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1.) PERSONAL BACKGROUND INFORMATION
Name
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Last
Email
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Business Profession
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Professional Title
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Are you a Foreign Investor?
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2.) OVERALL INVESTMENT STRATEGIES
Please put a number from 1 through 4 next to rank your investment objectives; 1 being the highest:*
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Please put a number from 1 through 4 next to rank your investment objectives; 1 being the highest:
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Please put a number from 1 through 4 next to rank your investment objectives; 1 being the highest:
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Please put a number from 1 through 4 next to rank your investment objectives; 1 being the highest:
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3.) RISK TOLERANCE
Please select 1 which risk tolerance level is appropriate for you.
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Highly Aggressive
Somewhat Aggressive
Moderate
Conservative
Very Conservative
4.) PRIMARY SOURCE OF INCOME:
Please select the answer most appropriate for you.
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Investments
Salary, commissions or other regularly earned compensation
5.) PRIOR INVESTMENT EXPERIENCE
Please select all that apply:*
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Select All
Rentals and Real Property.
Stocks which are listed on a national securities exchange.
Mutual funds which hold a portfolio primarily of stocks.
Taxable bonds or other debt instruments.
Tax exempt bonds.
Partnerships, limited liability companies, corporations that invest in real estate or REITs.
Other types of investments not mentioned in the previous categories
6.) CERTIFICATION OF SOPHISTICATED INVESTOR STATUS
Please check the box below that is true for you
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I have such knowledge and experience in financial, investment and business matters that I am capable of evaluating the merits and risks of any investment
I am using a financial advisor, planner, consultant, or some other advisor who has such knowledge and experience in financial and business matters that he/she is capable of evaluating the merits and risks of any investments
7.) CERTIFICATION OF ACCREDITED INVESTOR STATUS
I acknowledge and warrant that I am an “accredited investor” for the following reasons: (a) My individual net worth, along with the net worth of my spouse exceeds $1,000,000, excluding the value of my personal residence and excluding from my liabilities the mortgages of my primary residence, provided the mortgages to not exceed the value of my primary residence (b) My individual income was in excess of $200,000 in each of the past two years (excluding my spouse’s income) and I expect to have income (excluding my spouse’s income) in excess of that amount in the current year or my individual income for each such years together with my spouse’s is in excess of $300,000 each
Yes, (a) is true
Yes, (b) is true
Yes, both (a) and (b) are true
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8.) DATE AND SIGNATURE CONFIRMATION (required)
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