INSTRUCTIONS:
The
purpose of this Questionnaire is
to determine whether you meet the
standards for participation in
a non-public offering under Section
4(2) of the Securities Act of 1933,
as amended ("Act").
The securities have not been and
will not be registered with the
Securities and Exchange Commission
under the Act . The shares are
being sold in reliance upon an
exemption from the registration
and qualification requirements
of the Act .
Please complete
and deliver this Questionnaire
to to Fordham Financial Management
electronically. Your answers will,
at all times, be kept strictly
confidential; however, each individual
who completes this Questionnaire
hereby agrees that to Fordham Financial
Management may present this Questionnaire
to such parties as it deems appropriate
for verification in order to assure
itself and future issuers that
the subsequent offer and sale of
securities will not result in violation
of the registration provisions
of the Act. |
