Name *

First Name

Last Name

Phone *

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Overall Investment Objectives *

Please select the investment objective(s) which align with your current goals:

Income: focus on generating cash flow without regard to growth of capital

Income with Some Growth: focus on generating cash flow with some growth of capital

Equal Growth/Income: equal focus on generating cash flow and growth of capital

Growth with Some Income: focus on growth of capital with some cash flow

Maximum Growth: focus on growth of capital without regard to cash flow

Risk Tolerance *

Aggressive

Moderate

Conservative

Prior Relationship *

I have a pre-existing personal or business relationship with the company making the offering.

I have a pre-existing personal or business relationship with the general partners, officers, directors, or LLC managers of the company.

I do not have a pre-existing personal or business relationship, but I believe that I am aware of the character, business acumen and general business and financial circumstances of the company and/or general partners, officers, directors, or LLC managers of the company.

Prior Investment Experience *

I have experience as an investor in:

Stocks which are listed on a national securities exchange.

Mutual funds which hold a portfolio primarily consisting of stocks.

Taxable or tax exempt bonds or other debt instruments.

Partnerships, limited liability companies, corporations which invest in real estate or real estate investment trusts (REITs).

Sophisticated Investor *

Please check each item that applies

I have such knowledge and experience in financial, investment and business matters that I am capable of evaluating the merits and risks of any investments.

I am using a financial advisor, planner, or consultant, or some other advisor who has such knowledge and experience in financial and business matters that he/she/it is capable of evaluating the merits and risks of any investments.

Accredited Investor *

Please check any/all items that apply:

My net worth (either individually or with my spouse, if any), excluding the value of my primary residence, but including all other real estate, investments and assets is at least $1,000,000.

My individual annual income was at least $200,000 in each of the two most recent years, and I expect such income in the current year.

My annual income, jointly with my spouse, was at least $300,000 in each of the two most recent years, and I expect such income in the current year.

I am signing for an entity and all of the entity's equity owners meet at least one of the three tests listed above.

I am signing for an organization not formed for the specific purpose of acquiring the securities offered with total assets in excess of $5,000,000.

I am signing for a revocable trust created by the undersigned for his or her own benefit who meets at least one of the first three tests listed above.

If I invest, I will be investing more than $150,000 and that investment will not exceed 10% of my net worth, including my spouse's assets, if any (and including the net equity in my residence).

None of the above.

Date *

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