NEI - Natural Econometric - CWVRC EB5 Regional Center

Name on passport:

*

Passport issued by what country:

*

Country of birth:

*

Contact Address:

*

City:

State:

Zip Code:

Country:

E-mail:

*

Phone:

*

Fax:

Current Status:

*

Are you an accredited investor?

Yes No*

If yes, please check:

a natural person who has individual net worth, or joint net worth with the person’s spouse, that exceeds $1 million at the time of the purchase
a natural person with income exceeding $200,000 in each of the two most recent years or joint income with a spouse exceeding $300,000 for those years and a reasonable expectation of the same income level in the current year
a trust with assets in excess of $5 million, not formed to acquire the securities offered, whose purchases a sophisticated person makes *

Are you able to proof the invested capital is lawful by providing evidence of source of funds:

Yes No*

If yes, please check:

Profits or proceeds from the sale of real estate
Profits or earnings from stock or other investments
Bank statements
Investment account statements
Documents showing ownership in real estate or a company, accompanied by an appraisal of value and registration of ownership, loan or mortgage, promissory note, security agreement, or other evidence of borrowing which is secured by assets of applicant
Tax returns from the last 5 years
Inheritance, gifts or loans *

Your Level of Education:

No Education
High School Education
4 year University or College
Master or PhD

Major:

*

Investment Experience:

No
Less than 1 year
1 to 3 years
3 to 6 years
7 to 12 years
More than 12 years

Which EB-5 Program are you interested in:

equity based California Wineries & Vineyards
loan based Central Coast Wineries & Vineyards

Message:

Check the form. Make sure you provide us information at places marked *, otherwise the form cannot send out.