Form for Taking Notes

When Your Broker Calls,
Take Notes!

A checklist To Use When Talking To A Broker

Use this checklist to record your conversation with any broker who recommends that you buy or sell an investment.

 
Name of Broker:_________________________________________________

Company: ______________________________________________

Company Location:______________________________________________

Date:_________________        Time: ____________

  ___ Phone call

  ___ Meeting      Location: ____________________

Recommended that I:     ___ buy         ___ sell

Name of security: _________________________________________

How does this recommendation meet my investment objectives? What are the specific reasons why I should invest in this? (or sell this?)

___________________________________________________________

___________________________________________________________

___________________________________________________________

What are the specific risks if I buy this investment?

____________________________________________________________

____________________________________________________________

____________________________________________________________

I asked to receive written information about this investment before making a decision:

    ___ yes         ___ no

I asked for:

___ a prospectus
___ most recent annual report (10K)
___ most recent quarterly report (10Q)
___ any other recent report (8K)
___ any other available written material
___ other _____________________

After looking at the written material, I decided to:

___ do nothing
___ buy
___ sell
how much? _______________
at what price? _______________

The total cost of this transaction will be: _______________

Other Notes:

Date: __________________________

If you suspect wrongdoing, contact:

Office of Investor Education and Advocacy
U.S. Securities & Exchange Commission
100 F Street, NE
Washington D.C. 20549-0213
Fax: (202) 772-9295
Online Complaint Form