Verner Financial Company.

Let's Get Started Now!

Whether you are investing personal or IRA funds, we simply need to know the amounts you have available and the time frame in which your funds are available. All information provided will be kept strictly confidential.

C O N F I D E N T I A L

Items marked with a red asterisk(*) are required. If you are unable to answer a required question, give us your best guess or enter a "?", "NA", "0", "don't know", etc.
Fields marked with a dollar sign ($) indicate a monetary amount should be entered without COMMAS. (format: ###.## or #####.##)
Fields marked with a percent sign (%) indicate a percentage amount should be entered without COMMAS. (format: #.## or ##.##)

Your Investment Information
Yes, I'm interested in putting my money to work earning safe, good returns.
*I have the following funds available for investment:
Personal Funds		$
IRA Funds		$
Business Funds		$
*Date funds will be available for use:		format: mm/dd/yyyy
*I want to make a loan to you for a:
*I would like the payments to be:		Interest Accruing Annual Semi-Annual Quarterly Monthly
I would like to know more about how to move my money from my current brokerage IRA to a self-directed IRA so I can make loans to you.
I would like to know more about the interest accruing account.

Your Contact Information

* First Name
* Last Name
* Email

*Day Phone	x
*Evening Phone	x
Cell/Pager	x
*Best Time to Reach You

*Address
*City
*State
*Zip
Do you have any questions or comments you would like to share with us?
*How did you hear about us?

C O N F I D E N T I A L
Thank you for taking the time to share your information with us. We will review your information and contact you shortly. If you have any problem submitting this form, please contact us and let us know. NOTE: Be sure to submit this form before using the « Back \| Home » buttons below. Splendid supply: superior placards with noted star create poster on www.idposter.com!