RFI FORM

REQUEST FOR INFORMATION
Items followed by an asterisk ( * ) require completion.

* Indicates required field

Name *

First

Last

Email *

Telephone *

Street Address 1 *

Street Address 2 *

Skype Name *

City *

State or Province *

Zip or Mail Code *

Country *

THIS IS MY REQUEST FOR INFORMATION ON THE TYPE OF PROGRAMS I HAVE SPECIFIED BELOW.

I HEREBY MAKE THE FOLLOWING REPRESENTATIONS:

MY REPRESENTATIONS *

I recognize that SRM makes no warranties or representations about any financial program (Program). I stipulate that SRM Services Limited (SRM) has not solicited or induced me in any manner nor will I construe any information that I may receive from SRM to be financial counsel, advice, a recommendation for securities or a security offering. I recognize that SRM is not a licensed dealer, broker or investment adviser and that no Programs revealed to me by SRM have been registered with any governmental securities commissions. I agree that SRM business sources and contacts are highly confidential and proprietary to SRM and I agree to honor the confidentiality of SRM information and to not distribute it to other parties without SRM's advance consent. I agree that SRM shall be the intermediary used for entry into any Program revealed by SRM in which I wish to participate. I attest that I am not associated with, nor am I an informant for, any governmental law enforcement or regulatory agency.

Type Your Signature Here *

Date Submitted *

Submit Your Request

HOME PRIVATE PROGRAMS ILLUSTRATIONS FAQs GETTING STARTED ABOUT US CONTACT