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Services  Partners Form

For additional information on Introducing arrangements
please complete This Contact Form:



First Name :
Last Name :
Name Of Business :
City/Region :
State/Province :
Country :
Phone Number :
E-mail :
Website URL :
Subject :

Briefly describe your business (i.e. Introducing broker, Introducing Agent; money manager, advisory service, white Label etc.)
Years in Business :
Number of existing customer accounts :
Amount of customer margin
(in USD) :
What region or country will
you be targeting ?
Are you a registered entity
in the U.S. ?

If so, please describe



If outside the U.S., are you registered with a foreign governing body ?
Have any formal complaints been filed against you or
your company ?
Are you currently an IB with
any other broker or FCM ?
Proposed commission structure :
  Customer Charged Rebate to IB
     Futures and Options
     Foreign Exchange
Estimated volume of business that you plan to execute or introduce :
Lots per month : Nominal value (FX/off exchange only)
What are the major instruments to be traded ?
Please provide any additional information that you deem relevant :

* All Fields are Required

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Foreign Exchange (FX) and Margin trading is a high risk investment and it is possible to lose more than your initial investment. Only speculate with money you can afford to lose. These products may not be suitable for all investors, therefore ensure you fully understand the risks involved and seek independent advice if necessary.
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