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Years in the Business: Less than one year. 1 to 5 years. 5 to 10 years. 10 to 15 years. 15 to 20 years. More than 20 years. Approximate last 12 Months production in gross comissions: $100,000 Plus $50,000 to $99,000 $20,000 to $49,000 $10,000 to $19,000 $10,000 or under Approximate percent of business that is securities: 100% 80% - 99% 60% - 79% 40% - 59% 20% - 39% 0% - 19% Approximate percent of business that is insurance: 100% 80% - 99% 60% - 79% 40% - 59% 20% - 39% 0% - 19% The products you currently sell include: The licenses you currently hold: When are you planning to change BD's?: ASAP (within 30 days) 60 Days 90 to 180 Days One year Not sure Why are you changing Broker Dealers?: Special Circumstances/Remarks: