The information you supply below will be kept strictly confidential and is only for the purpose of qualifying you to receive information about possible investment opportunities.

This is not an offer of securities.  The actual investment offering will be made only through a Private Placement Memorandum.

After you complete this questionnaire, we will contact you.  Thanks for your interest in Private Label Equities.

Contact & Login Information
   
First Name *
Last Name *
Company
Email *
Password *
Re-Password *
Address *
Address Continued
City *
State *
Zip Code *
Fax
Best Tel # *
Alt Phone#
 
Other Information
 
How Do You Know Us? *
If Referred, Who Referred You?
Funds Available to Invest (Include Cash & Non-Cash Accounts) *
 
Miscellaneous
 
At least one of the following questions must be answered in the affirmative to qualify as a purchaser:
Yes No
*
I have had an individual income in excess of $200,000 in each of the two most recent years and reasonably expect an individual income in excess of $200,000 in the current year.
Yes No
*
My spouse and I have had joint income in the excess of $300,000 in each of the two most recent past years and we reasonably expect joint income of $300,000 or more in the current year.
Yes No
*
I have an individual net worth or joint net worth with my spouse in excess of $1,000,000.
Yes
At Least One of the Above Income or Net Worth Statements Is Answered Affirmatively with a "Yes".
(Check Your Email for Private Placement Details.)
 
Yes
*
I have read the required disclaimer (click here) and the foregoing statements are true and accurate to the best of my information and belief and I will promptly notify Private Label Equities, LLC of any changes in the foregoing answers.