Address / City / State / Zip*
1. Are you an "Accredited Investor," as defined below?
For Individuals -select either item (a) or (b):
A. 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, excluding the value of your primary residence* My approximate net worth is :B.Any natural person who had an 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 (both spouses should sign) in each of those years and has a reasonable expectation of reaching the same income level in the current year.
Between $0-$999,999.00Between $1,000,000 and $1,500,000Between $1,500,000 and $2,000,000Between $2,000,00 and $5,000,000Over $5,000,000
2. Do you also meet the Portfolio Requirement of a “Qualified Client” which means any natural person whose individual net worth, or joint net worth with that person's spouse, at the time of his purchase exceeds $2,000,000, excluding the value of your primary residence? *
3. In which industries do you prefer to invest?
3D TechnologyAdvanced MaterialsAdvertisingAerospaceAgricultureAgriTechAlternative MedicineAnalyticsAndroidAnimal WelfareArtificial IntelligenceArtsAudioAutomotiveAutonomous VehiclesAviationB2BB2CBankingBig DataBiotechnologyBlockchainBrand MarketingBuy-OutsCannabisCareer PlanningCasinoChemicalsChildrenChiropracticCivicTechCivil EngineeringClean EnergyClinical TrialsCloud ComputingCollaborationCommoditiesCommunicationsCommunityComputerConstructionConsultingConsumer GoodsContentCosmeticsCreditCRMCryptocurrencyCustomer ServiceCyber SecurityData MiningData StorageDatingDebt CollectionDelivery ServiceDentalDroneseCommerceEcosystemsEducationElectronicsEnergyEngineeringEntertainmenteSportsEventsFarmingFashionFintechFinanceFishingFitnessFood/BeverageFood ProcessingFood TechForestryFuelFuture of WorkGamingGasGeneticsGeospatialGovTechGreen EnergyGreen TechnologyGroceryHealthcareHealthTechHome & GardenHospitalsHospitalityHotelsHuman ResourcesICOIndustrial AutomationIndustryInfantInfrastructureInsuranceIntelligenceInternetIoTITLegalLeisureLife SciencesLifestyleLodgingLogisticsMachine LearningManufacturingMarketplaceMarket ResearchMediaMedicalMedical DevicesMedTechMiningMobileMobile AppsMusicNational SecurityNatural ResourcesNavigationNetwork SecurityNetworksNeuroscienceOilOnline PortalsOrganic FoodPackagingPaymentsPetsPharmaceuticalPhotographyPoliticsPredictive AnalyticsPrintingPsychologyPublishingReal EstateReal TimeRecruitingRecycled GoodsRenewable EnergyRestuarantsRetailRide SharingRoboticsSaaSSatellite CommunicationsSciencesSearch EngineSecuritySemiconductorSensor TechnologyService IndustryServicesShoppingSmart BuildingSocial MediaSoftwareSolarSpace TravelSportsSupply Chain ManagementSurgicalSustainabilityTask ManagementTechnology - HardwareTelecommunicationsTherapeuticsTicketingTourismTransportationTravelVeganVideoVirtual RealityWealth ManagementWeb DesignWeb HostingWellnessWeddingWireless
*When calculating net worth, you should (i) exclude your primary residence as an asset, (ii) exclude debt secured by your primary residence, up to the fair market value of your residence, (iii) include the amount of any increase on the debt secured by your primary residence incurred within the last 60 days of making a purchase of the securities (unless related to the acquisition of your primary residence, and (iv) include debt in excess of the fair market value of your primary residence.
I certify that I am an Accredited Investor and/or Qualified Client as noted above.