ValGrowth Fund Management LLC

Client Area

New Users for ValGrowth Fund, LP

Accredited Investor Questionnaire

The Purpose of this Questionnaire is to solicit certain information regarding your financial status to determine whether you are an “Accredited Investor”, as defined under applicable federal and state securities laws, and otherwise meet the suitability criteria established by the Company for purchasing Shares. This questionnaire is not an offer to sell securities.

Your answers will be kept as confidential as possible. You agree, however, that this Questionnaire may be shown to such persons as the Company deems appropriate to determine your eligibility as an Accredited Investor or to ascertain your general suitability for investing in the Shares.


Last Name *
Middle Initial
First Name *
E-mail Address *
Age *
Date Of Birth *
Occupation *
Residential Address *
City *
State *
Zip Code *
Business Address
City
State
Zip Code
Do you or your spouse have a combined net worth of $1 million or more? *	Yes No
For each of the past two years has your annual income been greater than or equal to $200,000 or has the combined annual income of you and your spouse been greater than or equal to $300,000? *	Yes No
Do you anticipate your income will continue at this level? *	Yes No
Is this an account for a trust or business partnership with assets in excess of $5 million, that was not formed for the purpose of acquiring unregistered securities? *	Yes No
Is the investor for which you seek registration an entity wholly-owned by "accredited investors"? *	Yes No
Are you an officer of and investing on behalf of a firm which is a financial institutional, such as a bank, savings and loan association, insurance company, registered investment company, broker/dealer organization, employee benefit/retirement plan, business development company, or a Small Business Investment Company ("SBIC")? *	Yes No
Annual Income *
Liquid Net Worth *
Net Worth Excluding Home *
The foregoing statements are true and accurate to the best of my information and belief and I will promptly notify ValGrowth Fund Management LLC of any changes in the foregoing answers. *	True False
(This will act as your signature)Full Name:*
Date: *
Daytime Phone Number: *
Fax Number: *

ValGrowth Fund Management LLC
where growth goes beyond values