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.
Login Information:
* indicates required field
Don't use spaces or
special characters for your login name.
Be sure to enter a valid e-mail address, your password will
be sent to that address.
Personal Information:
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.