Online Application Form

1. Account Registration Details

Registered Account Name:*

This Account Will Trade:*

Equities

Funds

Bonds

Currencies

Account Management:*

Fully Managed

Broker Assisted

Self Managed

Currencies

Transferring from an existing broker to Global Standard Capital?:*

Yes

No

2. Personal Information (Primary Account Holder)

First Name:*

Middle Name:*

Surname:*

Date of Birth:

Current Address:*

Address 2:*

City / State:*

Preferred E-Mail Address:*

Alternative E-Mail Address:

Preferred Contact Phone #:*

Alternative Phone #:

Current Employment Status:*

Employed (full/part time)

Self-Employed

Retired

Other

Employment Industry/ Sector:*

Annual Income (USD):

Less than $25,000

$25,001 - $99,999

$100,000 - $499,999

$500,000 +

Your Trading Experience:

Novice

Semi-Experienced

Experienced

Advanced

Read Disclosure Agreement

Accept:

By checking this box and by typing my/our signature(s) below and forwarding this application form to Global Standard Capital via the Internet, I/we acknowledge, understand and agree to the Disclosure Agreement as set forth above and verify that all information submitted in this application to be true and correct. Further, I/we understand and agree that my/our electronic signature(s) is/are the equivalent of a manual signature and that Global Standard Capital may rely upon it/them as such.

Primary Account Holder:

Secondary Account Holder:

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Documents can be sent via email to info@globalstandardcapital.com