RFI REQUEST

REQUEST FOR INFORMATION
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Name *

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Skype Name *

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THIS IS MY REQUEST FOR INFORMATION ON THE TYPES OF PROGRAMS SPECIFIED BELOW.

ARE YOU LOOKING FOR SOME OTHER TYPE OF PROGRAM?

Specify type and size of other programs in which you have interest *

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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