Name

*

Street

*

City

*

State

*

Zip Code

*

Home Phone

*

Work Phone

*

Cell Phone

E-mail

*

Are you an accreditted investor? * yes no

Accreditted is 200,000 annual income or 1,000,000 assets

Net Worth Annual Income Both

Optional Fields

How were your investments last year? Good Fair

What have you invested in before?

Oil and Gas Options Real Estate - Commercial

Residential Farm Ranch Hunting Lease

Land Lease Stocks Mutual Funds Metals

Private Placement Mineral Rights

Are you looking to invest this year? Yes No

Are you the decision maker? Yes No Broker Planner CPA Trust Individual

Investment Capital 10,000-25,000 25,000-50,000 50,000-100,000 1,000,000 & Up Not Sure