PLEASE ENTER YOUR INFORMATION


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




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
66 Exchange Place
Salt Lake City, UT 84111

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

INVESTMENT AMOUNT

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


Minimum purchase amount $100.00

Maximum purchase amount N/A

Maximum ACH amount $2,000.00








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/.

Offering Prospectus
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: