CloudRaise Investor Portal - Equity Track Funding

PLEASE ENTER YOUR INFORMATION

Investor Type

Individual

Joint Tenants With Rights of Survivorship

Other (corporation, LLC, partnership, trust, etc.)

First Name

Last Name

Mobile Phone Number

Address 1

Address 2

City

Zip Code

Country

Your Name

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 into 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

Name 1 (as shown on your income tax return)

Name 2, if a joint account (as shown on your income tax return)

I am not a resident of the United States and do not have a US Taxpayer ID. I acknowledge that I must provide a W-8BEN form if I am an individual or a W-8BEN-E if I am an entity.

Social Security Number

--OR--

Employee Identification Number

Federal Tax Classification

Individual/Sole Proprietor/Single Member LLC

Other (corporation, LLC, partnership, trust, etc.)

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

The number shown on this form is my correct taxpayer identification number, and
Select one

I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding, and (c) the IRS has notified me that I am no longer subject to backup withholding.

I am currently subject to backup withholding because I have been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest and dividends on my tax return.

I am a US citizen or other US person
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 $0.20

Maximum purchase amount $1,000,000.00

Maximum ACH amount $100,000.00

*Please note that the Number of Shares will be automatically calculated after you enter your Annual Household Income or Net Worth, your Investment Amount, and check the acknowledgement checkbox.

Annual Household Income or Net Worth

Investment Amount

Number of Shares*

Offering Price

I understand that Federal Law limits the amount that an investor may invest into a Regulation A offering to 10% of the greater of the investor's net worth or annual income, UNLESS the investor meets the definition of an accredited investor under Rule 501 of Regulation D.

If you are an accredited investor and would like to invest more than 10% of your net worth or annual income, please continue to input your annual income or net worth and enter $100 for your investment amount. Then download the subscription agreement in Step 4 and manually complete and send in with your payment.

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.

Investment1 Amount (hereinafter referred to as "Subscription Amount")

Number of Shares (hereinafter referred to as "Shares")

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

I have read the Subscription Agreement And agree To its terms. By checking this box I understand that this will constitute my electronic signature.

PAYMENT INFORMATION

Please Select the method Of payment To fund your investment.

Investment Amount

Number of Shares

Payment Method

ACH (Maximum ACH amount $100,000.00)
Wire Transfer

Bank Account Information

Checking Savings

Account Holder Name

Bank Name

Routing Number

Account Number

Verify Account Number

By clicking 'Next' on this step and then 'Submit' on the following step, this constitutes my electronic signature, wherein I hereby authorize the Issuer of this Offering, or its agents, to debit my bank account for the dollar amount subscribed to in this Offering.

This Is a Single transaction, And does Not provide authorization For additional debits.

Please send your wire To:

Bank Name BANK OF AMERICA

Bank Address 1 8959 ELK GROVE BLVD

Bank Address 2 ELK GROVE, CA 95624

Bank Routing 121000358

Bank Swift Number

Bank Account Number 325124989627

Bank Account Name

Wire Reference

For Further Credit To [Investor Name]

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 :

Payment Method :

Annual Household Income Or Net Worth: