If you wish to download this form and fill it out by hand, please download the PDF Form and Email it to email@example.com
What is the name of the corporate entity you will be filing your membership application under?
Where is the corporate head quarters for the company located?
What is the official web site of your company?
Who are the major principals and owners of the corporation? (Anyone who is more than a 10% owner)
Is the firm currently licensed or regulated in any jurisdiction?
How many years has your company been in business as a financial services provider?
What markets is your company currently operating in?
What languages does your company support?
Which trading platforms does your company offer your customers?
Which financial trading products does your company currently offer to your clients?
What is the minimum account size available to trade with your company?
What price vendors are used to determine settlement price?
Does the firm cover all or part of its positions? If yes, please list the name of counter-parties.
Does the firm outsource their dealing desk?
Does your company store tick data?
How many complaints do you estimate would be handled by Broker-status per month coming from your company?
Has your company ever had any previous disciplinary actions from a regulator or legal entity?
Has your company been previously registered with a regulatory entity and is no longer regulated?
Company Contact for future communications with Broker-status
Position Held with the company
Direct Phone Number
Broker-status asks that you please supply the following documentation along with your application:
Please send all documentation to: firstname.lastname@example.org
Signature By signing this document you agree that you have completely reviewed all information and attest to the best of your knowledge that the information you have provided on Broker-status Membership Application is 100% accurate and has not been falsified in any way.
Position Held with Company