous Information
Underwriting:	Yes No	WRAP:	Yes No
Market Making:	Yes No	AUM:
Advisory:	Yes No
Current Clearing Firm:
Reason For Leaving:

Confidential Fact Sheet

General Information

Principal Business Characteristics

Trading Activity & Volumes

Financial Information

Customer Balances

Firm Account Information

Miscellaneous Information