PLEASE ENTER YOUR INFORMATION


CERTIFY TAXPAYER IDENTIFICATION


Please enter your tax identification and certification information in the fields below. The W-9 Form is to be completed by US citizens only (including resident aliens).

Why do I need to provide my taxpayer identification?

The IRS requires that we obtain your W-9 certification at the time of your investment in our company. This information is transmitted via SSL directly to our transfer agent, Colonial Stock Transfer, and is stored on their secure servers.

Tax Identification




Federal Tax Classification


Partnership, Trust/Estates, C Corporation or S Corporation Classification, Limited Liability Company or Other Classification

If this Taxpayer Identification Number is for one of these Federal Tax Classifications, do not complete this form. You must complete and mail this IRS form W-9 with your completed subscription agreement to:

Colonial Stock Transfer
7840 South 700 East
Sandy, UT 84070

or via email at investor@colonialstock.com.

Classification of Taxpayer Identification Number


Under penalties of perjury, I certify that

  1. The number shown on this form is my correct taxpayer identification number, and
  2. Select one
  3. I am a US citizen or other US person
  4. I am exempt from FATCA reporting (FATCA is the Foreign Account Tax Compliance Act)

How do I know if I am subject to backup withholding?

U.S. citizens and resident aliens will be exempt from backup withholding if:
1. You properly report your name and Social Security number to the payer using Form W-9, and that information matches the IRS records, and
2. You have not been notified by the IRS that you are subject to mandatory backup withholding.

INVESTMENT AMOUNT

Please enter your annual household income or net worth and investment amount into the fields below.


Minimum purchase amount: N/ A

Maximum purchase amount: $1,000,000.00


Investments must be less than 10% of the investor's income, per Federal law.



SUBSCRIPTION AGREEMENT

Please review the following subscription agreement and click the checkbox to agree to its terms. By doing so you are electronically signing the subscription agreement.



Please click to view the subscription agreement in PDF format. You may download Adobe Reader for free by visiting https://get.adobe.com/reader/.

Subscription Agreement

PAYMENT INFORMATION

Please select the method of payment to fund your investment.




REVIEW AND CONFIRM INVESTMENT

Please review your information for accuracy and confirm your investment.


Review Your Information

Name:
Joint Name :
Investor:
Phone:
Email:
Address:


Investment Amount :
Shares:
Payment Method :
Annual Household Income or Net Worth: