ACCREDITED INVESTOR QUESTIONNAIRE. In order for the Company to offer and sell the Securities in conformance with state and federal securities laws, the following information must be obtained regarding your investor status. Please initial each category applicable to you as a Purchaser of Securities of the Company. (1) A bank as defined in Section 3(a)(2) of the Securities Act, or any savings and loan association or other institution as defined in Section 3(a)(5)(A) of the Securities Act whether acting in its individual or fiduciary capacity;
Appears in 5 contracts
Samples: Securities Purchase Agreement (Shuttle Pharmaceuticals Holdings, Inc.), Securities Purchase Agreement (Reed's, Inc.), Securities Purchase Agreement (Alpine Immune Sciences, Inc.)
ACCREDITED INVESTOR QUESTIONNAIRE. In order for the Company Corporation to offer and sell the Securities in conformance with state and federal securities laws, the following information must be obtained regarding your investor status. Please initial each category applicable to you as a Purchaser purchaser of Securities of the Company.
Corporation. ¨ (1) A bank as defined in Section 3(a)(2) of the Securities Act, or any savings and loan association or other institution as defined in Section 3(a)(5)(A) of the Securities Act whether acting in its individual or fiduciary capacity;
Appears in 3 contracts
Samples: Securities Purchase Agreement (Selecta Biosciences Inc), Securities Purchase Agreement (Selecta Biosciences Inc), Securities Purchase Agreement (Ardelyx, Inc.)
ACCREDITED INVESTOR QUESTIONNAIRE. In order for the Company to offer and sell the Securities in conformance with state and federal securities laws, the following information must be obtained regarding your investor status. Please initial each category applicable to you as a Purchaser of Securities of the Company.
. o (1) A bank as defined in Section 3(a)(2) of the Securities Act, or any savings and loan association or other institution as defined in Section 3(a)(5)(A) of the Securities Act whether acting in its individual or fiduciary capacity;
Appears in 2 contracts
Samples: Securities Purchase Agreement (Gemphire Therapeutics Inc.), Securities Purchase Agreement (Ocera Therapeutics, Inc.)
ACCREDITED INVESTOR QUESTIONNAIRE. In order for the Company to offer and sell the Securities in conformance with state and federal securities laws, the following information must be obtained regarding your investor status. Please initial each category applicable to you as a Purchaser purchaser of Securities of the Company.
. o (1) A bank as defined in Section 3(a)(2) of the Securities Act, or any savings and loan association or other institution as defined in Section 3(a)(5)(A) of the Securities Act whether acting in its individual or fiduciary capacity;
Appears in 2 contracts
Samples: Securities Purchase Agreement (GTT Communications, Inc.), Securities Purchase Agreement (GTT Communications, Inc.)
ACCREDITED INVESTOR QUESTIONNAIRE. In order for the Company to offer and sell the Securities in conformance with state and federal securities laws, the following information must be obtained regarding your investor status. Please initial each category applicable to you as a Purchaser of Securities of the Company.
. __ (1) A bank as defined in Section 3(a)(2) of the Securities Act, or any savings and loan association or other institution as defined in Section 3(a)(5)(A) of the Securities Act whether acting in its individual or fiduciary capacity;
Appears in 2 contracts
Samples: Securities Purchase Agreement (Oncothyreon Inc.), Securities Purchase Agreement (Cytori Therapeutics, Inc.)
ACCREDITED INVESTOR QUESTIONNAIRE. In order for the Company Bank to offer and sell the Securities Shares in conformance with state and federal securities laws, the following information must be obtained regarding your investor status. Please initial each category applicable to you as a the Purchaser of Securities of the Company.
(Shares. ☐ 1) . A bank as defined in Section 3(a)(2) of the Securities Act, or any savings and loan association or other institution as defined in Section 3(a)(5)(A) of the Securities Act whether acting in its individual or fiduciary capacity;
Appears in 1 contract
Samples: Stock Purchase Agreement (Southern California Bancorp \ CA)
ACCREDITED INVESTOR QUESTIONNAIRE. In order for the Company Corporation to offer and sell the Securities in conformance with state and federal securities laws, the following information must be obtained regarding your investor status. Please initial each category applicable to you as a Purchaser purchaser of Securities of the Company.
Corporation. ☐ (1) A bank as defined in Section 3(a)(2) of the Securities Act, or any savings and loan association or other institution as defined in Section 3(a)(5)(A) of the Securities Act whether acting in its individual or fiduciary capacity;
Appears in 1 contract
Samples: Securities Purchase Agreement
ACCREDITED INVESTOR QUESTIONNAIRE. In order for the Company to offer and sell the Securities in conformance with state and federal securities laws, the following information must be obtained regarding your investor status. Please initial each category applicable to you as a Purchaser of Securities of the Company.
. o (11 ) A bank as defined in Section 3(a)(2) of the Securities Act, or any savings and loan association or other institution as defined in Section 3(a)(5)(A) of the Securities Act whether acting in its individual or fiduciary capacity;
Appears in 1 contract
Samples: Securities Purchase Agreement (Versant Ventures II LLC)
ACCREDITED INVESTOR QUESTIONNAIRE. In order for the Company to offer and sell the Securities Shares in conformance with state and federal securities laws, the following information must be obtained regarding your investor status. Please initial each category applicable to you as a Purchaser of Securities of the CompanyShares.
(1) A bank as defined in Section 3(a)(2) of the Securities Act, or any savings and loan association or other institution as defined in Section 3(a)(5)(A) of the Securities Act whether acting in its individual or fiduciary capacity;
Appears in 1 contract
Samples: Securities Purchase Agreement (Citizens South Banking Corp)
ACCREDITED INVESTOR QUESTIONNAIRE. In order for the Company to offer and sell the Securities Shares in conformance with state and federal securities laws, the following information must be obtained regarding your investor status. Please initial each category applicable to you as a Purchaser of Securities of the Company.
Shares. ____(1) A bank as defined in Section 3(a)(2) of the Securities Act, or any savings and loan association or other institution as defined in Section 3(a)(5)(A) of the Securities Act whether acting in its individual or fiduciary capacity;
Appears in 1 contract
Samples: Securities Purchase Agreement (Fidelity Southern Corp)
ACCREDITED INVESTOR QUESTIONNAIRE. In order for the Company Corporation to offer and sell the Securities in conformance with state and federal securities laws, the following information must be obtained regarding your investor status. Please initial each category applicable to you as a Purchaser purchaser of Securities of the Company.
Corporation. [ ] (1) A bank as defined in Section 3(a)(2) of the Securities Act, or any savings and loan association or other institution as defined in Section 3(a)(5)(A) of the Securities Act whether acting in its individual or fiduciary capacity;
Appears in 1 contract
ACCREDITED INVESTOR QUESTIONNAIRE. In order for the Company to offer and sell the Securities Shares in conformance with state and federal securities laws, the following information must be obtained regarding your investor status. Please initial each category applicable to you as a Purchaser of Securities of the Company.
(Shares. _____ 1) . A bank as defined in Section 3(a)(2) of the Securities Act, or any savings and loan association or other institution as defined in Section 3(a)(5)(A) of the Securities Act whether acting in its individual or fiduciary capacity;
Appears in 1 contract
Samples: Securities Purchase Agreement (First Mid Illinois Bancshares Inc)
ACCREDITED INVESTOR QUESTIONNAIRE. In order for the Company to offer and sell the Securities in conformance with state and federal securities laws, the following information must be obtained regarding your investor status. Please initial each category applicable to you as a Purchaser purchaser of Securities of the Company.
. ☐ (1) A bank as defined in Section 3(a)(2) of the Securities Act, or any savings and loan association or other institution as defined in Section 3(a)(5)(A) of the Securities Act whether acting in its individual or fiduciary capacity;; ☐
Appears in 1 contract
ACCREDITED INVESTOR QUESTIONNAIRE. In order for the Company to offer and sell the Securities Shares in conformance with state and federal securities laws, the following information must be obtained regarding your investor status. Please initial each category applicable to you as a Purchaser of Securities of the Company.
(Shares. ☐ 1) . A bank as defined in Section 3(a)(2) of the Securities Act, or any savings and loan association or other institution as defined in Section 3(a)(5)(A) of the Securities Act whether acting in its individual or fiduciary capacity;
Appears in 1 contract
Samples: Securities Purchase Agreement (Central Federal Corp)
ACCREDITED INVESTOR QUESTIONNAIRE. In order for the Company to offer and sell the Securities Shares in conformance with state and federal securities laws, the following information must be obtained regarding your investor status. Please initial each category applicable to you as a Purchaser of Securities of the Company.
Shares. __ (1) A bank as defined in Section 3(a)(2) of the Securities Act, or any savings and loan association or other institution as defined in Section 3(a)(5)(A) of the Securities Act whether acting in its individual or fiduciary capacity;
Appears in 1 contract
Samples: Securities Purchase Agreement (MidWestOne Financial Group, Inc.)
ACCREDITED INVESTOR QUESTIONNAIRE. In order for the Company to offer and sell the Securities in conformance with state and federal securities laws, the following information must be obtained regarding your investor status. Please initial each category applicable to you as a Purchaser of Securities of the Company.
. ____ (1) A bank as defined in Section 3(a)(2) of the Securities Act, or any savings and loan association or other institution as defined in Section 3(a)(5)(A) of the Securities Act whether acting in its individual or fiduciary capacity;
Appears in 1 contract
