RFI FORM

REQUEST FOR INFORMATION
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Skype Name *

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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.

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