Forex Licensing/White Label

First Name:
*

Last Name:
*

Name of Business:
*

Street Address:
*

City/Region:
*

State/Province:
*

Phone:
*

Fax:
 

E-mail:
*

Website URL:
 

Country:
--------------------Please Choose--------------------- United States Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia & Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Islands Central African Republic Chad Chile China Colombia Comores Congo Costa Rica Croatia Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Morocco Mozambique Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Singapore Slovak Republic Slovenia Solomon Islands Somalia South Africa South Korea Spain Sri Lanka Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Venezuela Vietnam Yemen Zambia

Briefly describe the nature of your business:

*Organization
*Promotional & Advertisizing
*Sales Process
*Revenue/Distribution

 

Years in Business:

Number of existing customer accounts (active/inactive):

Total amount of customer margin (in USD):

 

Are you currently an IB or in any other way associated with another market maker?
Yes No

 

Will you be targeting U.S. clients: Yes No

 

Which of our platforms would you like to white label?
MetaTrader 4 FXDD Trader

 

Number of sales people:

Number of support people:

 

Select the average account size you expect your customers to have:
0-5k 5-25k 25-100k over 100k

 

Are you registered in the U.S. as a: FCM IB CTA Other None

If outside the US, is the IB registered with a foreign regulatory body?

 

Have any formal complaints been filed against you or your company? Yes No

 

What geographic region will you mainly be targeting?

 

Additional information:
Please provide any information you think might be relevant in the review/compliance check process.

 

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