Accredited Investor Seminar Acknowledgement Form printable pdf download

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

SECURITIES OFFERED THROUGH CAPWEST SECURITIES, INC., MEMBER NASD/SIPC/MSRB,

3900 S. WADSWORTH BLVD. SUITE 590 LAKEWOOD, CO 80235; TELEPHONE: 303-798-5407

Accredited Investor Seminar Acknowledgement Form