Limited Liability Company Account Application - US LLC

Limited Liability Company Name

Tax ID Number

Formation State

Limited Liability Company Type - Enter the tax filing type for the Limited Liability Company

E-mail Address for Limited Liability Company

Member/Manager authorized to act on behalf of Limited Liability Company

Owner Name	% Ownership	Address	SS# or Tax ID	Employer	Position

Please describe the nature of the primary activities of the Limited Liability Company

Please describe the reason why the Limited Liability Company trades securities

Limited Liability Company Physical Address - Enter the entire address including city, state, and zip code.

Limited Liability Company Telephone Number

Mailing Address (if different from physical address) - Enter the entire address including city, state, and zip code.

Have you granted trading authorization to another party?

Yes
No

If yes, please proved the name of the trading authorization agent

Is the account holder a control person of a publicly traded company? (Director, Officer or 10% Stock Owner) Include the Limited Liability Company, and any officers, directors, or shareholders in your response.

Yes
No

If yes, please list the name of the company(s) and the stock ticker symbol.

Are you. or anyone authorized to trade in your account, affiliated with or work with or work for a member form of a stock exchange or FINRA? Include the Limited Liability Company, and any officers, directors, or members in your response.

Yes
No

If yes, please provide the name of the firm:

Name of the Limited Liability Company's your bank

Type of account that the Limited Liability Company has at bank

select

Provide the last 4 digits of the bank account

Describe the investment objectives for the Limited Liability Company.

Speculation
Income
Growth
Capital Preservation
Other

Describe the Limited Liability Company's investment experience

None
Limited
Good
Extensive

What is the Limited Liability Company's annual income?

Under $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $200,000
$200,001 to $300,000
$300,001 to $500,000
$500,001 to $1,200,000
Over $1,200,001

What is the Limited Liability Company's liquid net worth? (cash & liquid investments only)

Under $50,000
$50,001 to $100,000
$100,001 to $200,000
$200,001 to $500,000
$500,001 to $1,00,000
$1,000,001 to $5,000,000

What is the Limited Liability Company's total net worth excluding your residence?

Under $50,000
$50,001 to $100,000
$100,001 to $200,000
$200,001 to $500,000
$500,001 to $1,00,000
$1,000,001 to $5,000,000

What is the Limited Liability Company's risk tolerance?

High
Medium
Low

What tax bracket is the Limited Liability Company in?

select

Rule 14b-1(c) of the Securities Exchange Act, unless you object, requires us to disclose to an issuer, upon its request, the names, addresses, and securities positions of our customers who are beneficial owners of the issuer’s securities held by us in nominee name. The issuer would be permitted to use your name and other related information for corporation communication only. If you object to this disclosure check the box.

Yes, I do object to the disclosure of such information.

Is the account maintained for a current or former Politically Exposed Person or Public Official (includes U.S. and Foreign Individuals)? Include the Limited Liability Company, and any officers, directors, or shareholders in your response.

Yes
No

If yes, please provide the names of that official and official's immediate family members (including former spouses). Include the Limited Liability Company, and any officers, directors, or members in your response.

If yes, please provide the name of the related political organization.

Is the account maintained for a Foreign Financial Institution as defined by Title 30 of the Code of Federal Regulations? If yes, please complete the "Foreign Financial Institution Due Diligence Questionnaire" form.

Yes
No

Is this account a Foreign Bank organized under foreign law and located outside of the United States as defined by Title 31 of the Code of Federal Regulations? If "yes", please ensure the "Certification Regarding Correspondent Accounts" is complete (in addition to the "Foreign Financial Institution Due Diligence Questionnaire" form). NOTE: Broker-dealers are prohibited from establishing, maintaining, administering or managing correspondent accounts in the United States for foreign shell banks. The prohibition does not include foreign shell banks that are regulated affiliates.

Yes
No

How was the Limited Liability Company referred to Glendale Securities, Inc.?

select

Please describe "Broker" or "Other" referral sources

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