|
WR HAMBRECHT + CO
CONFIRMATION OF STATUS AS ACCREDITED INVESTOR
(ALL INFORMATION WILL BE TREATED CONFIDENTIALLY)
I represent that the information set forth below, as indicated by the boxes I have checked,
is true and correct and that all other information contained in my Account Application for
Individual, Joint and Custodial Accounts continues to be true and correct:
| __ |
I had individual gross income (exclusive of any income attributable to my spouse) of more than $200,000 in each of
the most recent two tax years and I reasonably expect to have an individual gross income in excess of $200,000 for the current
tax year. (Gross income means adjusted gross income for tax purposes, plus tax exempt income, contributions to a retirement plan,
and any amount by which income from long term capital gains has been reduced in arriving at adjusted gross income). |
| __ |
My spouse and I together had gross income of more than $300,000 in each of the two most recent tax years and I
reasonably expect that we will have gross income in excess of $300,000 for the current tax year. |
| __ |
I have an individual net worth (total assets less total liabilities) or my spouse and I have a combined net
worth in excess of $1,000,000. |
| __ |
I own $5,000,000 or more in investments in securities, real estate (excluding my residence), cash, and cash
equivalents held for investment, reduced by any related indebtedness. By certifying that you meet this requirement, we will
register you as a Qualified Purchaser, which will allow us greater flexibility in offering you a larger
allocation in each deal.
|
Please sign and date this form and send it to:
Accredited Investors
WR Hambrecht + Co
P.O. Box 677
Berwyn, PA 19312
Name |
Name (if more than one) |
Social Security Number |
Social Security Number (if more than one) |
Signature and Date |
Signature (if more than one) and Date |
sf-424185
|