Accredited Investor Registration

ACCREDITED INVESTOR REGISTRATION

THIS QUESTIONNAIRE MUST BE COMPLETED AND DELIVERED TO FORDHAM FINANCIAL MANAGEMENT IN ORDER FOR YOU TO REGISTER AS AN ACCREDITED INVESTOR AND BE CONSIDERED AS A PROSPECTIVE PURCHASER OF SECURITIES IN PRIVATE OFFERINGS

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”), under Section 25102(f) of the California Corporate Securities Law of 1968, as amended (“California Act”), and under the laws of other states. The securities have not been and will not be registered with the Securities and Exchange Commission under the Act or qualified with the California Department of Corporations or with the securities agency of any other state. The shares are being sold in reliance upon an exemption from the registration and qualification requirements of the Act, the California Act, and other similar state laws.

Please complete as thoroughly as possible, date, and deliver this Questionnaire to Fordham Financial Management.

If the answer to any question is “None” or “Not Applicable,” please so state.

Your answers will, at all times, be kept strictly confidential; however, each individual who completes this Questionnaire hereby agrees that 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, the qualification provisions of the California Act, or the provisions of other similar state laws.

  • Part One

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    Part Two

    Please provide the following information:

    ..Are you :

     
  • PART THREE

  • The foregoing statements are true and accurate to the best of my information and belief and I will promptly notify Fordham Financial Management of any changes in the foregoing answers.