Brick Financial Management - Building Wealth One Brick At A Time

Thank you for your interest in establishing an account with Brick Financial. We do not take custody of client assets. Your assets will be held in your name at Foliofn.com and Brick Financial is granted limited trading authority on the account.

Please tell us a little about yourself by filling out the form below. Brick Financial will keep your personal information private as stated in the privacy policy and terms & conditions. If you have any questions about the services we provide please feel free to contact us and we will respond directly.

Prefix
First Name^*		Last Name^*
Address 1^*		Address 2
City^*		State^*
Zip^*
Day Phone^*		Evening Phone
Fax
Email^*
^* required

Age?
under 35
35 - 50
50 - 65
over 65
Gender?
Male
Female

Current Household Income?
$50,000 and under
$50,001 - $100,000
$100,001 - $200,000
over $200,000
Investable Assets?
under $10,000
$10,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
over $500,000

Occupation?
Employee
Self-employed
Executive
Retired
How much can/will you invest each month?
under $500
$501 to $1,000
$1,001 to $5,000
$5,001 to $10,000
over $10,000

What is your investment time horizon?
I'll need my money in less than 5 years.
I'll need my money in about 7 - 10 years.
I won't need my money for at least 15 years.
I plan to leave this money to my children/charity
What is your risk tolerance?
Conservative
Moderate
Aggressive

What will you use your money for?
Family needs/obligations
Personal freedom/comfort
Relieve financial worries
Influence/power/prestige
Start a business
Retirement

How did you hear about us?^*

If other please specify:

Please add any comments you have below:

IMPORTANT: The security of electronic mail sent through the Internet is not guaranteed. Brick Financial Management therefore recommends that you do not send confidential information to us via electronic mail, including social security numbers, account numbers and other personal identification numbers.

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