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ACCREDITED AND SOPHISTICATED INVESTOR FORM

Please check one of the following:
I hereby certify that I am an accredited investor with S.E.C. Rule 501(a) of Regulation D, in that:
(Check one)

I am an individual with a net income exceeding $200,000. I/We have a net income exceeding $300,000I/We have total assets in excess of $1,000,000.I hereby certify that I am a sophisticated non-accredited investor, meaning that although I may not be an accredited investor by nature of my income or net worth, I have sufficient investing experience and an understanding of the risks and benefits of investing in general.

Please check on of the following:
I would be interested in investing:

$100,000 - $150,000$150,000 - $500,000$500,000 - $1,000,000$1,000,000 - $5,000,000$5,000,000 - $10,000,000

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