Accredited Investors Request

Please enable JavaScript in your browser to complete this form.

Investor Name *

First

Last

Email Address *

Phone Number *

Residential Address *

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Social Security Number or Tax ID *

Date of Birth *

Investment Amount Commitment Minimum $5,000

Price: $0.00

Investor Type *IndividualEntity (Corporation, LLC, Trust, etc.)

Are you an Accredited Investor? *

• Yes
• No

Accredited Investor Questionnaire (AIQ) – Individual Investor Accreditation – Natural Persons

Please select all that apply (Individual Accreditation)

• Income exceeds $200,000 (or $300,000 with spouse) in each of the last two years, and expect same this year
• Net worth exceeds $1,000,000 (excluding primary residence)
• Holder of Series 7, 65, or 82 license in good standing

Entity Investor Accreditation – Corporations, LLCs, Trusts, etc.

Please select all that apply (Entity Accreditation)

• Entity with assets exceeding $5,000,000, not formed for this investment
• All equity owners are accredited investors
• Entity is a bank, insurance company, registered investment company, business development company, or small business investment company

Verification Method (Rule 506c Only)

How will your status be verified? *

• Third-party letter from CPA, attorney, broker-dealer, or investment advisor
• Income documentation (W-2, tax return, etc.)
• Net worth documentation (bank/brokerage statements, etc.)

Final Execution

Signature *

(Entity Accreditation) Investor

Date Signed *

Submit Agreement

🔒 Confidentiality Disclaimer: Accelerated Investor Verification
Please read this disclaimer carefully before submitting your information.
The information requested and provided on this form is collected solely for the purpose of internal verification to determine your status as an accelerated investor.

• No Sale or Distribution: Your personal or financial data collected through this verification process is not sold, rented, leased, or distributed to any third parties whatsoever.
• Internal Use Only: The data is used strictly for internal purposes by GONEN CORP to comply with regulatory standards and assess your eligibility for specific investment opportunities.
• Data Security: GONEN CORP is committed to protecting your information and employs reasonable security measures to prevent unauthorized access or disclosure.

• By submitting your information, you acknowledge and agree to these terms.

• ❓ Questions or Concerns?
  If you have any questions regarding this disclaimer, the information requested, or the verification process, please contact the GONEN CORP Finance Department directly:
• Phone: 704.352.3258
  

GONEN FUNDS GENERAL DISCLOSURE