Purchase Order for Funds Brokers - TEN STAR Financial Inc.

REQUEST TO PURCHASE

If you have already done the research for yourself and want to make a purchase of funds without also paying for advice use this form.

First Name:

Initial:Last Name:

Complete Address:

Tel:Fax:

Email:

E-mail address required by our server and will ONLY be used by us for approved contact

S.I.N.*

Date of Birth:

Are these funds to be registered? :

Is this a spousal RRSP?:

If yes, is the above person making the contribution?:

Name & S.I.N.* of Spouse:

Beneficiary: Estate:

Or: Relationship:

THE FUNDS IN WHICH I WISH TO INVEST ARE:

$ Or%

Approximate Total:

$ Total % :

PLEASE COMPLETE REPRESENTATIVE TRANSFER FORMFOR THE TRANSFER OF ANY REGISTERED FUNDS

Enter Comments:

Upon Receipt
We Will:

1) Confirm receipt of these instructions

2) Immediately complete and forward the necessary documents

3) Monitor the transaction unitil complete

PLEASE CONTACT US TO DISCUSS ANY OTHER DETAILS.

Note: Social insurance number not required until purchase is authorized.

TEN STAR Group
Peterborough Office:
159 King St., - Suite 103
Peterborough, Ontario, Canada
K9J 2G8
(800) 526 1505 (705) 742 8188 Fax. (705) 742 3238