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FOR INVESTORS THAT ARE CORPORATIONS, PARTNERSHIPS, TRUSTS, OR OTHER ENTITIES
Name (name of corporation, partnership, trust, or other entity)
*
Office Phone
*
Address of Principle Office
*
Line 1
Line 2
City
State
Zip Code
Country
*
Indicates required field
State of Incorporation or Organization
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
Date of Incorporation or Organization (MM/DD/YYYY)
*
Taxpayer Identification Number
*
Nature of Business
*
Name and Title (Name and Title of Authorized Individual to Execute the Questionnaire)
*
Name of record and beneficial owners of entity (10% ownership or more). Please list name and percentage of ownership. One name per line.
*
FOR ALL INVESTORS
Relationship to the Company or Manager of the Company
*
Is the undersigned an officer or director of a publicly-held company?
*
Yes
No
I ______ personally invested in investments sold by means of private placements within the past five years.
*
Have
Have Not
Do you consider yourself to have such knowledge and experience in financial and business matters to enable yourself to evaluate the merits and risks of investment in the Company?
*
Yes
No
Listed below are the categories of accredited investors, as defined by Regulation D, promulgated under the Securities Act of 1933, as amended. Please check the appropriate space provided below if the Investor falls within one or more of these categories.
*
Any natural person whose individual net worth or joint net worth with that person's spouse, at the time of his purchase, exceeds $1,000,000. Net worth includes homes, furnishings and automobiles.
Any natural person who had an individual income in excess of $200,000 in each of the two most recent years or joint income with that person's spouse in excess of $300,000 in each of those years and has a reasonable expectation of reaching the same income level in the current year.
A bank, insurance company, registered investment company, employee benefit plan if the investment decision is made by a bank, insurance company or registered investment adviser, or an employee benefit plan with more than $5 million of assets.
Any private business development company as defined in Section 202(a) (22) of the Investment Advisers Act of 1940.
Any organization described in Section 501(c)(3) of the Internal Revenue Code, corporation, Massachusetts or similar business trust, or partnership, not formed for the specific purpose or acquiring the securities offered, with total assets in excess of $5,000,000.
Any director, executive officer or general partner of the issuer of the securities being offered or sold, or any director, executive officer or general partner of a general partner of that issuer.
Any trust with total assets in excess of $5,000,000, not formed for the specific purpose of acquiring the securities offered, whose purchase is directed by a sophisticated person as described in Rule 506(b)(2)(ii).
Any entity in which all of the equity owners are accredited investors.
The Investor does not qualify in any accredited category as indicated above.
Please indicate whether you intend to have an attorney, accountant, investment advisor or other consultant act as its Purchaser Representative in connection with this investment
*
Yes
No
NET WORTH
INVESTOR ACKNOWLEDGEMENT
The Investor hereby certifies that the information contained herein is complete and accurate and the Investor will notify the Company promptly of any change of information. Specifically, the Investor hereby certifies that the information contained above concerning the residency of the Investor is true and correct. The Investor realizes and understands that, but for the truth of the information contained herein, the Investor would not receive consideration by the Company pertaining to this investment. If the Questionnaire is completed on behalf of a corporation, partnership, trust, or estate, I, the person executing on behalf of the Investor, represent that I have the authority to execute and deliver the Questionnaire on behalf of such corporation, partnership, trust, or estate.
DATE (MM/DD/YYYY)
*
SIGNATURE FOR CORPORATION, PARTNERSHIP, TRUST, OR OTHER ENTITY
Name of Investor
*
By
*
Signature
*
Name
*
Title
*
DIGITAL SIGNATURE
By checking this box, you agree and understand that using an "electronic signature" is legal and binding. By filling in the field labeled "Signature," you are agreeing that all the information given is to the best of your abilities true.*
*
I agree
Submit
Working with Red Fox Capital was a wonderful experience. As a stressed out female pediatric oncologist, I needed an investment team I could trust and help me build wealth.
Ashley
Baltimore, Maryland
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Investor Questionnaire
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