Private Placement Intake

Investor Inquiry.

Confidential intake for the $100M Private Capital Program. Your responses determine eligibility for the Private Placement Memorandum and qualified investor materials.

Section I

Investor Identification

First Name

Last Name

Phone

Entity / Family Office (optional)

Country of Residence

Section II

Accreditation Status

Required by SEC Rule 501. Select the option that best describes you.

Accredited Investor

Income $200K+ ($300K joint) or net worth $1M+ excluding primary residence.

Qualified Purchaser

$5M+ in investments (individual) or $25M+ (entity).

Non-Accredited

Does not currently meet accreditation thresholds.

Unsure / Need Guidance

I'd like a strategist to help determine my status.

Section III

Investment Profile

Anticipated Allocation Range

Investment Horizon

Source of Funds

Areas of Interest

Section IV

Additional Context

Objectives, prior placements, or questions

Confidential · Encrypted · Subject to Verification