Investor Information Form State of Tax Filing Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Outside U.S. Preferred Mailing Address Who is your primary contact? Merrill Kaliser David Davidenko Are you a Broker or Dealer? Yes No Net Worth of at least $1,000,000 (not including personal residence)? Yes No Annual income (if single) of more than $200,000? Yes No N/A Annual income (if married) of more than $300,000? Yes No N/A What would your expected investment be? $50,000 to $100,000 $100,000 to $200,000 $200,000 to $500,000 $500,000+ Undecided Are your funds readily available within the next 30 days? Yes No If funds are not available within the next 30 days, what is their availablity? What type of funds do you plan to invest? Cash IRA Do you have any real estate experience, certification(s), or training? Additional Information:
