West Virginia State Auditor's Office
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Securities Commission

Form 16: Application for Renewal of

Dealer's Registration

The undersigned hereby applies for renewal of its registration as a securities dealer in West Virginia. The following information, representations of fact, and attached Exhibits are submitted in support of said renewal registration.
A certified check for payment of the renewal fee in the amount of $250.00 payable to the STATE AUDITOR of West Virginia, is attached.

Adobe PDF Form 16: Application for Renewal of Dealer's Registration

For further information, please contact John Seymour at 304.558.2257
(Rev. 8-99)


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