Investor Information



Please enter the following Information:

Name
 
Age
 
                                                          Marital Status   
Citizenship
 
 
           
( If US Citizen, Social Security Number or Tax Identification Number )
Home Address
 
Home City
 
        Home Zip or Postcode  
Home State
 
Country
 
Home Telephone
 
        Cell / Mobile  
Email Address
 



( If purchased by firm or company )

Firm Name
 
Nature of Business
 
Contact Name
 
Position/Title
 
        Length of time in Position  
Business Address
 
Bus Address
 
Bus City
 
        Zip or Postcode  
Bus State
 
        Bus Country  
Bus Telephone
 
Email Address
 
Zip Code
 

Send Correspondence to (Mark with Check)

 
 Home  Business




Purchaser Acknowledgement

I,    (“Purchaser”), do hereby acknowledge as follows:

 
 I have read and understand the Disclosure Statement;
 
 I have read and understand the Subscription Agreement and agree to be bound by its terms;
 
I agree to invest for a total of units and have made a wire transfer to the Escrow Agent for this amount in accordance with the Subscription Agreement;
 
 I have read and understand the Amended and Restated Operating Agreement and agree to be bound by its terms upon being admitted as a member of Holdings ;
 
 I have read and understand the Risk Factors associated with my purchase of the units;
 
 I agree to the terms set forth in the Purchaser’s Statement;
 
 I understand that I can only purchase the Units if I qualify as an Accredited Investor, and as such, have provided Holdings with a certification of a third party that I am an Accredited Investor;
 
 I understand that my purchase of the Units will not close until Holdings has received an adequate number of subscriptions, as determined by Holdings in its sole discretion; and
 
 I understand that Holdings may terminate the Offer in its sole discretion prior to the Termination Date, but that I may not terminate my Purchase of the Units.



 
 



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