Access Individual Intake

Access Person Information

This field is hidden when viewing the form

Submission Date

Full Legal Name(Required)

First Middle Last Suffix

Social Security Number(Required)

Date Of Birth(Required)

Cell Phone Number(Required)

Personal Email(Required)

Legal Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Business Address, if different from Home Address

Street Address Address Line 2 City State ZIP Code

This is the address(s) for any "office" locations you plan or will be meeting clients, or conducting business.

Are you currently, or have previously, worked in the financial industry?(Required)

What custodian have you worked with?(Required)

What portfolio management, performance reporting, and/or billing systems have you used?(Required)

What CRM (Client Relationship Manager) system have you used?(Required)

Will you be bringing your own device? If so, please list the computer model, device name, and operating system version (e.g. Windows 11 Home). You can find this information in the System/About section of your computer.(Required)

What cyber protection software (or service) do you currently use?(Required)

Have you ever been a registered professional?(Required)

In what capacity?(Required)

What licenses or certificates do you, or did you, possess?(Required)

Criminal or Civil Litigation Attestation(Required)

Please set forth below the charge, the date of the charge and the disposition or status. You must attach a copy of the charging document and the court order showing the disposition of the case.(Required)

Attach a copy of the charging document and the court order showing the disposition of the case.(Required)

Max. file size: 2 GB.

Please upload your valid government ID.(Required)

Max. file size: 2 GB.

By checking this box you are consenting the the outlined: Obligations To Prior Employers; Compliance With Securities And Privacy Laws(Required)

We are honored by your consideration to be an employee at Bison Wealth, LLC (“Bison Wealth”). As you consider employment with our firm, please be advised that Bison Wealth’s policies regarding the protection of client non-public personal information require our strict adherence with state and federal securities laws, including, without limitation, Regulation S-P and similar privacy laws and rules. To that end, please avoid sharing with us any non-public client information or data, including, without limitation, client names, account numbers, account balances or holdings, tax identification numbers, and the like, unless and until you have received the consent from the underlying client(s) for the release of such information and have been authorized by your prior employer to do so. By agreeing to become and employee of Bison Wealth, you represent and warrant that, (1) you will not possess, as of your start date with the firm and during your employment with the firm, any material, tangible, confidential or proprietary information, including documents, files, disks, or other materials, belonging to your former employer or its affiliates; (2) as of your start date with the firm, you have not solicited any employees or clients of your former employer or its affiliates to change their association with or otherwise materially alter or reduce their relationship with your former employer or its affiliates; and (3) you are not subject to any restrictive covenant, notice of termination requirement, non-competition or non-solicitation provision with any former employer or any agreement that prevents your affiliation with the Firm and that you have conducted a reasonable review of copies of all agreements you may have entered into with your former employer to ensure that this is correct. By accepting a position with Bison Wealth, you further agree to indemnify, defend, and hold harmless the firm, its affiliates, and their respective principals, officers, directors, members, and employees from all losses, damages, liabilities, and expenses (including attorneys’ fees and court costs) arising from or related in any way to your breach of any obligations to any of your former employers. Thank you for your interest in joining our growing team. If you have any questions or concerns, please contact us at 404-841-2224 or compliance@bisonwealth.com.

Signature(Required)

By signing, I state that the information contained herein is true and complete. I understand that failure to fully disclose the information requested herein may be grounds for termination.