Accredited Investor Qualification Form

For regulatory purposes, please fill out the requested information below and select the items that best apply to you. We will provide you with a login name and password to additional portions of our website.

A * indicates the field is required to process your request.

Personal Information

First Name *

Last Name *

Company Name

Address *

Address 2

City *

State *

Zip *

Phone

Email *

Accredited Investor Status

Check all of the following indicating the basis upon which you qualify as an accredited investor under Regulation D. At least one selection is required.

For Individual Investors Only

(1) I certify that I am an accredited investor because I have an individual net worth, or my spouse and I have a combined net worth, in excess of $1,000,000. For purposes of this questionnaire, "net worth" means the excess of total assets at fair market value, including home, home furnishings and automobiles, over total liabilities.

(2) I certify that I am an accredited investor because I had individual income (exclusive of any income attributable to my spouse) of more than $200,000 in each of the past two years, or joint income with my spouse of more than $300,000 in each of those years, and I reasonably expect to reach the same income level in the current year.

For Corporations, Foundations, Endowments or Partnerships

(3) The Investor hereby certifies that it is an accredited investor because it has total assets in excess of $5,000,000 and was not formed for the specific purpose of acquiring the securities offered.

(4) The Investor hereby certifies that it is an accredited investor because all of its equity owners are accredited investors. The General Partner, in its sole discretion, may request information regarding the basis on which such equity owners are accredited.

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