Prospective Investor Questionnaire
Please provide some information about yourself and we will contact you to discuss investment opportunities.
1. Your net income in each of the two most recently completed years was in excess of $200,000, and you expect to reach the same in this current year.
2. You are married, and in each of the two most recently completed years the joint net income of you and your spouse was in excess of $300,000, and you and your spouse have a reasonable expectation of reaching the same income level in the current year.
3. If you (a) exclude the value of your primary residence from your list of assets and (b) you exclude from your list of liabilities the lesser of (i) the indebtedness that is secured by your primary residence or (ii) the current fair market value of your primary residence, your individual net worth, or the joint net worth of you and your spouse, still exceeds $1,000,000.
1. If you have a self-directed IRA, please check each box that applies to you:
You checked "YES" in at least one of the boxes Section A
2. You are the grantor of a revocable grantor trust, please check each box that applies to you:
You checked "YES" in at least one of the boxes in Section A above.
3. If you are in charge of an entity, other than a trust or an employee benefit plan, with total assets which exceed $5,000,000, please check each box that applies to the entity:
The entity is corporation, LLC, partnership, business trust, or an organization described in Section 501(c)(3) of the Internal Revenue Code.
The entity was not formed for the specific purpose of acquiring any particular issue of securities.
4. If you are the trustee of a trust other than the kind described in #2 above, please check each box that applies to the trust:
The trust’s total assets exceed $5,000,000.
The trust’s investment decisions to purchase securities are made by a person with such knowledge and experience in financial and business matters.
5. If you are in charge of an employee benefit plan within the meaning of the Employee Retirement Income Security Act of 1974 (also known as ERISA), please check each box that applies to the plan:
The plan’s total assets exceed $5,000,000.
Investment decisions for the plan are made by a plan fiduciary (as defined in ERISA) - bank, savings & loan association, insurance co. or advisor.
The plan is a self-directed plan whose investment decisions a made solely by persons who are accredited investors.
Plan assets are $5,000,000+ even it it's not a plan defined by ERISA
6. If you are in charge of a private business development company, is the company a private business development company as defined in section 202(a)(22) of the Investment Advisors Act of 1940.
7. If you are in charge of an institutional investor, please check each box which applies to that institution:
A bank as defined in Section 3(a)(2) of the Securities Act of 1933.
A savings and loan association or other institution as defined in Section 3(a)(5)(A) of the Securities Act of 1933.
A broker or dealer registered pursuant to section 15 of the Securities Exchange Act of 1934.
An insurance company as defined in Section 2(a)(13) of the Securities Act of 1933.
An investment company registered under the Investment Company Act of 1940.
A business development company as defined in Section 2(a)(48) of the Securities Act of 1933.
A Small Business Investment Company licensed by the U.S. SBA under section 301(c) or (d) of the Small Business Investment Act of 1958.
8. If you are associated with an entity in which all of the equity owners are accredited investors, please check each box that applies to that entity:
All of the equity owners of this entity are human beings who are accredited investors.
All of the equity owners of this entity are other entities who are accredited investors.
The equity owners of this entity are both human beings and other entities, all of which are accredited investors.
Do Not Fill This Out