Oklahoma Accredited Investor Exemption Supplemental Information Form Page 2
ADVERTISEMENT
1
2PART C
1. What is the minimum investment that will be accepted from any purchaser?..............................................................$_______________________
2. Does the offering permit joint ownership of a single security?.....................................................
YES
NO
PART D
Enter the information requested for each person (other than any broker-dealer listed in the Uniform Notice or agents thereof) who has been or will be
paid or given, directly or indirectly, any commission or similar remuneration for solicitation of purchasers in Oklahoma in connection with sales
of securities in the offering.
Full Name (Last name first, if individual)
Business or Residence Address (Number and Street, City, State, Zip Code)
Full Name (Last name first, if individual)
Business or Residence Address (Number and Street, City, State, Zip Code)
Full Name (Last name first, if individual)
Business or Residence Address (Number and Street, City, State, Zip Code)
Full Name (Last name first, if individual)
Business or Residence Address (Number and Street, City, State, Zip Code)
(Use blank sheet, or copy and use additional copies of this sheet, as necessary.)
PART E
Jurisdictions in Which the Issuer Has Solicited or Intends to Solicit Purchasers
(Check “All Jurisdictions” or check individual jurisdictions) ......................................................................................................
All Jurisdictions
[AL] [AK] [AZ] [AR] [CA] [CO] [CT] [DE] [DC] [FL] [GA] [HI] [ID] [IL] [IN] [IA] [KS] [KY][LA] [ME] [MD] [MA] [MI] [MN]
[MS] [MO] [MT] [NE] [NV] [NH] [NJ] [NM] [NY] [NC] [ND][OH] [OK] [OR] [PA] [RI] [SC] [SD] [TN] [TX] [UT] [VT] [VA] [WA]
[WV] [WI] [WY] [PR]
The undersigned represents that the Issuer is familiar with the conditions that must be satisfied to be entitled to the Oklahoma
Accredited Investor Exemption and understands that the Issuer claiming the availability of this exemption has the burden of
establishing that these conditions have been satisfied.
The undersigned, a duly authorized person to act on behalf of the issuer, has read this notification and knows the contents to be true
and has signed this notice on behalf of the issuer.
Issuer (Print or Type)
Signature
Date
Name (Print or Type)
Title (Print or Type)
[Adopted on March 9, 1999; Amended effective July 1, 2004]
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal