Equity Logic

Compliance - Secure Disclosure Form

Please fill out and submit this disclosure form electronically. We will send you an email shortly after, and answer all of your questions by email or phone.

These disclosures are required by compliance before we can communicate with potential investors. We are highly regulated by NASD and FINRA, and there are no exceptions to this rule. This form is not a commitment to invest, but a disclosure that will allow us to communicate with you.

Privacy Policy: We respect your privacy and NONE of your personal information will be shared with anyone outside of Equity Logic at any time, for any reason. We do not sell your name, number, or personal information, and we respect the privacy of our clients and prospective clients.

* All Fields Required.

Name* : Address * : City * : State * : Phone Number * : Email Address * : Age * : Occupation * : Marital Status *: Number of Children *: Employer (number of years) *: Industry *: Investment Experience (years) *: Are you an accredited investor? *: Yes No What is your estimated net worth? *: What is your estimated liquid net worth? *: How much are you considering for Equity Logic? *: Have you read the Brochure on www.equitylogic.net? *: Yes No Did you review the fees shown in the Brochure? *: Yes No Have you used risk controls in your portfolio before? *: Yes No Do you own bonds or bond funds? *: Yes No Have you adopted a plan for asset allocation? *: Yes No Is your current equity account diversified? *: Yes No Overall Risk Tolerance *: CONSERVATIVE MODERATE AGGRESSIVE Risk Tolerance for this account *: CONSERVATIVE MODERATE AGGRESSIVE

Please describe your Investment Objectives and Restrictions (if any) * :

How did you learn about Equity Logic? * :

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Equity Logic

Compliance - Secure Disclosure Form

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