Questionnaire

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As a securities law firm dedicated to helping public investors obtain compensation from stockbrokers,
financial advisers and insurance salesmen, we will gladly give you a free e-mail consultation and
opinion about the likelihood of success of your claim. Just fill out the questionnaire below and
e-mail us, and an experienced securities lawyer will respond to you.

Answer as many questions as you can. The more information we have the better we can advise you.

* = required fields.

First Name:* Last Name:*

Address:Suite / Apt#:

City: State:*Zip:*

Email:* Phone:*

Best way to contact you:

Age:

Name of Brokerage in Question:*

Name of Broker:

Location of Firm:

What were your investment objectives?

 Long term growth Speculation Income return Conservative

What investments were purchased in your account?

 IPO Stocks Bonds Mutual Funds Options Whatever the broker suggested I bought

How much did you lose?

How many years ago did the loss occur?

What do you think the broker did wrong?

 Bought stocks without my permission Churned my account with a lot of in and out trades Bought stocks which were too risky Failed to follow my instructions with regard to specific investments

If Klayman & Toskes feels I have a meritorious claim, I may be willing to file an action to recover my losses.

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