Do You Qualify?

CONFIDENTIAL INVESTOR QUESTIONNAIRE

Investor Questionnaire

Name*

SECTION A – NATURE OF PURCHASER

If you consider yourself an ‘Accredited Investor’ within the meaning of Rule 501(a) of Regulation D, you must select at least one of the following options # 1-5. If you consider yourself not an ‘Accredited Investor’, please check #6*
(PLEASE CHECK ONE)

SECTION B – QUESTIONS FOR INDIVIDUALS

Occupation:
Employer
Years with Employer
Title
Please provide the states/countries in which you have maintained your principal residence during the past three years and the dates in which you resided in each state/country. Are you registered to vote in, or do you have a driver’s license issued by, or do you maintain a residence in any other state/country? If yes, in which state(s)/country(ies)
Please describe your educational background and degrees obtained, if any:
Please indicate the number of years of experience you have (if any) in Stocks/Bonds/Mutual Funds
Please indicate the number of years of experience you have (if any) in Real Estate
Please indicate the number of years of experience you have (if any) in LPs, LLCs, Hedge Funds
This field is for validation purposes and should be left unchanged.