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Pre Qualification Form
* Required.
Investor Type   *    
1. First Name   *    
Last Name   *    
2. Address (Principal Residential Address)
Telephone   *    
Fax #
Email   *      
3. Accredited Investor Status   *  
Specific details regarding private investment funds may not be discussed with a potential investor unless the investor is, among other things, an "accredited investor" as that term is defined in Rule 501(a) of Regulation D under the Securities Act of 1933, as amended (the "Securities Act").
Please select where appropriate below.
(a) Individuals, IRAs and Keogh Plans  

(b) Corporations, Foundations, Endowments, Partnerships or Limited Liability Companies

(c) Trusts  

(a) Does the investor recognize the speculative nature of investments in illiquid, privately-placed funds?   *    
(b) Is the investor able to bear the economic risk of such investments?   *    
(c) Does the investor have sufficient knowledge and experience in financial, business and tax matters, to be capable of evaluating the merits and risks of such investments?   *    
(d) Has the investor ever invested in investment partnerships or other investment funds, venture capital funds, arbitrage transactions, real estate syndications, or other non-marketable securities or restricted securities?   *    
(e) If the answer to 4(d) is "yes", please indicate the frequency of the investor's investment in nonmarketable securities:   *    
(a) Is the plan an "employee benefit plan" within the meaning of Title I of The Employee Retirement Income Security Act of 1974 ("ERISA")?   *    
(b) If so, is the plan fiduciary (as defined in Section 3(21) of ERISA) a bank, savings and loan association, insurance company or registered investment advisor?
(c) If the plan fiduciary is a bank, savings and loan association, insurance company or registered investment advisor, will such plan fiduciary be making the investment decisions?
Type Name   *    
Date   *    
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