Order Form
Ad Hoc Report Request for Oklahoma to submit to the Central Registration Depository (CRD)
Requestor Contact Name       
Shipping Address  (address we will use to mail the requested data) 
City State Zip
Contact Phone () - E-Mail        
Report Limited to Approved Agents Registered with Oklahoma
Include the following items of information on the report:
Individual CRD#
Individual Name
Hire Date with Affiliated Firm
Office of Employment Address
Branch ID Number
Branch Phone
Type of Office
Registered Location Indicator
Independent Contractor Indicator
Affiliated Firm CRD#
Affiliated Firm Name
Affiliated Firm Main Office Address
Affiliated Firm Main Office Phone Number
Individual Approval Date in requesting jurisdiction
Individual Continuous Registration Date
Exams    Exams with Dates
Registration Licenses
Employment History (Provided as a separate file) $240.00 
Include only those approved agents who meet the following criteria:
NOTE: Selecting any boxes below will REDUCE the amount of data you receive
Reside in requesting state
Work in requesting state
Reside in specified state(s):
Reside in specified ZIP code(s):
Work in specified state(s):
Work in specified ZIP code(s):

Limit to individuals who hold:
Any one of the following FINRA licenses (check those that apply)
All of the following FINRA licenses (check those that apply)
    GS    GP    IR     IP    SU    OP   
    Other (specify)
Limit to individuals who have taken and passed:
Any one of the following exams (check those that apply)
All of the following exams (check those that apply)
    S4      S6      S7       S9      S10
    S24    S26    S63    S65    S66
    Other (specify)
Total Enclosed: (amount of your check) $        
INSTRUCTIONS: Complete this form online and press the Submit button. You will then see a printable version of the completed request. Print and send that form, along with a check for the appropriate amount, to the address noted below. Make checks payable to the Oklahoma Securities Department. Your request cannot be processed until your check is received.
Please mail Order Form along with check to: Oklahoma Department of Securities
204 N. Robinson, Suite 400
Oklahoma City, OK 73102
(405) 280-7700 or Electronic