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VistaWEB PPM Download - Sophisticated Investor

The information included in this web site is the responsibility of the respective issuers and any related broker/dealers offering their securities. VistaWeb has not taken any steps to verify the adequacy, accuracy or completeness of any information. Neither VistaWeb, its officers, directors, agents or employees have in any way made or make any warranty, express or implied, of any kind whatsoever and none of the foregoing parties shall be liable for any loss, damages, costs or expenses of every kind and description relating to the adequacy, accuracy or completeness of any information on this web site or the use of the information on this web site.

Information regarding private placements available from VistaWeb IPO shall be forwarded to qualified investors only by e-mail unless another means of written verification is requested and agreed to between VistaWeb IPO and the respective qualified investor. Please register to receive further information.


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Personal Information:
Last Name:
Middle Initial:
First Name:
Age:
Date of Birth:
Occupation:

Residential Address:
City:
State:
Zip Code:
Business Address:
City:
State:
Zip Code:

To participate as an investor qualified as a "Sophisticated Investor" under the United States securities laws and to be able to receive private placements and participate in private placements available from VistaWeb IPO, you must establish your status as a sophisticated investor by answering the following specific questions.

Employment Occupation Information
1. Retired
Unemployed
Employed/Not Owner
Owner of Business
Homemaker
Student

Employer Name
Position/Title
Nature of Business
Years Employed at this Employer
Employer's Address and Country

2. Indicate below any publicly traded firms of which you or any member of your household or any business affiliate are or would be considered a:
Director
Ten percent Shareholder
Officer
Name of Company

3. Do you or anyone in your organization hold any licenses for the trading of securities under NASD?
Yes
No

4. Investing Experience. In order to be deemed a sophisticated investor, we must determine your prior investing experience. Please advise as to how many years and types of matters in which you have experienced with:
Stocks
Limited Partnerships
Stock Options
Commodity Futures
Bonds
Mutual Funds
Certificates of Deposit
Private Placement Investing

Financial Information
Annual Income
Liquid Net Worth
Net Worth Excluding Home

Sign this Questionnaire

If you return this Questionnaire through the VistaWEB communications link,
please enter your full name on the signature line.

The foregoing statements are true and accurate to the best of my information and belief and I will promptly notify VistaWEB of any changes in the foregoing answers.

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Daytime Phone Number:
Date:
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