1. * First Name:
2. * Last Name:
3. * Email:
4. Company Name:
5. * Country:
6. * Address 1:
7. Address 2:
8. * City:
9. * State:
10. * Zip:
11. * Phone:
12. You are completing this information on behalf of:
Yourself
Your Organization
Both
13. You certify that you are an accredited investor as defined in Regulation D promulgated under the Securities Act of 1933? (Please select one or more of the following statements)
 
    A. Individual investors
I certify that I am an accredited investor because I have had individual income* (exclusive of any income earned by more spouse) of more than $200,000 in each of the most recent two years and I reasonably expect to have an individual income in excess of $200,000 for the current year.
I certify that I am an accredited investor because I have had individual income* (exclusive of any income earned by more spouse) of more than $200,000 in each of the most recent two years and I reasonably expect to have an individual income in excess of $200,000 for the current year.
I certify that I am an accredited investor because I have an individual net worth,** or my spouse I have a joint net worth, in excess of $1,000,000.
    B. Partnerships, corporations, trusts or other entities:
an employee benefit plan whose total assets exceed $5,000,000;
an employee benefit plan whose investments decisions are made by a plan fiduciary which is either a bank, savings and loan association or an insurance company (as defined in Section 3(a) of the U.S. Securities Act of 1933, as amended) or an investment adviser registered as such under the U.S. Investment Advisers Act of 1940, as amended;
a self-directed employee benefit plan, including an Individual Retirement Account, with investment decisions made solely by persons that are accredited investors;
an organization described in Section 501(c)(3) of the Internal Revenue Code of 1986, as amended, not formed for the specific purpose of investing in a particular fund, with total assets in excess of $5,000,000;
a corporation, partnership or Massachusetts or similar business trust, not formed for the specific purpose of investing in a particular fund, with total assets excess of $5,000,000;
a trust, not formed for the specific purpose of investing in a particular fund, with total assets exceed $5,000,000, whose purchase is directed by a person who has such knowledge and experience in financial and business matters that he is capable of evaluating the merits and risks of an investment in a particular fund; or
an entity (including a revocable grantor trust but other than a conventional trust) in which each of the equity owners qualifies as an accredited investor as otherwise described above.
14. Please choose the category that best describes you:
15. You heard about Atreaus Capital through:
16. Comments:

* For purposes of this Certification, the term "individual income" means adjusted gross income, as reported for federal income tax purposes, less any income attributable to a spouse or to property owned by a spouse, increased by the following amounts (but not including any amounts attributable to a spouse or to property owned by a spouse): (i) the amount of any tax-exempt interest income under Section 103 of the Internal Revenue Code, received; (ii) the amount of losses claimed as a limited partner in a limited partnership as reported on Schedule E of Form 1040; (iii) any deduction claimed for depletion under Section 611 et seq. of the Internal Revenue Code; (iv) amounts contributed to an Individual Retirement Account (as defined in the Internal Revenue Code) or Keogh retirement plan; (v) alimony paid; and (vi) any elective contributions to a cash or deferred arrangement under Section 401(k) of the Internal Revenue Code.

** For purposes of this Certification, the term "net worth" means the excess of total assets at fair market value, including home furnishings and automobiles, over total liabilities; provided that, (i) your primary residence shall not be included as an asset, (ii) indebtedness that is secured by your primary residence, up to the current estimated fair market value of the primary residence as of the date hereof, shall not be included as a liability (except that if the amount of such indebtedness outstanding as of the date hereof exceeds the amount outstanding 60 days before such time, other than as a result of the acquisition of the primary residence, the amount of such excess shall be included as a liability), and (iii) indebtedness that is secured by your primary residence in excess of the current estimated fair market value of the primary residence as of the date hereof shall be included as a liability.

We will review the information you have submitted and contact you directly with any follow-up questions we may have.