Form 133.9 - Notice Filing For Third Party Brokerage Arrangements On Financial Entity Premises (139.20)

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Form
133.9
Texas State Securities Board
P.O. Box 13167
Austin, Texas 78711-3167
Notice Filing for Third Party Brokerage Arrangements on Financial Entity Premises
(§139.20)
1.
Name of Financial Entity:
2.
Address of Financial Entity:
3.
Designated Officer/Contact:
4.
Name of Registered General Dealer Providing Services:
5.
Is the financial entity currently the subject of any litigation or arbitration relating in any
way to the offer or sale of securities?
Yes
No
6.
Please Attach the Following Fees:
Financial Entity (Same as dealer registration fee)
Designated Officer (contact person) (Same as agent registration fee)
By:
(Full Name - Printed or Typed)
(Signature)
Date:
08-16-2010

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