Questionnaire

Any natural person whose individual net worth or joint net worth with that person's spouse, at the time of his purchase, exceeds $1,000,000. Net worth includes homes, furnishings and automobiles.
Any natural person who had an individual income in excess of $200,000 in each of the two most recent years or joint income with that person's spouse in excess of $300,000 in each of those years and has a reasonable expectation of reaching the same income level in the current year.
A bank, insurance company, registered investment company, employee benefit plan if the investment decision is made by a bank, insurance company or registered investment adviser, or an employee benefit plan with more than $5 million of assets.
Any private business development company as defined in Section 202(a) (22) of the Investment Advisers Act of 1940.
Any organization described in Section 501(c)(3) of the Internal Revenue Code, corporation, Massachusetts or similar business trust, or partnership, not formed for the specific purpose or acquiring the securities offered, with total assets in excess of $5,000,000.
Any director, executive officer or general partner of the issuer of the securities being offered or sold, or any director, executive officer or general partner of a general partner of that issuer.
Any trust with total assets in excess of $5,000,000, not formed for the specific purpose of acquiring the securities offered, whose purchase is directed by a sophisticated person as described in Rule 506(b)(2)(ii).
Any entity in which all of the equity owners are accredited investors.
The Investor does not qualify in any accredited category as indicated above.

For Individual Investors

For Investors that are Corporations, Partnerships, Trusts, or other Entities

For All Investors

Gross Income

Net Worth

Investor Acknowledgement

Signature for Corporation, Partnership, Trust, or other Entity

Signature for Individual Investor

Digital Signature