REQUEST FOR INFORMATION Please enable JavaScript in your browser to complete this form.First Name *Last Name *Company NameJob TitleWebsite / URLMobile Phone Number *Email *City *State *AlabamaAlaskaArizonaArkansasCaliforniaCanal ZoneColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingZip Code *What regions are you interested in investing in?SoutheastNortheastMidwestSouthWestComments - Tell us about your business goals: Are you an Accredited Investor as defined by these requirements and willing to verify yourself as qualified?*Yes, I'm accredited and let's start the verification processNo. Or, not interested in qualifying yet.How did you hear about us? *ReferralWeb SearchTrade ShowPress ReleaseMotorsports MarketingOtherBy checking this box below you confirm receipt and acceptance of our NDA*NDA Acknowledgement and Acceptance INVESTOR ACCREDITATION QUESTIONNAIRE SUBSCRIPTION AGREEMENT SCHEDULE 1.01 Subscriber represents and warrants to the Company that Subscriber is an accredited investor based on the following (please check all that apply): Would you be investing as an individual or business entity? *IndividualBusiness EntityINVESTORS WHO HAVE NOT UTILIZED VERIFYINVESTOR.COM: Please provide that documentation which substantiates and evidences the representations and warranties made above. Such documentation would include bank account statements, investment account statements, tax returns, corporate, partnership, and other entity records, and any other information reasonably requested by the Company. Investors Who Used verifyinvestorIn addition to the representation and warranty made by Subscriber above, Subscriber represents and warrants that if Subscriber has utilized VerifyInvestor.com for the purposes of effectuating the Company’s determination that Investor is an accredited investor, that any and all information or documentation provided by Investor to VerifyInvestor.com was true and accurate at the time such information or documentation was provided to VerifyInvestor.com and remain true and accurate as of the date of Subscriber’s signature hereto.[1] As used herein, “income” means adjusted gross income, as reported for federal income tax purposes, increased by the following amounts: (i) the amount of any tax exempt interest income received; (ii) the amount of losses claimed as a limited partner in a limited partnership; (iii) any deduction claimed for depletion; (iv) amounts contributed to an individual retirement account or Keogh retirement plan; (v) alimony paid; and (vi) any amounts by which income from long-term capital gains has been reduced in arriving at adjusted gross income pursuant to the provisions of Section 1202 of the Code (as herein defined). [1] As used herein, “net worth” means the excess of total assets, excluding your primary residence, at fair market value over total liabilities, including your mortgage or any other liability secured by your primary residence only if and to the extent that it exceeds the value of your primary residence. Net worth should include the value of any other shares of stock or options held by you and your spouse and any personal property owned by you or your spouse (e.g. furniture, jewelry, other valuables, etc.).SUBMIT