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Accredited Investor Questionnaire
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Investor Name
Entity Legal Name (Optional)
Date of Completion
Are you completing this as an individual or entity?
Individual Investor
Entity Investor
Individual Qualification (check all that apply)
Individual income exceeded $200,000 in each of the two most recent years, and expected this year.
Joint income exceeded $300,000 in each of the two most recent years, and expected this year.
Net worth exceeds $1,000,000 excluding primary residence.
Holds qualifying certifications (Series 7, 65, or 82).
Other accredited investor category.
If "Other", describe basis
Entity Qualification (check all that apply)
Entity qualifies under Rule 501(a) of Regulation D.
All equity owners are accredited investors.
Entity has assets over $5,000,000 and was not formed for this investment.
Family office/family client or another qualifying category.
Entity qualification basis/details
Supporting Information (willing to provide if requested)
Written confirmation from CPA, attorney, broker-dealer, or investment adviser.
Basic financial information needed for eligibility determination.
Entity organizational/authority documents.
Electronic Signature (Full Legal Name)
Print Name
Title/Capacity (if entity)
Submit Questionnaire
Investor Intake Sheet
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Investor Name (Individual or Entity Name)
Entity Name (Optional)
Primary Contact Name
Mailing Address
Email Address
Phone Number
State / Country of Residence or Formation
Investment Amount (USD $)
Is the investor investing as:
Individual
Jointly with spouse / partner
Trust
LLC
Corporation
Partnership
Other
If "Other", specify investing capacity
Tax ID / EIN (if needed)
Name for signature block
Title / capacity if signing for an entity
Expected Wire / Payment Method
Wire Transfer
Check
Other
If "Other", specify payment method
Target Closing Date
Notes / Side Letter Terms (if any)
Documents to provide with intake (acknowledge receipt/understanding)
Completed investor questionnaire
Signature page / signed investment document
Entity authority documentation, if applicable
Wire confirmation or check copy, once funded
Submit Intake Sheet