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INSTRUCTION: Name of firm or, if a sole proprietor, individual owner’s name. State the full name of the firm or individual.
INSTRUCTION: Any related trade names
INSTRUCTION: State the street office for the head office of the firm or proprietorship. Do not include a P.O. box or agent for service
INSTRUCTION: State the website address for the firm. If there is no website address, state “not applicable”.
INSTRUCTION: Telephone number for firm or, if sole proprietor, individual. Telephone number should be numbers only with no spaces.
INSTRUCTION: Name of individual responsible for ensuring conditions to use this registration exemption are met. State the name of the individual who may be contacted with respect to any questions regarding the contents of this report. This individual should be a senior executive for the firm.
INSTRUCTION: Telephone number for responsible individual named above. Telephone number should be numbers only with no spaces.
INSTRUCTION: Email address for responsible individual named above.
INSTRUCTION: Names of salespersons employed by the firm to sell securities.