VistaWEB IPO - VistaWEB - accredited Investor

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VistaWEB PPM Download - Accredited 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:
Company	* Position / Title:

* Residential Address:
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* Business Address:
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To participate as an investor qualified as an "Accredited 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 an accredited investor by answering the following specific questions.

* 1. Do you or your spouse have a combined net worth of $1 million or more?
No
Yes

* 2. 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?
No
Yes

* 3. Do you anticipate your income will continue at this level?
No
Yes

* 4. 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?
No
Yes

* 5. Is the investor for which you seek registration an entity wholly-owned by "accredited investors"?
No
Yes

* 6. 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")?
No
Yes

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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* Date:
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