Full Name

Email

Phone

Full Address

POTENTIAL INVESTORS

PLEASE FILL OUT THE FOLLOWING:

1. Are you an "Accredited Investor," as defined below?

YesNo

If you qualify as an "Accredited Investor," please select either item (a) or (b):

a) Any natural person whose individual net worth, or joint net worth with that person's spouse, at the time of his purchase exceeds $5,000,000, excluding the value of your primary residence*

(b) Recent years or joint income with that person's spouse in excess of $300,000 in each of those years and has a reasonable expectation of reaching the same income level in the current year.

2. Do you also meet the Portfolio Requirement of a “Qualified Client” which means any natural person whose individual net worth, or joint net worth with that person's spouse, at the time of his purchase exceeds $5,000,000, excluding the value of your primary residence? *


YesNo

*When calculating net worth, you should (i) exclude your primary residence as an asset, (ii) exclude debt secured by your primary residence, up to the fair market value of your residence, (iii) include the amount of any increase on the debt secured by your primary residence incurred within the last 60 days of making a purchase of the securities (unless related to the acquisition of your primary residence, and (iv) include debt in excess of the fair market value of your primary residence.

My approximate net worth is:

Between $5,000,000 and $10,000,000Between $10,000,000 and $15,000,000$15,000,000 +

LAND OWNERS

PLEASE FILL OUT THE FOLLOWING:

Full Address of Potential Property, or GPS coordinates if no address

Tell us more about this property. What is it's current use, how long have you owned it, what is the traffic count driving by, and anything else that you feel may help to distinguish this property as a potential GTUSA location.

POTENTIAL BUSINESS PARTNERS

PLEASE FILL OUT THE FOLLOWING:

In what role(s) do you feel that you partner with GarageTown? Check all that apply:

I am a developer
I am a contractor
I am a builder
I am a real estate agent
I am a real estate investor
I am an entrepreneur
I am retired

In what capacity can you partner with GarageTown? Please list your skills and qualifications that you feel will make you a perfect candidate to partner with us at GarageTown USA:

What is 8 + 2?

SIGNATURE

Please type your name in lieu of a signature. By typing your name, you agree that all of the above statements are true and correct, to the best of your knowledge.