Douglas Bagwell & Co., LLC

Joint Client Application

Residency *
If you are not a resident of Missouri or Nebraska, please do not proceed and contact your advisor.
Name *
Date of Birth *
Date of Birth
Marital Status: *
Address *
Phone *
Are you a U.S. Citizen? *
Are you or any member of your immediate family a senior foreign political figure? *
Are you a director, 10% shareholder, or policy-making officer of a publicly traded company? *
Are you licensed or employed by a registered broker/dealer? *
Please specify if you are: *
Employer Address
Employer Address
By submitting this Client Application, I acknowledge I have received or will receive in the next 48 hours, the Adviser's ADV Part 2 Disclosure document, either in print or electronically including via the Adviser's website. I further acknowledge and understand the fee and fee structure, as disclosed in the ADV that the Adviser may invoice me; a) directly or b) via the Qualified Custodian, including; i) investment management fees, active or passive, OR ii) financial planning fees, OR iii) consultations. By submitting and dating below, a) I acknowledge my receipt and understanding of the Client Agreement and all provisions (including those pertaining to any pre-dispute arbitration clause) set forth within it; and b) Agree to abide by the provisions set forth within the Client Agreement, and any amendments thereto.