Contact Name:			Contact Title:
Contact Telephone #:			Contact Fax #:
Email Address:			IM Address (Optional):
Firm Name:			Address:
City:			State:
Zip code:			Website Address:
Is your firm a Registered Broker/Dealer?	YES   NO    (If yes, please also complete Section 5. Broker/Dealer Information)
Are you a Registered Investment Advisor?	YES   NO		Firm IARD#:
States Registered In:			Year of Firm Origination:

BUSINESS RELATIONSHIPS

Current Clearing Firm or Prime Broker:
Who is the Firm's Offshore Administrator?
Who is the Firm's Attorney?
Who is the Fund's Auditor/CPA?

BUSINESS CHARACTERISTICS

Describe the Firm's Investment Style:

Markets		Number of Shares Traded per Day		Average # of Stock Symbols Traded per Day
NASDAQ Equities:
NYSE/ASE Equities:
ECNs Equities:
Regional Equities:
Options:
Other:

ACCOUNT AND TRADING INFORMATION (Please indicate totals where appropriate)

Assets Under Management/Trading Deposit: $
Margin/Debit Balance: $
What is the firm's total number of short positions?
% of total positions?:
Does the firm carry short positions in what is deemed "Hard to Borrow" securities?	YES   NO
Does the firm trade bulletin board securities?:	YES   NO
What is the firm's asset mix?:
Does the firm maintain any concentrated positions?:

BROKER/DEALER INFORMATION (If the firm is a Broker/Dealer please complete this Section)

Firm CRD#:			Net Capital: $
Number of Offices:			Number of Employees:
General Principal:			CRD#:
Financial Principal:			CRD#:
Options Principal:			CRD#:
MSRB Principal:			CRD#:
Operations Manager:			CRD#:
Compliance Manager:			CRD#:
Individuals Authorized to Enter Orders (ie. President, Managers, General Partners):