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Accredited Investor Status:
Please Check Appropriate Box(es):
I warrant to SCIA and their “Presenting Companies” that I am an “accredited
investor,” as that term is defined in Regulation D, Rule 501(a) as
promulgated under the United States Securities Act of 1933: Specifically:
A
natural person whose net worth, or joint net worth with his spouse, exceeds
$1,000,000, and either is able to bear the economic risk of investment in
shares, the investment that does not exceed 10% of his net worth or joint net
worth with his spouse;
A natural person
who had individual income in excess of $200,000 in each of the two most
recent years, or joint income with that person's spouse in excess of
$300,000 in each of those years and reasonably expects to reach the same
income level in the current year, and is able, either to bear the economic
risk of investment in shares, or an investment not to exceed 10% of his net
worth or joint net worth with his spouse;
An organization
described in section 501(c)(3) of the Internal Revenue Code of 1986, as
amended, (i.e., tax exempt entities), corporation, Massachusetts or similar
business trust, or partnership, not formed for the specific purpose of
acquiring shares, with the total assets in excess of $5,000,000;
A trust, with total assets in
excess of $5,000,000, not formed for the specific purpose of acquiring shares,
whose purchase are directed by a sophisticated person as described in the
Rule;
A bank as defined in section
3(a)(2) of the Securities Act, or a savings and loan association or other
institution as defined under section 3(a)(5)(A) of the Securities Act,
whether acting in its individual or fiduciary capacity;
A broker or dealer
registered pursuant to section 15 of the Securities Exchange Act of 1934;
An Insurance Company as
defined in section 2(13) of the Securities Act, and certain other qualified
institutional investors.
Further, those desiring to purchase shares hereby, will be required to
represent that they are acquiring the shares for their own accounts, for
investment, not with a view to resale or distribution or subdivision thereof,
and that they meet the above suitability requirements.
Because potential shares will be offered without registration under the
Securities Act of 1933 in reliance upon an exemption there from, investors
will be required to represent that they know understand that their right to
transfer shares will be subject to certain restrictions under the Act or
applicable state securities laws.
The suitability standards set forth above represent minimum suitability
requirements for investors, and the satisfaction of such standards by
prospective investors does not necessarily mean that the shares,
or other investments are a suitable investment for them. Prior to
making a decision to acquire the shares, such prospective investors are urged
to carefully examine their own financial situations and, where applicable,
review their present financial situations with professional advisors in order
to determine whether the foregoing criteria are met.
The shares by any company involve a high degree of risk and only those
persons who can afford to sustain a total loss of their investment should
consider their purchase.
I HEREBY deem that
the foregoing is true and accurate, and I covenant and agree to INDEMNIFY and
hold SCIA, its members, affiliate members and/or any of their presenting
companies free and harmless in connection with proposed investments.
Electronic Signature: By checking this box, I agree to the
foregoing.
Name: Date:
Company Name: Title:
Address: City:
State: Zip: email:
Phone: Cell:
Dedicated
Fax:
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