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FOR INDIVIDUAL INVESTORS
*
Indicates required field
Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone Number
*
Email
*
Confirm Email
*
Birthday (MM/DD/YYYY)
*
Are you a U.S. Citizen?
*
Yes
No
College
*
How did you hear about us?
*
Business/Employer Name
*
Nature of Business Employment
*
Occupations or Duties
*
Please set forth other prior occupations or duties during the past five years
*
Year of Anticipated Retirement
*
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
GROSS INCOME
If the undersigned is an individual. was your personal income from all sources for the previous calendar year more than (check the HIGHEST number applicable for each year.)
2017
*
$150,000
$200,000
$250,000
2016
*
$150,000
$200,000
$250,000
2015
*
$150,000
$200,000
$250,000
NET WORTH
My estimated liquid assets equal:
*
My estimated non-liquid assets equal:
*
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 INDIVIDUAL INVESTOR
SIGNATURE
*
NAME
*
Signature of Joint Investor
*
Name of Joint Investor
*
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
My days of being a landlord are OVER! The Red Fox guys find and manage our real estate investments like pros.
Rocky
Washington, D.C.
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Blog
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Investor Questionnaire
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