Name *

First Name

Last Name

Mobile Phone *

(###)

###

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Accredited Investor? *

An accredited investor, in the context of a natural person, includes anyone who: Earned income that exceeded $200,000 (or $300,000 together with a spouse or spousal equivalent) in each of the prior two years, and reasonably expects the same for the current year, OR has a net worth over $1 million, either alone or together with a spouse or spousal equivalent (excluding the value of the person’s primary residence), OR holds in good standing a Series 7, 65 or 82 license.

Yes

No