Application for Broker/Dealer Firms

Agreement: We wish to apply for inclusion of the designated office(s) in The Bond Buyer's Municipal MarketplaceŽ & Municipal Marketplace Online. We understand that once we are qualified, our office(s) will be listed in each future edition. We will be billed according to the current fee schedule unless we request cancellation in writing. We understand the current listing fee for one main office is $435.00, which includes one listing in one edition of the directory & Municipal Marketplace Online. Each additional separate office listing is $105.00, each separate office listed within another listing is $105.00, per one edition of the directory and Municipal Marketplace Online.

Listing Information (Please Submit one form for each separate office to be listed)

	[ ] Main Office	OR	 [ ] Branch Office

Total number of offices to list:____ 

Full Name of Firm:________________________________________________________________

Company Address:________________________________________________________________

________________________________________________________________________________

City:__________________________________ State:________            Zip:__________

Telephone:_____________________________ Fax:__________________________________________

General E-Mail:________________________ Website Address:_______________________________

Clear Through:________________________________________________________________________

Memberships: [ ] PSA	[ ] SIA		[ ] NASD		[ ] ISDA

Tax ID: ______________________

DTC: ___________  NSCC: ___________   MSTC: ___________   PHILADEP: ___________

Practice areas
Indicate all of the municipal bond issue types that your firm has participated in the past 12 months.

	[ ] Education			[ ] Housing
	[ ] Environment Facilities		[ ] Industrial Development
	[ ] Electric Power			[ ] Public Facilities
	[ ] General Purpose			[ ] Transportation
	[ ] Health Care			[ ] Utilities

Contact Names Provide all of the names to be listed, in order. There's no limit to 
 the amount of names you can list; attach a typed list if you prefer. Please provide all 
 details requested, including individual telephone numbers and e-mails.


__________________________________       __________________________________    _____________________________
NAME		                        TITLE	  	                  DEPARTMENT		

_____________________________     ______________________________     ________________________ 
    DIRECT PHONE	             DIRECT FAX		    E-MAIL

__________________________________       __________________________________    _____________________________
NAME		                        TITLE	  	                  DEPARTMENT		

_____________________________     ______________________________     ________________________ 
    DIRECT PHONE	             DIRECT FAX		  E-MAIL

__________________________________       __________________________________    _____________________________
NAME		                        TITLE	  	                  DEPARTMENT		

_____________________________     ______________________________     ________________________ 
    DIRECT PHONE	             DIRECT FAX		  E-MAIL

__________________________________       __________________________________    _____________________________
NAME		                        TITLE	  	                  DEPARTMENT		

_____________________________     ______________________________     ________________________ 
    DIRECT PHONE	             DIRECT FAX		  E-MAIL

__________________________________       __________________________________    _____________________________
NAME		                        TITLE	  	                  DEPARTMENT		

_____________________________     ______________________________     ________________________ 
    DIRECT PHONE	             DIRECT FAX		  E-MAIL

__________________________________       __________________________________    _____________________________
NAME		                        TITLE	  	                  DEPARTMENT		

_____________________________     ______________________________     ________________________ 
    DIRECT PHONE	             DIRECT FAX		  E-MAIL


Individual responsible for updates (Update forms will be sent to this person twice a year; this name does not print in listing)

Name:_______________________________________  Title:___________________________

Address:____________________________________________________________________

City:_________________________________________  State:________  Zip:______________

Telephone:____________________________________  Fax:___________________________

E-Mail_________________________________
Individual responsible for billing (name will not print in listing): [  ] Same as above

Name:_______________________________________  Title:___________________________

Address:____________________________________________________________________

City:_________________________________________  State:________  Zip:______________

Telephone:___________________________________  Fax:___________________________

E-Mail_________________________________