You may use the link below to electronically submit Form G-40 using your MSRB Registration Number and Temporary password sent via USPS.

CLICK HERE TO ELECTRONICALLY SUBMIT YOUR FORM G-40.

Below is a sample form for illustrative purposes only.

ALL FORMS MUST BE SUBMITTED ELECTRONICALLY TO THE MSRB USING THE APPROPRIATE USER ID AND PASSWORD.
AMENDMENTS TO FORMS MUST BE MADE ELECTRONICALLY BY LOGGING ON TO THE MSRB’S WEB SITE (www.msrb.org) AND USING THE PRIMARY CONTACT’S USER ID AND PASSWORD TO CHANGE INFORMATION RELATING TO THAT PERSON, OR USING THE OPTIONAL CONTACT’S USER ID AND PASSWORD TO CHANGE INFORMATION RELATING TO THAT PERSON. FOR ASSISTANCE, PLEASE CALL THE MSRB AT (703) 797-6600.

                                                                                    MSRB Registration Number

Check one:

                          Original Form

                          Amended Form

Name of Dealer:

Saturday, March 13, 2010

The dealer named above designates (name) as its Primary Electronic Mail Contact for purposes of electronic communications with the MSRB. This Primary Contact person is a Series 53-registered municipal securities principal or a Series 51-registered municipal fund securities limited principal with the dealer.

E-Mail Address of Primary Contact:

Phone Number of Primary Contact:

(Optional):  The dealer named above designates (name) as its Optional Electronic Mail Contact.

E-mail Address of Optional Contact:

Phone Number of Optional Contact:

Name of person preparing this Form:

Title:

Telephone number: