SIGPAGE - Signatory Questionnaire V1 [DRAFT]

Signatory Questionnaire

Please fill out this short questionnaire to provide your signature block details in connection with your investment or other transaction.
Submitter Information

This should be your information, even if you are filling this information out for someone else. If the fields are already pre-filled with someone else's information from a prior submission, please go ahead and update the fields with your information.
Your Name*

First NameLast Name
Your Email*
example@example.com
Issuer Information
Issuer Name*
Example, Inc.
Investor Information - Type
Individual or Entity Investor*

IndividualEntity

Investor Information - Entity Type

Please select whether you are investing via a "simple entity" or a "complex entity" as illustrated below. Most entities are simple entities, unless you have a complex signature block due to one or more nested entities (like a management company or a corporate owner) that are signing on behalf of the investing entity.
Investor Entity Type*

Simple EntityComplex Entity

Investor Information - Other
Street Address*
City*
Country*
State*
Postal/Zip Code*
Preferred Signature Method*

DocuSignEmailed PDF
Carta Email
If the investor already has a Carta account, please provide the email address associated with the Carta account that Carta stock certificates should be sent to. If the investor does NOT already have a Carta account, please provide the email address that should be used to access information on Carta related to the investment.
Investment Process Contacts

Please list all individuals (not including the signatory) that should receive a copy of signature requests and other communications regarding the investment process. For example, if an attorney, back-office finance team, private wealth manager, or executive assistant is coordinating this investment on behalf of the investor, their information should be listed here.
Notice Copy

Please list all individuals (not including the signatory) that should receive a copy of any formal notices given or made pursuant to the agreements being signed. This information will be added to the signature pages. Typically only larger investment funds will provide information here, listing an in-house or external finance or legal team.
Additional Requests
Please list any additional requests here.
Asana Task ID
Should be Empty:

Signatory Questionnaire