Commerce Division of Securities : Request Records  
 

License Record Request Form


CONTACT INFORMATION


Your Name:
Your Address:
 
City: State:   Zip:
Telephone: Fax:
E-Mail:

RECORD REQUESTED

Information contained in our records will be provided to you via Regular United States mail or it will be transmitted electronically if an email address if provided.

In order to provide an accurate response about the person or entity for whom you are seeking information, the Division needs as much information about the person or firm as possible. For example, if you are seeking information about whether John Doe has a securities salesperson's license in Ohio, we need more than "John Doe" and "Ohio" because there are hundreds of John Doe's in Ohio.

Therefore, please state the entire legal name, including middle initial of the natural person on whom you are seeking information, OR the complete legal name of the entity on which you are seeking information.

Name:

Also, include the location of the person or entity relative to city and state:
City:   State:

If known, include information such as the person's:
CRD number:
Social Security number:
Street Address:
The employing firm the person represents:
Other:

SPECIFIC REQUEST

(please check any/all that apply)

An investment adviser license
An investment adviser representative license
A securities dealer license
A securities salesperson license

Please note any other questions or comments relevant to this Record Request: