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Pre-Qualify Investor Form

Name

Company

Address

City, State, Zip/Postal Code

Country, if not USA:

Phone (including area code)

Fax number (including area code)

E-Mail Address

You are an “Accredited Investor” as a result of satisfying one of the following conditions. Check one or more of the following, if applicable:

(Check for yes) You are a natural person with an individual net worth or a joint net worth with your spouse which exceeds US$1,000,000 at the current time;

(Check for yes) You are a natural person who has had an individual income in excess of US$200,000 in each of the two most recent years or a joint income with your spouse in excess of US$300,000 in each of those years and has a reasonable expectation of reaching the same level of income in the current year;

(Check for yes) You are not a U.S. person, as such term is defined in Rule 901 of Regulation S, adopted under the U.S. Securities Act of 1933; Regulation S is available only for offers and sales of securities outside of the United States. You further certify that you are not a resident of the United States of America;

(Check for yes) You are (a) a bank as defined in Section 3(a)(2) of the Securities Act, acting either in your individual or fiduciary capacity, (b) a savings and loan association or other institution as defined in Section 3(a)(5)(A) of the Securities Act acting either in your individual or fiduciary capacity, (c) a broker or dealer registered pursuant to Section 15 of the Securities Exchange Act of 1934, as amended (the “Exchange Act”), or (d) an insurance company as defined in Section 2(13) of the Act;

(Check for yes) You are an investment company registered under the Investment Company Act of 1940 or a business development company as defined in section 2(a)(48) of that Act;

(Check for yes) You are a Small Business Investment Company licensed by the U.S. Small Business Administration under section 301(c) or (d) of the Small Business Investment Act of 1958;

(Check for yes) Any plan established and maintained by a state, its political subdivisions, or any agency or instrumentality of a state or its political subdivisions, for the benefit of its employees, if such plan has total assets in excess of $5,000,000;

(Check for yes) Any employee benefit plan within the meaning of the Employee Retirement Income Security Act of 1974 if the investment decision is made by a plan fiduciary, as defined in section 3(21) of such act, which is either a bank, savings and loan association, insurance company, or registered investment advisor, or if the employee benefit plan has total assets in excess of $5,000,000 or, if a self-directed plan, with investment decisions made solely by persons that are accredited investors;

(Check for yes) Any private business development company as defined in section 202(a)22 of the Investment Advisors Act of 1940;

(Check for yes) You are the authorized representative of an entity in which all of the equity owners satisfy at least one of the conditions set forth herein.


Please note that company listings on this site are only suitable for accredited investors who are familiar with and willing to accept the high risk associated with private investments. Any Investor who intends to utilize this Website must be an accredited investor. (Please click here for the definition of an accredited investor or go to: www.sec.gov). There has been no investigation to the accuracy of any information or terms contained herein. There may be errors in the information posted on this site and we strongly suggest that you seek legal counsel prior to commencement of any potential transaction. All materials reviewed on this site are strictly for informational purposed only. OTC BB Hub and its affiliated companies are not a registered Securities Broker or Dealer or any other entity regulated under the securities law. OTC BB Hub and its affiliated companies do not sell or offer to sell any securities and no information contained on this site is intended to constitute or to be interpreted as any such offer. Any investor requesting to contact a company listed within the site, does so at its own risk and is solely responsible for conducting any legal, accounting or due diligence review.

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