New Account Approval

Please fill out all applicable fields below and click “submit” when complete.

Name For Filing

Date Account Opened Month 1 2 3 4 5 6 7 8 9 10 11 12 Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

First Name Last Name

Social Sec or Fed ID # Email

Send Mail To Residence Address Mailing Address Employer's Address

Address (No PO Boxes)

City State AK AR AZ CA CO CT DC DE FL GA IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip

Phone Number

US Citizen? Yes No    Of Legal Age? Yes No

If not a US Citizen, what country are you a citizen of?

Birthdate Month 1 2 3 4 5 6 7 8 9 10 11 12 Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Marital Status Single Married Divorced Widowed N/A

Employer Position

Spouse's First Name Last Name

Spouse's Employer Position

Is the client a control person? Yes No

Name of Company(ies) Controlled

Credit References (check all that apply)

Bank Branch & Type A/C Broker Branch & Type A/C Other (please specify) If account is being operated by another person, please provide the following:   First Name Last Name Address City State AK AR AZ CA CO CT DC DE FL GA IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip Employer

Investment Objectives (check all that apply)

Long term growth with safety Long term growth with greater risk Short term growth with high risk Short term trading with high risk

Estimated Annual Income  $ USD

Estimated Net Worth  $ USD

Nature of Account (select one only)

Employee of the company

Relative of above, please specify relationship

Employee of an insurance company, bank, fund, or another broker

None

Initial Transaction Amount  $ USD

Initial Deposit Amount  $ USD    Via check Via wired funds

Please indicate the type of registration (select one only)

Individual Community Property Tenants in common Joint tenants with right of survivorship (ok except in California and Louisiana) If Custodian, please provide the following information about the minor         (all other information must be regarding the Custodian):

Minor's Social Security #

Minor's Birthdate Month 1 2 3 4 5 6 7 8 9 10 11 12 Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Other (select one only)

Investment Club Trust Sole Partnership Estate Coprorate Non-Corporate Partnership Delivery vs. Payment (appropriate documents are required) IRA, SEP, etc

Instructions

Securities: Transfer and Ship (1) Hold Street Name (2) Money: Pay (1) Hold (7) Difference (3) Money: Pay (1) Hold (4)

How did you hear about JPR Capital's website? (check all that apply)

Referral Banner Ad International Daytrading Expo Online Investors Expo

How many years trading experience do you have? 0 - 6 months 6 months - 1 year 1 - 2 year 2 - 5 year over 5 years

Have you used Realtick III from Townsend Analytics before? Yes No

What other trading software have you used, if any?

What is the amount of capital that you will be trading?  $ $10,000 - $25,000 $25,000 - $75,000 $75,000 - $150,000 Over $150,000 USD

What is the typical size of your trades? 100 to 300 shares 300 to 500 shares 500 to 1000 shares 1000 to 2000 shares Over 2000 shares

Are you going to be daytrading part-time? Yes No

Computer Requirements

Internet Speed (one of following required) DSL ISDN Cable

Processor Speed Pentium II Pentium III Other

Computer RAM MB

Are you interested in daytrading seminars? Yes No