Application Please enable JavaScript in your browser to complete this form.Investor Name *FirstLastCo Investor NameFirstLastInvestor Address *Telephone Number *Co Investor AddressCo Investor Telephone NumberEstimated Annual Income *$0-$50,000$50,001-$100,000$100,001-$200,00$200,001-$300,000$300,001-$500,000$500,001-$750,000$750,001-$1,000,000$1,000,000-$5,000,000$5,000,001-$10,000,000Estimated Liquid Assets(Cash in bank, marketable stock and Bond) *$0-$50,000$50,001-$100,000$100,001-$200,000$200,001-$300,000$300,001-$500,000$500,001-$750,000$750,001-$1,000,000$1,000,000-$5,000,000$5,000,001-$10,000,000Estimated Net Worth *$0-$50,000$50,001-$100,000$100,001-$200,000$200,001-$300,000$300,001-$500,000$500,001-$750,000$750,001-$1,000,000$1,000,001-$5,000,000$5,000,001-$10,000,000Source Income *Liquidity Needs *Primary need is liquidity/cashNeed some liquidity for possible quick access to cashNo liquidity needed.;have other sources of cashInvestment Experience *No investment experienceMutual FundsStock/SharesReal EstateAnnuitiesNotesBondsOptionsOhtersOther Investments Currently Held *OTHER EDUCATIONAL, BUSINESS, OR FINANCIAL EXPERIENCES, INVESTMENT CONSIDERATIONS, FINANCIAL SITUATIONS, TRAINING (INCLUDING SEMINARS, CONTINUING EDUCATION, ETC.), OR PROFESSIONAL LICENSES AND CERTIFICATIONS *OBJECTIVE OF INVESTOR(S) FOR PURCHASING OR INVESTING IN TRUST DEEDS OR REAL PROPERTY SALES CONTRACTS *I certify (or declare) that the information provided in this questionnaire is true and correct to the best of my knowledge. I am providing this information for the purpose of determining whether or not trust deed or real property sales contract investments are suitable for me. I understand that the broker may request an annual update of this information and that the broker may request additional information regarding my suitability as an investor for each specific transaction. I acknowledge that investments in notes secured by trust deeds and real property sales contracts are subject to risk of loss of principal and monthly income. *FirstLastInvestor Email *EmailConfirm EmailI certify (or declare) that the information provided in this questionnaire is true and correct to the best of my knowledge. I am providing this information for the purpose of determining whether or not trust deed or real property sales contract investments are suitable for me. I understand that the broker may request an annual update of this information and that the broker may request additional information regarding my suitability as an investor for each specific transaction. I acknowledge that investments in notes secured by trust deeds and real property sales contracts are subject to risk of loss of principal and monthly income. *FirstLastCo Investor EmailEmailConfirm EmailA broker shall maintain records of the information used to determine that an investment is suitable and appropriate for each investor/purchaser for at least four years. *AcknowledgementNameSubmit
