Investor Registry Form

 

Fill out and submit the following information form if you wish to be registered with Nicholas Financial, Inc. as an investor or potential investor. Upon verification you will be included in the investor database which will make you elegible to receive company mailings.

Please provide the following contact information:

      First name 
       Last name 
  Middle initial 
           Title 
    Organization 
  Street address 
 Address (cont.) 
            City 
  State/Province 
 Zip/Postal code 
         Country 
      Work Phone 
      Home Phone 
             FAX 
          E-mail 
             URL 
Check the following Box if you currently own shares 
of Nicholas Stock: 
How many shares do you own?

Contact Information

Telephone
CompanyPhone
FAX
CompanyFAX
Postal address
CompanyAddress
Electronic mail
Nicholas Employee E-Mail Directory
Investor Information:  skrause@nicfn.com
Webmaster: mmarika@nicfn.com

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Last modified: December 11, 2001