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Hickory Creek CP
Hickory Creek CP
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Investor Questionnaire

  • For Individual Investors

  • For Investors that are Corporations, Partnerships, Trusts, or other Entities

  • Name of Corporation, Partnership, Trust, or Other Entity
  • Name and Title of Authorized Individual to Execute the Questionnaire
  • Please list name and percentage of ownership. One name per line.
  • For All Investors

  • If yes, please list below the name, business address and telephone number of the person who is your purchaser representative.
  • If the undersigned utilizes a Purchaser Representative, the Purchaser Representative will be required to complete a questionnaire to be supplied by the Company.
  • Gross Income

    If the undersigned is an individual. was your personal income from all sources for the previous calendar year more than (check the HIGHEST number applicable for each year.)
  • Net Worth

  • If the undersigned is an entity which checked item (8) under Paragraph 3(f) above in reliance upon the accredited investor categories set forth in items 1 and 2 of Paragraph 3(f), please state the name, address, total personal income from all sources for the previous calendar year, and the net worth (exclusive of home, furnishings, and personal automobiles) for each equity owner of said entity.
  • Investor Acknowledgement

    The Investor hereby certifies that the information contained herein is complete and accurate and the Investor will notify the Company promptly of any change of information. Specifically, the Investor hereby certifies that the information contained above concerning the residency of the Investor is true and correct. The Investor realizes and understands that, but for the truth of the information contained herein, the Investor would not receive consideration by the Company pertaining to this investment. If the Questionnaire is completed on behalf of a corporation, partnership, trust, or estate, I, the person executing on behalf of the Investor, represent that I have the authority to execute and deliver the Questionnaire on behalf of such corporation, partnership, trust, or estate.
  • Signature for Corporation, Partnership, Trust, or other Entity

  • Signature for Individual Investor

  • Digital Signature