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REGULATION D
“ACCREDITED INVESTOR”
INVESTOR QUESTIONNAIRE

REGULATION D QUALIFICATION STATEMENT

An investor represents to an issuer of securities that they undersigned qualify as an “accredited investor” pursuant to Regulation D under the Act, as a result of having the following status:

Certification that:

(a) The Investor has not filed or been involved in bankruptcy proceedings, and there are no suits pending or judgments outstanding against the Investor, that would impair the Investor’s ability to make payments on this investment;

(b) The investment is solely for the Investor’s own account and not for the account of any other person; and

(c) The Investor’s assets do not constitute plan assets within the meaning of ERISA.

The Investor further certifies:

In signing this Investor Questionnaire, they acknowledge they have received and carefully reviewed all of the following documentation:

(a) The Issuer’s Company Operating Agreement.
(b) The offering’s Subscription Agreement.
(c) The Offering’s Private Placement Memorandum

Additionally in making this investment, the Investor is able to bear the economic risk of this investment and the Investor acknowledges that this investment involves a high degree of risk and that the Investor should not be making this investment unless the Investor can afford to lose the amount invested in its entirety. 

The foregoing statements and documents attached hereto are true and accurate to my knowledge and belief, and the Investor is authorized to rely on the information in entering into the Investment as of the date completed below.

SIGNATURE OF INVESTOR:

ADDITIONAL INFORMATION WHICH AN ISSUER MAY REQUIRE BEFORE ACCEPTING INVESTMENT FROM AN INVESTOR:

Type of ownership:

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