Application For Licensing Of A Branch Office - Nevada Secretary Of State
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1State of Nevada
Secretary of State
Securities Division
Application For Licensing of a Branch Office
Nevada Form 360-2 rev 11/2001)
To:
Office of the Secretary of State
Securities Division
Ms. Terry Sanchez, Licensing Examiner
555 E. Washington Avenue, Suite 5200
Las Vegas, Nevada 891 01
(702) 486-2440
NOTE: Please submit a separate form for each branch office. Attach proof of certificate to do business from the Nevada Secretary
of State, if the broker-dealer is a foreign corporation, and include filing fee of $100.00.
Name of Broker-Dealer:
Firm's CRD Number:
Hereby requests licensing of the following office located in Nevada at:
Address: Number, Street, City, State and Zip must be included. Do Not Use a P.O. Box Number
90.370 ''Branch Office'' means any place of business in [Nevada] from which one or more sales
representatives transact business.
Telephone Number:
THIS OFFICE IS A(N):
NASD OSJ Branch
(Check One)
NASD NON-OSJ Branch
NEVADA Branch Only
BRANCH OFFICE INFORMATION
Name of Registered Representative located in this branch
CRD NO.
SOCIAL
SECURITY NO.
Name of Registered Supervisor of Office
CRD NO.
SOCIAL
SECURITY NO
Address of the Office of Supervisory Jurisdiction to which branch reports
The registrant submitting this form and its attachments and the person executing it represent hereby that it and
all materials filed in connection with it contain a true, correct and complete statement of all required information.
Dated the
day of
I
(Typed Name of Undersigned)
Reset
(Signature of Executive Officer, Partner, Sole Proprietor)
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