VistaWEB IPO- VistaWEB

VistaWEB PPM Download - Foreign 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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Be sure to enter a valid e-mail address, your password will be sent to that address.

* Choose a login name:
* Your E-mail Address:
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Personal Information:

* Last Name:	Middle Initial:	* First Name:
Age:	* Date of Birth:
Company	* Position / Title:

* Residential Address:
* City:

* State:
* Zip Code:

* Country:

* Business Address:
* City:

* State:
* Zip Code:

* Country:

To participate as an investor qualified as an "Foreign 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 foreign investor by answering the following specific questions.

1. Are you a U.S. citizen?
No
Yes

If you are not a U.S. citizen, insert the following information:
2. Country of citizenship

3. Passport number?

4. Country issuing passport

5. Are you a non-resident alien?
No
Yes

6.Marital Status:
Single
Married
Divorced
Number of Dependents

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.

* Full Name:
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* Date:
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