Legacy Investment Network

Membership
Participation in Legacy Investment Network is restricted to accredited investors. Most of our investors expect to invest between $50,000 and $250,000 per year in high-risk opportunities. If you think alternative investing may be an appropriate part of your long-term investing strategy, please complete the questionnaire below.

Prior to providing information about possible investment opportunities, the Legacy Investment Network is required by the U.S. Securities and Exchange Commission (SEC) to gather key information. This information is used to ensure that investors possess sufficient sophistication, knowledge or experience about the investments they are making.

The information supplied is kept strictly confidential and used only for the purpose of providing information about possible investment opportunities. Investment opportunities are provided only to those who qualify as determined by the SEC (see SEC guidelines).

Please complete the questionnaire below to be prequalified to become a member of the Legacy Investment Network.

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-ALL FIELDS MUST BE COMPLETED FOR A VALID SUBMISSION-

Incomplete questionnaires will not be considered.

Full Name:
Email address:
Address:
City:
State, Zip :
Phone:
*Sponsor:
Approximate Assets Available to Invest:
Investment Risk Profile:	Conservative Moderate Aggressive
Indicate which of the following statements apply to your situation. You must answer affirmative to statement A, B, or C to qualify as an equity partner:	(A) My annual net income was at least $200,000 in each of the last two years, or my joint income with my spouse was in excess of $300,000 in each of those years, and I have reasonable expectation of the same income level for the immediate future. (B) My current individual net worth or joint net worth with my spouse is at least $1 million. (C) I am an experienced investor as demonstrated by my investment, business and financial background information. (D) None of the above apply
If you selected statement C from above, please indicate your Occupation/Profession, Business/Financial experience, and any Degrees or designations you may have.
Please indicate the approximate number of investments you have:
If applicable, please indicate the type of investments you have (check all that apply):	Stocks Bonds Mutual Funds Real Estate Oil & Gas Business Ownership Other I do not own any investments
Please indicate the number of years of investment experience you hold:
If applicable, please indicate the current value of your investments:
THIS IS NOT AN OFFER TO SELL OR SOLICITATION OF AN OFFER TO PURCHASE AN INVESTMENT OR SECURITY. THIS INFORMATION RELATES TO POSSIBLE OPPORTUNITIES FOR QUALIFIED INVESTORS. INTERESTED PERSONS MAY QUALIFY AS INVESTORS BY VIRTUE OF A PRE-EXISTING RELATIONSHIPS AND BY PROOF OF BUSINESS EXPERIENCE, INCOME AND NET WORTH. I/we hereby certify the above is true and correct and certify that I/we have read and agree with the disclaimer at the bottom of the webpage.	Yes No