Prospective Broker Questionnaire

If you are a Registered Representative interested in more information about Harbour Investments, or would like to receive a 30 day Guest Password to our Private access site, please complete and submit the following form:

Contact Information:
* required fields
*Name:                       
*E-mail:                      
Address:                   
City, State, Zip:         
*Telephone:              
 
Best time to contact you?              8:00 - 5:00 CST   5:00 - 9:00 CST  
 
Current B/D Firm:             
 
How long have you been involved in the financial/insurance industry?
under 2       2-4      4-7      7-10      over 10
 
Designations / Licenses:
S1 S7 S26 S63   CFP   LUTCF
S4 S22 S27/S28 S65   CLU   Other: 
S6 S24 S62 S66   ChFC  
How would you rate the importance for the following products and services that a Broker/Dealer would provide you?
 
Payout very important     1  2  3  45     least important
Transaction Costs very important     1  2  3  45     least important
Research very important     1  2  3  45     least important
Technology very important     1  2  3  45     least important
Back-office support very important     1  2  3  45     least important
Choice of Clearing Firm very important     1  2  3  45     least important
   
 
If you had to pick only 3 of the above items, which 3 items would be most important to you?
 
1.
2.
3.
 
What is your 12 months trailing gross production?
What are your total assets under management?
 
How did you hear about us?           
 
Why are you considering a change of Broker/Dealer? 
 
Describe what you are ideally looking for in a Broker/Dealer?
 
Is there other information we should know?

 

I am interested in more information on:

 

Harbour Investments, Inc.
One Odana Court      Madison, WI   53719
Phone:  (608) 274-7744   (888) 855-6960   Fax:  (608) 274-4474
Email:  info@harbourinv.com
      Members FINRA and SIPC       
© 2005 Harbour Investments, Inc.

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