Accredited Investors Questionnaire
(At least one selection required)
Regulated entity: I am (i) a bank as defined in the Securities Act of 1933, as amended or a savings and loan association or other institution as defined in the Securities Act of 1933, whether acting in an individual or fiduciary capacity; (ii) a broker or dealer registered pursuant to Section 15 of the Securities Exchange Act of 1934; (iii) an insurance company as defined in the Securities Act of 1933; or (iv) an investment company registered under the Investment Company Act of 1940
Business development company: I am a "business development company" as defined in the Investment Company Act of 1940
Private business development company: I am a "private business development company" as defined in the Investment Advisers Act of 1940
Small business investment company: I am a "small business investment company" licensed by the U.S. Small Business Administration under Section 301(c) or 501(c)(3) of the Small Business Investment Act of 1958
Entity not formed for the specific purpose of acquiring the security offered: I am an organization described in Section 501(c)(3) of the Internal Revenue Code of 1986, as amended, a corporation, a Massachusetts or similar business trust, or partnership, not formed for the specific purpose of acquiring any specific security, with total assets in excess of $5,000,000
Individual (NET WORTH): I am a natural person whose individual net worth, or joint net worth with my spouse, as of the date hereof exceeds $1,000,000. As used herein, “net worth” means the excess of total assets at fair market value, including home furnishings and automobiles (but excluding the value of the primary residence), over total liabilities (excluding the indebtedness secured by the primary residence up to its fair market value)
Individual (INCOME): I am a natural person who had an individual income in excess of $200,000 in each of the two most recent years or joint income with my spouse in excess of $300,000 in each of those years and I have a reasonable expectation of reaching the same income level in the current year
Employee benefit plan: I am an "employee benefit plan" within the meaning of Title I of the Employee Retirement Income Security Act of 1974, as amended ("ERISA"), and either (i) the investment decision to invest is made by a plan fiduciary, as defined in ERISA, which is either a bank, savings and loan association, insurance company, or registered investment adviser; or (ii) the employee benefit plan has total assets in excess of $5,000,000; or (iii) if a self-directed plan, the investment decisions are made solely by persons that are "accredited investors"
State plan: I am a plan established and maintained by a State, its political subdivisions, or any agency or instrumentality of a State or its political subdivisions, for the benefit of its employees, if such plan has total assets in excess of $5,000,000
Trust: I am a trust with total assets in excess of $5,000,000, not formed for the specific purpose of acquiring any specific security, whose purchase is directed by a sophisticated person as described in Regulation D
Revocable trust: I am a "revocable trust" that may be amended or revoked at any time by the grantors thereof, an all of the grantors are "accredited investors"
Entity (beneficial owners are accredited investors) : I am an entity the beneficial owners of which are all accredited investors as discussed above.