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Private Client Application Form PERSONAL INFORMATION First Name: CONTACT US Last Name: Address: VISIT us at: www.calforex.com Postal Code: City: Province: Phone: Fax: Email: DOB: CALL for a live quote
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CAD USD. AUD. CDN. GBP. INR. NZD. JPY. CAR. RUB. SGD. NOK. DKK. NOV. SEK. CHF. CZK. PLN. PHP. AED. RON. DKK. SEK. CZK. JPY. CNY. JPY. HKD. HUF. CZK. SGD. Other Country: Company, Firm, or individual: Is the purchaser a new client or an existing client who wishes to cancel? If you do not know the name of your existing client, please call us at:. Client's address. Client is a (Please check one): New client or existing Client Name and number of accounts. Address (e.g. PO Box) is where client would like the transaction processed. If not known please call us at: NOTE: If you call or fax us to confirm the information, please enclose a note telling us of the change in the following manner: “Change Name and number of accounts.” DO NOT send any check or other payment directly or indirectly to the company listed on this page. DO NOT send any money through the mail to this company unless it is from a bank. DO NOT send any money or other payment to the company listed on this page unless the bank is Chase (USA) or Wells Fargo (USA). DO NOT send any money or other payment to this company unless the check has a current or valid SWIFT/UPS account number from an authorized company or bank. Any funds received are subject to applicable taxes. DO NOT send any money or other payment to this company unless we are instructed to remit the payment to you. FOR THE SAFETY AND SECURITY OF OUR Clients AND ITS INVESTORS I, /S/ /SUBJECT IS FOUND TO BE: (Please see attached copy of license to be issued by the Canadian Securities Administrators or CSA) DATE: March 23, 2014 (Please check one year for the latest date, in case of an increase) REGISTRATION NO.: (Please check one year for the latest date, in case of increase) SURRENDER: No, the money will be paid to you immediately.

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