Business Telephone Number. (____) _____________
Business Telephone Number. (Area Code) (Number) I prefer to have correspondence sent to: / / Residence / / Business
Business Telephone Number. Mobile Telephone Number
Business Telephone Number. Part B — Type of Investor
1. Are you:
(i) A bank as defined in Section 3(a)(2) of the Securities Act of 1933 (the “Securities Act”) or a 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? Yes o No o
(ii) A broker or dealer registered pursuant to Section 15 of the Securities Exchange Act of 1934? Yes o No o
Business Telephone Number. Social Security: or Tax I.
Business Telephone Number. Social Security or tax identification Number: ______________________________________________________________ Occupation or Profession: ____________________________________________________________________________ Are you purchasing Units for your own account? ( ) Yes ( ) No If you are not purchasing Units for your own account, please complete the following:
Business Telephone Number. (Area Code) (Number)
Business Telephone Number. (Area Code) (Number) I prefer to have correspondence sent to: / / Residence / / Business NASD Affiliation or Association, if any: ---------------------------------------- If none, check here / / Spouse, if Co-Owner Name: --------------------------------------------------------------------------- Social Security or Taxpayer Identification Number: ------------------------------ Residence Address: -------------------------------------------------------------- (Number and Street) -------------------------------------------------------------------------------- (City) (State) (Zip Code)
Business Telephone Number. (Area Code) (Number) I prefer to have correspondence sent to: / / Residence / / Business NASD Affiliation or Association, if any: --------------------------------------- If none, check here / / SPOUSE, IF CO-OWNER: Name: --------------------------------------------------------------------------- Social Security or Taxpayer Identification Number: ------------------------------ Residence Address: -------------------------------------------------------------- (Number and Street) -------------------------------------------------------------------------------- (City) (State) (Zip Code) Residence Telephone Number (IF DIFFERENT FROM PURCHASER'S): -------------------- (Area Code) (Number) Business Address (IF DIFFERENT FROM PURCHASER'S): ------------------------------- (Number and Street) -------------------------------------------------------------------------------- (City) (State) (Zip Code) Business Telephone Number (IF DIFFERENT FROM PURCHASER'S): ---------------------- (Area Code) (Number) I prefer to have correspondence sent to: / / Residence / / Business NASD Affiliation or Association, if any: ---------------------------------------- If none, check here / /
Business Telephone Number. State or other Jurisdiction in which Organized or Incorporated: ____________
