welcome
PRE-QUALIFICATION FORM
First Name:
Last Name:
Address:
Apt/Box/Suite:
City:
State:
Zip:
Country:
Email:
Phone:
( ) - ext.
Fax:
( ) -
Cell:
( ) -
PERSONAL INFORMATION
Date of Birth:
/ / (enter year)
Occupation:
Employer:
Business Phone:
( ) - ext.
Bus. Address:
Bus. Apt/Box/Suite:
Bus. City:
Bus. State:
Bus. Zip:

All users of this web page must be Accredited Investors and certify and warrant their status as such by checking the appropriate box below. If a user of this web page is an Entity then all of its equity owners must be Accredited Investors, and a user entity is making such certification when answering the following questions. Please answer the following certifying your status as an "Accredited Investor," to wit:

Please "check" any statement that describes you below:

1) any natural person whose individual net worth, or joint net worth with that person's spouse, exceeds $1 million, or 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 who has a reasonable expectation of reaching the same level in the current year;
2) any corporation, partnership, business trust, limited liability company or Section 501(c)(3) organization with total assets in excess of $5 million that was not formed for the purpose of investing in the Partnership;
3) any employee benefit plan within the meaning of ERISA, whose investment decisions are made by a plan fiduciary, which is a bank, savings and loan association insurance company or registered investment advisor, or if the plan has total assets in excess of $5 million, or if self-directed, its investment decisions are made solely by persons who are Accredited Investors;
4) any plan established and maintained by a state, its political subdivisions, or any agency or instrumentality thereof, for the benefit of its employees, if such plan has total assets in excess of $5 million;
5) a small business investment company licensed by the U.S. Small Business Administration;
6) any director, executive officer or general partner of the Partnership or any director, executive officer or general partner of the General Partner.
7) a bank as defined in Section 3(a)(2) of the 1933 Act, whether acting in its individual or fiduciary capacity;
8) a savings and loan association or other institution as defined in Section 3(a)(5)(A) of the 1933 Act, whether acting in its individual or fiduciary capacity;
9) an insurance company as defined in Section 2(13) of the 1933 Act;
10) an investment company registered under the 1940 Act or a business development company as defined in Section 2(a)(48) of the 1940 Act;
11) a Small Business Investment Company licensed by the U.S. Small Business Administration under Section 301 (c) or (d) of the Small Business Act of 1985;
12) a private business development company as defined in Section 202(a)(22) of the Investment Advisers Act of 1940;
13) any trust, which is not formed for the specific purpose of investing in the Partnership, with total assets in excess of $5 million, whose purchase is directed by a person who has such knowledge and experience in financial and business matters that he is capable of evaluating the merits and risks of the prospective investment;
14) any entity (other than Trusts) in which all of the equity owners are Accredited Investors.
 
INVESTMENT EXPERIENCE
15) Have you ever had a securities brokerage account?
Yes | No
16) Have you ever before bought securities that were exempt from Federal and state registration?
Yes | No
17) Have you ever before invested in a limited partnership?
Yes | No
ACKNOWLEDGEMENTS
18) By reason of the undersigned's knowledge and experience in financial and business matters in general, and investments in particular, or the knowledge and experience in financial and business matters of any Offeree Representative the undersigned may engage, the undersigned has, or the Offeree Representative and the undersigned together have sufficient knowledge and experience to evaluate adequately the merits and risks of an investment by the undersigned in the Partnership.
19) Considering all of the facts and circumstances, including family matters, tax and other financial responsibilities, the undersigned concludes that the undersigned is able to bear the full economic risk of this investment including the loss of the entire investment amount.
20) The undersigned fully understands that the Interests are not freely transferable and are subject to significant resale and redemption restrictions.
21) The undersigned represents and warrants that the information contained in this Questionnaire is complete, true and correct, that it may be relied upon and that the undersigned will notify the G.P. immediately of any material change in any statement made herein occurring prior to the issuance of the Interests to the undersigned.