Commodity Trading Advisor - Info by AutumnGold

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Please complete the following form if you wish to be contacted by a Broker
Your request will be forwarded to a Non-Affiliated Broker that handles Managed Futures

Title
Last Name	First Name
Age	Marital Status
Occupation	Company Name
How much of an alloation do you expect to make to futures over the next 12 months?
What is your experience level with Managed Futures
Address	Address 2
City	State
Postal Code	Country
Daytime Phone	Evening Phone
Fax	E-mail Address

Email & Telephone Communications. Written Consent and Waiver of National Do-Not-Call Registration
Do you want to know more about the National Do-Not-Call Registry? Click here to access the Do Not Call Registry Website

By selecting one of the following "I Agree" alternatives, you acknowledge that you have read and agree to the "Electronic Signature Consent" box below. In addition, your "I Agree" selection below serves as your written invitation, permission and affirmative consent for us to: (1) contact you by telephone at the numbers designated below in connection with any account, relationship or transaction you may have or seek to establish with us; and to (2) contact you at your email address provided above:

Please indicate one of the following

I Agree, and you may call me at either my Daytime or Evening phone number provided above

I Agree, and you may call me at my Daytime phone number provided above

I Agree, and you may call me at my Evening phone number provided above

This written consent permits us to call you by telephone, and communicate with you by email, notwithstanding any registration of your telephone number or other identifying information on any national or state "do-not-call" list, including the National Do-Not-Call Registry administered by the Federal Communications Commission and/or the Federal Trade Commission. You acknowledge and agree that this written consent will continue for an indefinite period unless specifically revoked by you.

Please type your name

Authorized Electronic Signature