Accredited Investor - Indication of Interest |
Regulatory agencies require that potential investors have a relationship with our personnel prior to disclosure of
property opportunities. As a result, some of the investment
property information on the EARTH FIRST GROUP web site are password protected. Please
complete and submit this Accredited Investor Indication of
Interest Form.
Upon receipt of this form, we will send an e-mail with a
password for accessing property information and will
periodically notify you of new EARTH FIRST GROUP investment opportunities.
All information you submit is kept in complete confidence with EARTH FIRST GROUP... |
I. *Type of Opportunities
you are interested in:
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*Full Name: |
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Business Title: |
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Business or Organization: |
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*Cellular Phone: |
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Home Phone: |
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Business Phone: |
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Fax: |
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*Mailing Address: |
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City: |
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State: |
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Zip: |
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*E-Mail: |
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II. Read the accredited investor certification and acknowledge below. I hereby acknowledge and certify that I am an Accredited Investor as defined by the United States Securities and Exchange Commission's Regulation D, Rule 501, because (check all that apply): |
My
net worth, or joint net worth with my spouse, exceeds $1
million; |
My
income has exceeded $200,000 in each of the two most
recent years, or joint income with my spouse exceeded
$300,000 in each of those years, and I (we) have a
reasonable expectation of reaching the same income level
in the current year; |
I
am a principal or fiduciary of a bank as defined in
section 3(a)(2) of the Securities Act of 1933, or a
savings and loan association or other institution defined
in section 3(a)(5)(A) of the same Act; |
I
am a principal or fiduciary of a broker or dealer
registered pursuant to section 15 of the Securities
Exchange Act of 1934; |
I
am a principal or fiduciary of an insurance company as
defined in section 2(13) of the Securities Act of 1933; |
I
am a principal or fiduciary of an investment company
registered under the Investment Company Act of 1940, or
business development company as defined in section
2(a)(48) of that Act; |
I
am a principal or a fiduciary of 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; or |
I
am a principal or a fiduciary of a 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 million. |
Ill. Read the legal
disclaimer and acknowledge below.
1. Investing in private placements involves a degree
of risk, and investors should not invest any funds unless
they can afford to lose their investment.
2. In making an investment decision, investors must
rely on their own examination of the securities issuer and
the terms of the securities. It is solely the investor's
responsibility to determine and consider thoroughly the
validity, merits, and risks of each offer made by the
small business before investing in it.
3. Securities listed have not been recommended by
any federal or state securities commission, regulatory
authority or government entity. Furthermore, none of these
authorities have confirmed the accuracy, or determined the
adequacy, of the securities issuer's information listed.
Any representation to the contrary by anyone is a criminal
offense.
4. All investors are encouraged to seek legal
counsel and other professional advice prior to entering
any investment transactions.
5. The information you provide on this Application
will be kept strictly confidential; however you hereby
agree that we may provide this Application to such parties
as necessary for verification in order to assure that any
sale of securities resulting from a listing will not
result in violation of securities law. |
I
hereby acknowledge that I have read, understand, and agree
to the above disclaimer. |
Today's Date:
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