Benjamin & Jerold Create An Account

Thank you for your interest in creating account with Benjamin & Jerold Brokerage, LLC. Please fill out the information below. If you have any questions for comments, our contact details can be found here.

Step 1: Choose Account Type

Enter Primary Account Holder or Custodian Information

First Name:
Middle Initial:
Last Name:
E-Mail Address:
Confirm E-Mail Address:     

Select the Type of Account - Move your mouse over any of these items for more information

Individual account
Joint account
Custodial account

Tell Us How You Would Like to Trade in the Account

Cash Account Only
Margin Account
Margin Account with Options Trading

Step 2: Provide Information About Account Holder(s)

Enter Primary Account Holder or Custodian Information

Street Address:
Street Address, line 2:
Zip/Postal Code:

Home Phone (xxx-xxx-xxxx):
Business Phone (xxx-xxx-xxxx):
Mobile Phone (xxx-xxx-xxxx):

Enter Your Tax and Citizenship Information

Why do we need this information?
Securities industry regulations require we collect all of the information requested in this section for IRS tax reporting purposes.

Tax ID Type:
Social Security (SSN)
International Tax ID (ITIN)
SSN or ITIN Number
Date of Birth (mm/dd/yyyy):
Country of Legal Residence:
Citizenship Status:
US Citizen
A resident alien of the US but not US citizen
Neither a resident alien nor a citizen of the US

Enter Your Employment Status and Where You are Working (if Applicable)

Why do we need this information?
Securities industry regulations require we collect all of the information requested in this section.

Employer :
Employer Street Address
Employer City:
Employer State:
Employer Zip/Postal Code:
Employer Country:

Are you (the primary applicant) employed by a registered broker-dealer, a securitues exchange, or the FINRA?
Are you (the primary applicant) a Director or policymaker of a publicly owned company?
Are you (the primary applicant) a 10% shareholder of a publicy owned company?

Step 3: Choose Additional Account Preferences

Tell us about your financial backgroud.

Income and Net Worth

Investment Objectives
Capital Preservation
Investment Experience
Annual Income (combined if joint account):
Liquid Net Worth (cash, stocks, etc):
Total Net Worth (excluding residence):

Step 4: Terms & Conditions

Please read and accept the terms & conditions

I am of legal age to contract. I acknowledge that I have received, read, and agree to be bound by the terms and conditions of the Benjamin & Jerold Brokerage, LLC Customer Agreement in its current form and as amended from time to time. I UNDERSTAND THAT BY CONTINUING TO MAINTAIN MY SECURITIES BROKERAGE ACCOUNT WITHOUT OBJECTING TO REVISED TERMS OF THE CUSTOMER AGREEMENT, I AM ACCEPTING THE TERMS OF THE REVISED CUSTOMER AGREEMENT AND I WILL BE LEGALLY BOUND BY ITS TERMS AND CONDITIONS. I acknowledge that I have had the opportunity to read the PRIVACY STATEMENT. I ACKNOWLEDGE THAT Benjamin & Jerold Brokerage, LLC DOES NOT PROVIDE INVESTMENT, TAX, OR LEGAL ADVICE OR RECOMMENDATIONS. Important Information About Procedures for Opening a New Account: To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. When you open an account, we will ask for your name, address, date of birth and other information that will allow us to identify you. We may also request additional identifying documents. I understand that my name will be supplied to issuers of any securities held in my account so that I might receive any important information from them, unless I notify you in writing not to do so. I acknowledge that securities held in my Margin account may be pledged, re-pledged, hypothecated, or rehypothecated for any amount due Benjamin & Jerold Brokerage, LLC, in my account(s) or for a greater amount. Securities products and services: (i) are not insured by the FDIC; (ii) carry no bank or government guarantees; and (iii) are subject to investment risks, including possible loss of principal invested. The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding. Under penalty of perjury, I certify (1) that my Social Security (or taxpayer ID) number shown on this form is my correct number and (2) that I am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not been notified by the IRS that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) I have been notified by the IRS that I am no longer subject to backup withholding, and (3) I am a U.S. person (including U.S. resident alien). I UNDERSTAND THAT THIS ACCOUNT IS GOVERNED BY A PRE-DISPUTE ARBITRATION CLAUSE CONTAINED IN THE BENJAMIN & JEROLD BROKERAGE, LLC CUSTOMER AGREEMENT.
I understand and agree to the terms and conditions of the Benjamin & Jerold Brokerage, LLC Customer Agreement.

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