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Initial Investor Questionnaire
Legal Name
*
Date of birth
*
Address
Email
*
Phone
*
Position
Social Security Number or Government Issued Tax Identification Number
*
Citizenship
*
If you are not a U.S. Citizen, are you a permanent U.S. resident?
Yes
No
Employment Status (i.e., retired, former profession, and/or if self-employed, type of business)
*
Occupation and Title
*
Employer Name and Address
*
Annual Income
*
Net Worth (Excluding value of primary residence)
*
Investment Objective
Generate Income
Growth
Preserving Wealth
Speculation
Other
Knowledge of Investments
Very Little
Somewhat familiar
Very Good Understanding
Risk Tolerance
Conservative
Moderately Conservative
Moderate
Moderately Aggressive
Aggressive
Source of Funds
Money Market or Cash Equivalents
Investment Assets
Savings
Selling of Assets
Cryptocurrency
Other
Do you have prior experience in investing in private placements of restricted securities?
Yes
No
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