» Personal Trading Module Add On Request
Consulting Firm Initiating Request: *
Legal Name of Company Licensing Module: *
Primary Contact First name: *
Primary Contact Last name: *
Primary Contact Email: *
Primary Contact Phone: *
Street: *
City: *
State: *
ZIP: *
Number of Employees Accessing BasisCode?: *
Billing Contact Full Name (if different):
Billing Contact Email (if different):
Name of person who should receive the agreement? (We use DocuSign): *
DocuSign Recipient's Email Address: *
Name of individual to be copied on Docusign:
Email of individual to be copied on Docusign:
* These fields are required.
