Atrium Asset Management



INVESTOR REGISTRATION REQUEST
* Are you a U.S. Citizen? YES, I am a citizen of the United States
NO, I am not a citizen of the United States
* First Name:
(Given Name)
* Last Name:
(Family Name)
* Primary Phone Number:
(Country Code, Area Code, Number)
Alternate Phone Number:
Optional
* E-Mail Address:
* Confirm E-Mail Address:
* Gender: Male
Female
* Date of Birth:
* Street Address:
* City/Town:
* State/Province:
* ZIP or Postal Code:
* Country:

Question A:
Did your annual income during each of the two most recent years exceed $200,000? And do you reasonably expect such annual income during the current year to exceed such amount?

If you answered No: Did your annual income together with your spouse's annual income exceed $300,000? And do you reasonably expect such annual income during the current year to exceed such amount?

Question B:
Does your net worth (excluding the value of your primary place of residence) exceed $1,000,000?

Question C:
If you are acting on behalf of your Investment Retirement Account (IRA), does the present net worth of such IRA exceed $5,000,000?

Question D:
Have you ever invested in a "hedge fund" before?


If you chose yes, how much did you invest?

Question E:
Within the past two years, have you made a general assignment for the benefit of creditors; been in receivership; or filed or had filed against you a petition in bankruptcy?

Question F:
Are there any lawsuits or claims against you that might affect your net worth?


If you chose yes, please provide details:
How did you hear about us?

Terms and Agreements

By submitting this form, you hereby confirm the following statements:

  • You are aware that the offering of Interests will involve securities for which no market exists, thereby requiring my investment to be maintained for an indefinite period of time.
  • You are aware, and acknowledge, that if the information supplied herein is inaccurate, the offering or sale to you of an Interest could result in the loss of an exemption from registration under the 1933 Act which the Offeror or representative of the Offeror is relying in connection with the offering of the Interests.
  • You acknowledge that any delivery to such Entity of the Private Placement Memorandum referred to on the cover and any supplement thereto relating to the Interests prior to the determination by the Offeror of the suitability of the individual as an investor shall not constitute an offer of Interests until such determination of suitability shall be made, and that the Private Placement Memorandum and any supplement and attachment thereto shall be returned promptly to the Offeror upon request.
  • Your answers to the foregoing questions are true and complete to the best of your information and belief, and the Offeror will be notified promptly of any changes in the foregoing answers.



By submitting this form, I hereby declare that I have read, understood, and agree the terms set forth above.