Accredited Investor Questionnaire
Boise Angel Alliance
Boise Angel Fund
Treasure Valley Angel Fund
Accredited Investor Status
Member is an “accredited investor” by virtue of the following (check ALL that apply):
____ 1. Any natural person whose net worth, or joint net worth together with such individual’s spouse, excluding the positive equity in their primary residence, exceeds $1,000,000.
____ 2. A natural person whose individual income was in excess of $200,000 or whose joint income with his or her spouse was in excess of $300,000, in each of the two most recent years, and who has a reasonable expectation of reaching the same income level in the current year
____ 3. A bank, insurance company, registered investment company, business development company, small business development company or employee benefit plan.
____ 4. A savings and loan association, credit union, or similar financial institution, or registered broker dealer.
____ 5. A private business development company.
____ 6. An organization described in Section 501(c)(3) of the Internal Revenue Code with assets in excess of $5 million.
____ 7. A corporation, limited liability company, Massachusetts or similar business trust, or partnership with assets in excess of $5,000,000.
____ 8. A trust with assets in excess of $5,000,000.
____ 9. An entity in which all of the equity owners are accredited investors. Also check the items 1 through 8 that apply. (This item is not available to an irrevocable trust).
____ 10. A self-directed IRA, Keogh, or similar plan of which the individual directing the investments qualifies as an “accredited investor” under one or more of items 1 through 8 above. Check the item(s) 1 through 8 that apply.
____ 11. A revocable trust for the benefit of the grantor and/or the grantor’s family members, whose grantor qualifies as an “accredited investor” under one or more of the items 1 through 8 above. Check the item(s) 1 through 8 that apply.
Printed Name of Member:________________________________
Signature of Member:___________________________________
Date:________________________________________________
Updated July 22, 2012
Boise Angel Fund
Treasure Valley Angel Fund
Accredited Investor Status
Member is an “accredited investor” by virtue of the following (check ALL that apply):
____ 1. Any natural person whose net worth, or joint net worth together with such individual’s spouse, excluding the positive equity in their primary residence, exceeds $1,000,000.
____ 2. A natural person whose individual income was in excess of $200,000 or whose joint income with his or her spouse was in excess of $300,000, in each of the two most recent years, and who has a reasonable expectation of reaching the same income level in the current year
____ 3. A bank, insurance company, registered investment company, business development company, small business development company or employee benefit plan.
____ 4. A savings and loan association, credit union, or similar financial institution, or registered broker dealer.
____ 5. A private business development company.
____ 6. An organization described in Section 501(c)(3) of the Internal Revenue Code with assets in excess of $5 million.
____ 7. A corporation, limited liability company, Massachusetts or similar business trust, or partnership with assets in excess of $5,000,000.
____ 8. A trust with assets in excess of $5,000,000.
____ 9. An entity in which all of the equity owners are accredited investors. Also check the items 1 through 8 that apply. (This item is not available to an irrevocable trust).
____ 10. A self-directed IRA, Keogh, or similar plan of which the individual directing the investments qualifies as an “accredited investor” under one or more of items 1 through 8 above. Check the item(s) 1 through 8 that apply.
____ 11. A revocable trust for the benefit of the grantor and/or the grantor’s family members, whose grantor qualifies as an “accredited investor” under one or more of the items 1 through 8 above. Check the item(s) 1 through 8 that apply.
Printed Name of Member:________________________________
Signature of Member:___________________________________
Date:________________________________________________
Updated July 22, 2012
