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Accredited Investor Registration Form 


Each of the Keystone Companies has been thoroughly evaluated by the Hoffman Row Group. In fact, Hoffman Row principals may serve on their respective boards of directors. We believe that each of them is an outstanding investment opportunity. However, we encourage each investor to perform due diligence before investing.
    The detailed information on the Keystone Companies is restricted to Accredited Investors as defined by the United States Securities Act of 1933, Rule 501(a) (see explanation below). Therefore, the Keystone Companies site can be accessed only by password.
    If you are an Accredited Investor, please complete the following form and e-mail it to the Hoffman Row Group. Your password will be given to you by return e-mail.


 

FIRST NAME M.I. LAST NAME
RESIDENCE ADDRESS
CITY
STATE ZIP COUNTRY
TELEPHONE FAX
() ()
E-MAIL ADDRESS

"Accredited Investor" is a person who meets one of the following requirements:
   (1) Bank, Broker, Insurance Company, Investment Company, Small Business Investment Company, State Plan, or Employee Benefit Plan. Any bank as defined in section 3(a)(2) of the Act, or any savings and loan association or other institution as defined in section 3(a)(5)(A) of the Act whether acting in its individual or fiduciary capacity; any broker or dealer registered pursuant to section 15 of the Securities Exchange act of 1934; any insurance company as defined in section 2(13) of the Act; any investment company registered under the Investment Company Act of 1940 or a business development company as defined in section 2(a)(48) of that Act; any Small Business investment Company licensed by the U.S. Small Business Administration under section 301(c) or (d) of the Small Business Investment Act of 1958; and plan established and maintained by a state, its political subdivisions, or any agency or instrumentality of a state or its political subdivisions, for the benefit of its employees, if such plan has total assets in excess of $5,000,000; any employee benefit plan within the meaning of the Employee Retirement Income Security Act of 1974, if the investment decision is made by a plan fiduciary, as defined in section 3(21) of such act, which is either a bank, savings and loan association, insurance company, or registered investment adviser, or if the employee benefit plan has total assets in excess of $5,000,000 or, if a self-directed plan, with investment decisions made solely by persons that are accredited investors;
   (2) Private Business Development Company. Any private business development company as defined in section 202(a)(22) of the Investment Advisers Act of 1940;
   (3) Organization, Partnership, Corporate or Other Entity Investor. Any organization described in section 501(c)(3) of the Internal Revenue Code, corporation, Massachusetts or similar business trust, or partnership, not formed for the specific purpose of acquiring the securities offered, with total assets in excess of $5,000,000;
   (4) Officer of Issuer. Any director, executive officer, or general partner of the issuer of the securities being offered or sold, or any director, executive officer, or general partner of a general partner of that issuer;
   (5) $1,000,000 Net Worth. Any natural person whose individual net worth, or joint net worth with that person's spouse, at the time of this purchase exceeds $1,000,000;
   (6) $200,000 Income. Any natural person who had individual income in excess of $200,000 in each of the two most recent years or joint income with that person's spouse in excess of $300,000 in each of those years and has a reasonable expectation of reaching the same level of income in the current year;
   (7) Trust. Any trust, with total assets in excess of $5,000,000 not formed for the specific purpose of acquiring the securities offered, whose purchase is directed by a sophisticated person as described in Rule 506(b)(2)(ii); and
   (8) Entity. Any entity in which all of the equity owners are accredited investors;
   I / We certify that I/we are "Accredited Investor(s)" under one or more of the categories described above and wish to obtain an Access Code. I / We do not wish to obtain an Access Code.

 

 



 
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