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Background Information
I currently have or have previously made investments in (please check all that apply):
Qualification
Accredited Investor Status

The Investor hereby represents and warrants that it is an "Accredited Investor" within the meaning of Rule 501(a) under the Securities Act and has initialed the box or boxes below which are next to the categories under which the Investor qualifies as an Accredited Investor. As one of the qualifications of being an Accredited Investor, the Investor agrees it has the financial ability to bear the economic risk of the Investor's investment and has adequate means for providing for the Investor's current needs and possible personal and other contingencies. The Investor is:

For Individual Investors Only
For Trusts, Partnership, Companies and Other Entities; Financial Institutions
D. The Investor is an entity which falls within one of the following categories of accredited investors set forth in Rule 501(a) of Regulation D under the Securities Act ("Regulation D"):
Others
Please choose the category that best describes you:

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