Full Name
Email Address
Phone Number
Entity Name (if applicable)
Entity Type
SelectIndividualBusiness ($5,000,000 in assets)Institutional InvestorFund of Fund Manager
Select all that apply to you or your entity:
I had an individual income over $200,000 in each of the last two years and expect the same this year.My joint income with a spouse or partner exceeded $300,000 in each of the last two years and I expect the same this year.My net worth exceeds $1,000,000, excluding my primary residence.I hold a Series 7, 65, or 82 securities license.I am a knowledgeable employee of a private fund (as defined by Rule 3c-5).This section does not apply to me - I’m a Business
The entity has over $5,000,000 in assets and was not formed solely to invest in this offering.All equity owners of the entity are accredited investors.The entity is a bank, insurance company, investment company, or business development company.The trust has over $5,000,000 in assets, wasn't formed to invest in this offering, and is managed by a financially sophisticated person.This is a Family Office with over $5,000,000 in AUM, investing on its own behalf.This is a Family Client of a qualifying family office.This Section does not apply to me - I’m an Individual
I certify that I meet one or more of the accredited investor criteria listed above and that the information provided is accurate and truthful to the best of my knowledge.
Signature (typed)
Date