Exhibit A - Example of Format for Rule 11Ac1-6 Quarterly Report

Sample Firm, Inc.
[address and telephone number]

SEC-Required Report on Routing of Customer Orders
For Quarter Ending Sept. 30, 2001

Sample Firm, Inc. has prepared this report pursuant to a U.S. Securities and Exchange Commission rule requiring all brokerage firms to make publicly available quarterly reports on their order routing practices. The report provides information on the routing of "non-directed orders" - any order that the customer has not specifically instructed to be routed to a particular venue for execution. For these non-directed orders, Sample Firm has selected the execution venue on behalf of its customers.

The report is divided into four sections: one for securities listed on the New York Stock Exchange, one for securities listed on The Nasdaq Stock Market, one for securities listed on the American Stock Exchange or regional exchanges, and one for exchange-listed options. For each section, this report identifies the venues most often selected by Sample Firm, sets forth the percentage of various types of orders routed to the venues, and discusses the material aspects of Sample Firm's relationship with the venues.

Securities Listed on New York Stock Exchange

Summary Statistics:
	Non-directed orders as percentage of total customer orders	86%
	Market orders as percentage of total non-directed orders	46%
	Limit orders as percentage of total non-directed orders	47%
	Other orders as percentage of total non-directed orders	7%

Venues Receiving Significant Percentage of Total Non-Directed Orders:
	1.	Exchange A	45%
	2.	Market Maker A	32%
	3.	Market Maker B	8%
	4.	Exchange B	4%
	5.	ECN A	3%

Information Concerning Significant Venues:
	1.	Exchange A Types of Orders Routed to Venue:
		Market orders as percentage of total market orders	24%
		Limit orders as percentage of total limit orders	61%
		Other orders as percentage of total other orders	91%
		Material Aspects of Relationship with Venue: [discussion]
	2.	Market Maker A Types of Orders Routed to Venue:
		Market orders as percentage of total market orders	57%
		Limit orders as percentage of total limit orders	12%
		Other orders as percentage of total other orders	5%
		Material Aspects of Relationship with Venue: [discussion]
	3.	Market Maker B Types of Orders Routed to Venue:
		Market orders as percentage of total market orders	13%
		Limit orders as percentage of total limit orders	--
		Other orders as percentage of total other orders	--
		Material Aspects of Relationship with Venue: [discussion]
	4.	Exchange B Types of Orders Routed to Venue:
		Market orders as percentage of total market orders	2%
		Limit orders as percentage of total limit orders	6%
		Other orders as percentage of total other orders	4%
		Material Aspects of Relationship with Venue: [discussion]
	5.	ECN A Types of Orders Routed to Venue:
		Market orders as percentage of total market orders	--
		Limit orders as percentage of total limit orders	7%
		Other orders as percentage of total other orders	--
		Material Aspects of Relationship with Venue: [discussion]

Securities Listed On The Nasdaq Stock Market

[same format as above]

Securities Listed on American Stock Exchange or Regional Exchanges

[same format as above]

Exchange-Listed Options

[same format as above]

http://www.sec.gov/interps/legal/mrslb13appxa.htm