Complaint Information Sheet - Missouri Secretary Of State Page 2
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3Investment Information
1. Explain what you were offered:
2. How much money did you invest?
Payment was made by:
cash
check
other
3. Date of investment(s):
Place of investment(s):
4. Please give a brief explanation of how you gained knowledge of this investment and exactly
what you were told about the investment.
a. What were you told your money would be used for?
b. What amount of return were you promised?
c. What were you told about the risks of this investment?
d. Did you receive a prospectus or other information regarding the financial condition of the
company?
e. Did the seller give you information that later turned out to be untrue?
If yes, please explain:
f. Did you sign a contract?
5. Have you contacted an attorney or any other government agency?
If yes, who?
6. Have you asked for the return of your initial investment?
If so, did you receive it?
7. Please provide the names, addresses, and telephone numbers of anybody else that you know
that made the same investment or dealt with the same representative:
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