Name of Broker:_________________________________________________
Company: ______________________________________________
- Company Location:______________________________________________
Date:_________________ Time: ____________
___ Phone call
___ Meeting Location: ____________________
Recommended that I: ___ buy ___ sell
- Name of security: _________________________________________
How does this recommendation meet my investment objectives? What are the specific reasons why I should invest in this? (or sell this?)
___________________________________________________________
___________________________________________________________
___________________________________________________________
What are the specific risks if I buy this investment?
____________________________________________________________
____________________________________________________________
____________________________________________________________
I asked to receive written information about this investment before making a decision:
- ___ yes ___ no
I asked for:
- ___ a prospectus
- ___ most recent annual report (10K)
- ___ most recent quarterly report (10Q)
- ___ any other recent report (8K)
- ___ any other available written material
- ___ other _____________________
After looking at the written material, I decided to:
- ___ do nothing
- ___ buy
- ___ sell
- how much? _______________
- at what price? _______________
The total cost of this transaction will be: _______________
Other Notes:
Date: __________________________
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