Name *

First Name

Last Name

Phone *

(###)

###

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Investor Status *

U.S. Taxable

U.S. Tax Exempt

Non-U.S. Investor

Qualified Purchaser Status *

In general, a "qualified purchaser" under the U.S. Company Act of 1940 is 1) an individual who owns (together with his or her spouse) at least $5 million of liquid investments, net of offsetting indebtedness; 2) an entity owned solely by closely related family members (and their estates, foundations or trusts) that owns at least $5 million of liquid investments, net of any offsetting indebtedness; 3) an entity that owns and invests on a discretionary basis at least $25 million of liquid investments, net of any offsetting indebtedness; or 4) an entity owned solely by persons who satisfy one of the foregoing requirements.

Yes

No