Chicago Forex Ltd.    
Account Application (For non-US citizens only)
Account Owner Nationality
Passport no. Driving license no.
Home street address Home telephone no. ()
Please, street address only - list P.O boxes below.      
City State Postal code Country
Complete only if mailing address is diferent than home street address above:
Address City State Postal code Country
Date of Birth U.S.citizen? YES No Marital Status Number of Dependents          
Employer Nature of business          
Business street address
City State Postal code Country
Business telephone no.() Position          
E-mail address Portable/Cellular phone no. ()          
Fax no.()
Annual income:
$25,000-$49,999 $50,000-$100,000
more than $100,000 if less than $25,000, please specify exact amount
   
Net worth (excluding equity in home):
$50,000-$99,999 $100,000-$249,999
$250,000-$499,999 $500,000-$1,000,000
more than $1,000,000 if less than $50,000, please specify exact amount
   
Estimated liquid net worth (excluding residence):
under $15,000 $15,000-$50,000
$50,001-$100,000 $100,001-$500,000
more than $500,000  
Residence: Own Rent Other
Is this a joint account?...................: Yes No

If YES, account will be Joint Tenants with Rights of Survivorship unless you indicate here for Tenants in Common Tenants in Common

Does any person other than the owner(s) of the account have authority to trade this Account? ............... Yes No

If YES, please list their name(s) and submit the separate form called MANAGED ACCOUNT AUTHORIZATION.

Are you related to any employee of Chicago Forex Ltd. or any other brokerage firm?....................: Yes No

If YES, please write name, firm and position:

Do you now, or did you ever, have an interest in a commodities account?....................: Yes No

If YES, please list:
Firm account Open Closed
Firm account Open Closed
 
Investment experience: ..... YES    (# of years)    NO
Stocks/Bonds
Fundss
Commodities
 
Affiliations:

Are you affiliated with or employed by a futures or securities exchange, NFA, NASD, a member firm of either of those entities.

YES, with NO
Trading Objective: Speculation Hedging
Currency Bank/Money Market accounts:
Firm Checking
City Saving
Acct.# Money market
Are you now or were you ever an NFA member..YESNO
Registration status and sponsor ...........