Teton Angels Investor Questionnaire/ Application
This form contains self-certification that you are an Accredited Investor as defined by the SEC. Please complete the below questions to receive communications and investment opportunities from Teton Angels.
Name
*
First Name
Last Name
Email
*
example@example.com
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
LinkedIn Profile or Website/Blog URL
Interests (check all that apply)
Deal Sourcing
Angel Investing Education
Screening Deals
Business Mentor
Leading Deals
Represent at Events
Serve as Board Member
Social
How much money are you looking to invest annually?
*
How many deals are you looking to participate in annually?
*
Briefly describe your angel investing experience or background.
Accredited Investor Verification:
All information contained in this questionnaire will be treated confidentially. The undersigned understands, however, that the Silicon Couloir Angel Group may present this Questionnaire to such parties as it deems appropriate if called upon to establish that the proposed offer and sale of any securities are exempt from registration under the Securities Act of 1933, as amended, or meets the requirements of applicable state securities laws. Further, the undersigned understands that any offering made by participants in the Silicon Couloir Angel Group is required to be reported to the Securities and Exchange Commission and to various state securities regulators. Please carefully review the SEC definition for Accredited Investor: sec.gov/education/capitalraising/building-blocks/accredited-investor
Select one of the following:
*
I am an individual with a net worth over $1 million, excluding primary residence (individually or with spouse or partner)
I am an individual with income over $200,000 (individually) or $300,000 (with spouse or partner) in each of the two prior years, and reasonably expect the same in the current year
I am an investment professional in good standing holding the general securities representative license (Series 7), the investment adviser representative license (Series 65), or the private securities offerings representative license (Series 82)
I am a 'family client' of a 'family office' that qualifies as an accredited investor
Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: