We would be glad to contact you to answer
questions about our firm and our products. Qualified investors also may be
eligible to receive written materials regarding our private investment
funds. Please complete the following questionnaire
and then click the “submit” button at the end of this document. We will contact you to review your questionnaire and to provide a user
name and password. If you have any questions
in completing this questionnaire, please contact Laura Flentye at Laura.Flentye@cuppscapital.com
or at (312) 263-1057.
Salutation:
First:
Last:
Address:
Phone:
E-mail:
Fax:
Please check ALL applicable boxes below:
The undersigned is an "Accredited Investor" as
defined in Rule 501(a) under the Act because:
The Member is a natural person whose individual net worth, or joint net worth with that person's spouse, exceeds $1,000,000.
The Member is a natural person who had an individual income in excess of $200,000 in each of the last two calendar years, or joint income with that person's spouse in excess of $300,000 in each of those years, and has a reasonable expectation of reaching the same income level in this calendar year.
The Member is an entity with total assets in excess of $5,000,000 which was not formed for the purpose of investing in any of the Funds and which is one of the following:
a corporation; or
a partnership; or
a limited liability company; or
a business trust; or
a tax-exempt organization described in Section 501(c) (3) of the Internal Revenue Code of 1986, as amended.
The Member is a personal (non-business) trust with total assets in excess of $5,000,000 which was not formed for the purpose of investing in any of the Funds and whose decisions to invest in the Funds will be directed by a person who has such knowledge and experience in financial and business matters that he is capable of evaluating the merits and risks of an investment in the Funds.
The Member is an employee benefit plan within the meaning of Title I of the Employee Retirement Income Security Act of 1974 (including an Individual Retirement Plan) which satisfies at least one of the following conditions:
it has total assets in excess of $5,000,000; or
the investment decision is made by a plan fiduciary which is a bank, savings and loan association, insurance company or registered investment adviser; or
it is a self-directed plan (i.e., a tax-qualified defined contribution plan in which a participant may exercise control over the investment of assets credited to his or her account) and the decision to invest is made by those participants investing, and each such participant qualifies as an accredited investor under the criteria listed in Question 2.
The Member is an employee benefit plan established and maintained by a state, its political subdivisions or any agency or instrumentality of a state or its political subdivisions, which has total assets in excess of $5,000,000.
The Member is licensed, or subject to supervision, by U.S. Federal or state examining authorities as a "bank," "savings and loan association," "insurance company," or "small business investment company" (as such terms are used and defined in 17 CFR §230.501 (a)) or is an account for which a bank or savings and loan association is subscribing in a fiduciary capacity and over which such fiduciary exercises investment discretion.
The Member is registered with the United States Securities and Exchange Commission as a broker or dealer or an investment company; or has elected to be treated or qualifies as a "business development company" (within the meaning of Section 2(a) (48) of the Investment Company Act of 1940 or Section 202(a) (22) of the Investment Advisers Act of 1940).
The Member is an entity in which all of the equity owners are qualified under one or more of the criteria listed above.
