Investor Interest Form
All information is kept strictly confidential
1.) PERSONAL BACKGROUND INFORMATION
First Name
Last Name
Address
Home Phone (optional)
Cell Phone
Email Address
Business Profession
Professional Title
Referred By (If Applicable)
2.) OVERALL INVESTMENT STRATEGIES
Please put a number from 1 through 4 next to each of the following to rank your investment objectives; 1 being the highest:
Growth:
Liquidity:
Tax Deferral:
Cash Flow:
3.) RISK TOLERANCE
Please select the risk tolerance level appropriate for you:
4.) PRIMARY SOURCE OF INCOME
Please select the answer most appropriate for you:
5.) PRIOR INVESTMENT EXPERIENCE
Please select all that apply:
Rentals and Real Property
Stocks which are listed on a national securities exchange
Mutual funds which hold a portfolio primarily of stocks
Taxable bonds or other debt instruments
Tax exempt bonds
Partnerships, limited liability companies, corporations that invest in real estate or REITs
Other types of investments not mentioned in the previous categories
6.) CERTIFICATION OF SOPHISTICATED INVESTOR STATUS
Please check the box below that is true for you:
I have such knowledge and experience in financial, investment and business matters that I am capable of evaluating the merits and risks of any investment
I am using a financial advisor, planner, consultant, or some other advisor who has such knowledge and experience in financial and business matters that he/she is capable of evaluating the merits and risks of any investments
7.) CERTIFICATION OF ACCREDITED INVESTOR STATUS
I acknowledge and warrant that I am an “accredited investor” for the following reasons:

(a) My individual net worth, along with the net worth of my spouse exceeds $1,000,000, excluding the value of my personal residence and excluding from my liabilities the mortgages of my primary residence, provided the mortgages to not exceed the value of my primary residence

(b) My individual income was in excess of $200,000 in each of the past two years (excluding my spouse’s income) and I expect to have income (excluding my spouse’s income) in excess of that amount in the current year or my individual income for each such years together with my spouse’s is in excess of $300,000 each
Yes, (a) is true
Yes, both (a) and (b) are true
8.) DATE AND SIGNATURE CONFIRMATION (required)
I confirm, by typing my name in below and electronically submitting this form, that the information supplied herein is current and accurate. I agree to sign a printed copy if asked to do so by recipient.
For any questions or concerns, please contact cs@mclaubscher.com
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