Prospective Investor Form
U.S securities laws limit the types of investors who can invest with us. The following questionnaire is intended to assist us in determining whether you meet suitability requirements for future investments. Any information you provide here will be kept in strict confidence.
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Occupation
*
Title
*
Date of Birth
*
-
Month
-
Day
Year
Date
What types of investments do you currently have?
*
Real Estate
Retirement Funds
Stocks
Gold/Silver
Bonds
Bitcoin
Running a Business
Current Investments ANSWER
What is your risk tolerance? (Please check the box that best represents your risk tolerance.)
*
Highly Aggressive
Somewhat Aggressive
Moderate
Conservative
Very Conservative
What is the value of your investments?
*
Less than $100,000
Between $100,000 - $500,000
Between $500,000 - $1,000,000
Above $1,000,000
Are you an Accredited Investor?
*
Please Select
No
Yes (Income)
Yes (Net Worth)
Find out more about
Accredited Investors
.
What is your approximate net worth?
*
Less than $250,000
Between $250,000 - $500,000
Between $500,000 - $1,000,000
Between $1,000,000 - $2,000,000
Above $2,000,000
What is your approximate income?
*
Less than $100,000
Between $250,000 - $500,000
Between $100,000 - $250,000
Over $500,000
Estimated Liquid Assets (Cash in Bank, Readily Marketable Stocks/Bonds, Precious Metals)
*
Less than $100,000
Between $200,000 - $300,000
Between $100,000 - $200,000
Above $300,000
Please estimate when you will need your liquidity back (such as a need for a house down payment or some other major financial need)
*
Less than 2 years
From 5 - 10 years
From 2 to 5 years
More than 10 years
Other considerations
Please feel free to add any other considerations you feel would be relevant to establishing your suitability for private placement investments, including other education, business or financial experiences, investment considerations, financial situations, trainings (including seminars, continuing education, etc) or professional licenses and certifications.
Submit
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