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FOREIGN INVESTOR QUESTIONNAIRE

 

THIS QUESTIONNAIRE MUST BE COMPLETED AND DELIVERED TO FORDHAM FINANCIAL MANAGEMENT IN ORDER FOR YOU TO REGISTER AS A FOREIGN INVESTOR AND BE CONSIDERED AS A PROSPECTIVE PURCHASER OF SECURITIES IN PRIVATE OFFERINGS.


INSTRUCTIONS:
The purpose of this Questionnaire is to determine whether you meet the standards for participation in a non-public offering under Section 4(2) of the Securities Act of 1933, as amended ("Act"). The securities have not been and will not be registered with the Securities and Exchange Commission under the Act . The shares are being sold in reliance upon an exemption from the registration and qualification requirements of the Act .

 Please complete and deliver this Questionnaire to to Fordham Financial Management electronically. Your answers will, at all times, be kept strictly confidential; however, each individual who completes this Questionnaire hereby agrees that to Fordham Financial Management may present this Questionnaire to such parties as it deems appropriate for verification in order to assure itself and future issuers that the subsequent offer and sale of securities will not result in violation of the registration provisions of the Act.

 

PART ONE

*Last Name:
*Middle Initial:
*First Name:
Age:
*Date of Birth:
*Occupation:
*Residential Address:
*City:
*State:
*Zip Code:
*Business Address:
*City:
*State:
*Zip Code:
*Your E-mail Address:

PART TWO

 

Please enter your fax number, if you have one as well as entering the date and place you are completing this form, in the space provided.
The foregoing statements are true and accurate to the best of my information and belief and I will promptly notify Fordham Financial Management of any changes in the foregoing answers.

 

Please forward information about private placements by email. I understand the minimum investment in these Private Placements is $30,000

I am interested in Hedge Funds I understand the minimum investment in Hedge Funds is between $250,000 & $5,000,000.

   
*E-mail Address:
*Daytime Phone Number:

*Private Fax Number:


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