Accredited Investor Seminar Acknowledgement Form
REQUESTED BY:
CapWest Securities, Inc.
3900 S. Wadsworth Blvd., Suite 590
Lakewood, CO 80235
I certify by my signature below that one or more of these statements apply:
I have an individual net worth or joint net worth with my spouse that exceeds one million
dollars ($1,000,000).
I had an individual annual income in excess of two hundred thousand dollars ($200,000)
or joint annual income with my spouse in excess of three hundred thousand dollars
($300,000), in each of the two most recent years, and I have a reasonable expectation of
reaching the same income level in the current year.
I can be considered an “Accredited Investor” under one or more of the definitions of an
“Accredited Investor” as noted in Securities and Exchange Commission Rule 501 relating
to Regulation D under the Securities Act of 1933.
Name(s)
Physical Address
Mailing Address
Phone Number
_____________________________
______________________________
Signature
Signature
SECURITIES OFFERED THROUGH CAPWEST SECURITIES, INC., MEMBER NASD/SIPC/MSRB,
3900 S. WADSWORTH BLVD. SUITE 590 LAKEWOOD, CO 80235; TELEPHONE: 303-798-5407