Borsellino.com: day trade with LBJ

First Name*	Last Name*	**Required information*

Company/Organization*		Your Title*

	Hedge fund managers		Banking institutions
	Individual investors		Brokerage firms
	Futures brokers		Investment research firms
	Introducing brokers		Other
	Equity traders

Address*

City*	State*	Zip Code*

Telephone*

Email* (please type twice)

Primary reason for purchasing this service*

Are you interested in subscribing to periodic reports on market direction by Lewis and other experts he recommends?*
	Yes		No

Are you interested in hearing about other investment services offered by Lewis?*
	Yes		No

How frequently would you like to schedule your sessions with Lewis?*
	Daily
	Weekly
	Bi-monthly
	Monthly
	Quarterly

How much time would you like to have with Lewis on the phone?*
	15 minutes
	30 minutes

If you are affiliated with a financial service firm, how many people do you anticipate will be on the call with you?

*If you are individual investor, please answer the following:*
Do you actively trade the S&P 500 on regular basis?
	Yes	No
Are you a part-time or full-time trader?
	Part-time	Full-time

Disclaimer*: I understand and agree that Borsellino.com (Mr. Lewis J. Borsellino) and it’s employees, agents, representatives and associates will not be liable for any direct, indirect, incidental, or consequential loss or damages resulting from the purchase, use, or access to Day Trade with LBJ Services. Additionally, I also understand the risk of trading futures and options can be substantial. Each investor must consider whether trading futures is a suitable investment. Past performance is not indicative of future results.

Yes, I understand and agree*