Investor Registration

Gemstone Securities LLC is looking for investors interested in participating in future investment opportunities.

If you are interested in being a part of the firm's investor database to be considered for future Private Placement Offering opportunities please provide the following information.

First Name*
Last Name*
Address*
Address Line 2 (if necessary)
City*
State*
Zip*
Phone*	Area Code Number Ext.
Fax
Email*
Have you invested in Private Placements in the past?*	Yes No
Please identify the type(s) of investments you are interested in: (check all that apply)*	Real Estate Manufacturing Technology Finance & Insurance Health Care Industries Franchises Utility Companies Secured Notes Equity Any
Are you an Accredited Investor?*	Yes No
Are you interested in viewing our current offerings?*	Yes No
Please provide a username and password for optional future use, such as accessing protected areas of this site. A username and password are also required to view our current offerings upon approval.
Username*
Password*
Repeat Password*
Your IP Address
Comments or Questions
*Required. We strive to earn and keep your trust. We do not share your personal information, including your email address, with other parties for any purpose. Please visit www.sipc.org for more information about account protection.

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GemStone Securities LLC • 19321 U.S. Hwy. 19 North • Arbor Shoreline Bldg. C, Ste. 606 • Clearwater, FL 33764
Phone 727-536-7900 • Fax 727-683-9169

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