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MAHAK Inc.

CONFIDENTIAL REQUEST FORM

Your privacy is very important. All information will remain confidential.

Please fill out the CONFIDENTIAL REQUEST FORM below. Upon completion, I will send you a FREE copy of my quarterly newsletter, which is available to my clients with $500,000 investments, invite you to my seminar, or contact you per your request.

Fields marked with an * are required.

* Country
Prefix	Select
* First Name
* Last Name
* Address 1
Address 2
* City
* State / Provice
* Zip
* email Address
* Home Phone #
Office Phone #
Fax #
* Total Investment Size

Would you like to meet and discuss joining my Private Client Group?
Would you like to receive a FREE copy of my quarterly newsletter?
Would you like to get invited to my next seminar?
Would you like to receive detailed quarterly performances, risk measures, and returns on all investments?

Please indicate the most appropriate phone number to reach you
Please indicate the most convenient time to reach you