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Personal and Employment Data Questionnaire

The following information is required to evaluate your qualifications to receive market information from the New York Stock Exchange, American Stock Exchange, National Association of Security Dealers, Inc. and Options Price Reporting Authority at non-professional rates.

All sections must be completed in order to be approved for non-professional rates.

 Step 1: Personal and Employment Data Questionnaire

Applicant's Name:
S.I.N:
Telephone Number:
Home Address:
Applicant's Occupation:

Street Address
where service will be installed:

Name of applicant’s present employer:

Employer’s Address:

Employer’s Telephone:

Applicant’s Title:

Market Data Intent of Use:

Step 2: Investor Status—Are You a Pro or Non-Pro?

These statements regard your non-professional investor status and intended use of the exchanges data. Please select True or False for the following statements. If you answer False to any of the questions you are classified as a PRO.

 
I am subscribing in an individual and personal capacity, and neither as a principal, officer, partner, employee or agent of any business nor on behalf of any other individual.

I am not registered or qualified with the Securities and Exchange Commission, the Commodities Futures Trading Commission, any state securities agency, any securities exchange association, or any commodities or futures contract market or association.

I am not engaged as an investment advisor; as that term is defined in Section 202(a)(11) of the Investment Advisors Act of 1940 (whether or not registered or qualified under that act).

I am not employed by a bank or other organization exempt from registration under Federal or state securities laws to perform a function that would require me to be so registered or qualified if I were to perform such functions for an organization not so exempt.

I do not plan to use the real-time data provided with this service for any commercial or business purposes.

I attest that the above information is correct.

 

Name:    

Date:      (eg.11/27/09)

Type "I Agree" in this Box:

   

PC Quote Canada Inc

revised Nov.27, 04