About Us Employee Login Contact Us

LionHedge HOLding

* First Name:	* Last Name
* E-mail Address:	* Company Name:
* Street Address:	* City
State/Province:	* Zip/Postal Code:
* Country:	* Work Phone:
Cell Phone	Title

* Home Phone:

Fax:

Position:

* I have a net worth, including vested pension or profit sharing plan investments but excluding my principal residence, home furnishings and automobiles (including joint net worth with my spouse) in excess of (please check one):

Under $1,000,000
$1,000,000 - $5,000,000
Over $5,000,000

* I currently have or have previously made investments in (please check all that apply):

stocks or bonds
mutual funds
futures, commodities, options or other derivative instruments
real estate
private investment funds (hedge funds, private equity funds, commodity pools, etc.)
other (please describe below)

Please describe

* Please indicate the frequency of your investments in securities:

often;
occasionally;
seldom;
never

The information set forth above is accurate and complete as of the date hereof, and you agree to promptly notify LionHedge Holding ("LionHedge") of any material change in such information. You hereby consent to the disclosure of any such information, and any other information furnished to LionHedge, to any governmental authority, self-regulatory organization or, to the extent required by law, to any other person.