CONFIDENTIAL INVESTOR QUESTIONNAIRE
My Pueblo LTD (the "Company") would like to request and know certain information regarding the investor to comply with the Securities Act of 1933, as amended (the "Act""). Certain sections of Regulation D require, among other things, that at the time of any potential sale of securities to an investor, the investor to be an "accredited investor" (as defined in Rule 501 of Regulation D) or that the issuer reasonably believes that the offeree is an “accredited investor” or, if the offeree is a non-accredited investor, that such offeree, either alone or together with an investor representative, has such knowledge and experience in financial and business matters to be capable of evaluating the merits and risks of the prospective investment. In order to obtain the facts needed to determine this, please complete this Investor Questionnaire. The form should be signed, dated, and forwarded to the Company.
ALL INFORMATION FURNISHED IS FOR THE SOLE USE OF THE COMPANY AND ITS COUNSEL AND WILL BE HELD IN CONFIDENCE BY THE COMPANY AND ITS COUNSEL, EXCEPT THAT THIS QUESTIONNAIRE MAY BE FURNISHED TO SUCH PARTIES AS THE COMPANY AND COUNSEL DEEM NECESSARY TO ESTABLISH COMPLIANCE WITH FEDERAL OR STATE SECURITIES LAWS OR TO THE EXTENT REQUIRED BY LAW.
Your organization is an "accredited investor" and has investible assets of more than $5,000,000.