Pentagram Investment Partners, LLC
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INVESTOR QUALIFICATION QUESTIONNAIRE AND AGREEMENT |
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The information contained in this Investor Qualification Questionnaire and
Agreement is being furnished by you in connection with determining whether you
will be granted access to certain password-protected areas of the website of
Pentagram Investment Partners, LLC and Quincunx Management, LLC and any of their
respective fund websites. |
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Are you a current Pentagram Investor?
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REPRESENTATIONS FOR (CHOSE ONE)
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| A. BACKGROUND INFORMATION |
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1. GENERAL INFORMATION |
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Name:
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Home Residence address: |
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Street:
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State/Province:
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City:
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Zip or Postal Code:
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Country:
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Home Residence Telephone:
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Mobile Telephone:
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Fax:
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E-mail Address:
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| 2. EMPLOYMENT AND BUSINESS
INFORMATION |
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Employer: (include all information for the last five years): |
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Business Address: (street, city, state or province, zip or postal code,
country): |
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Business Telephone: |
Position: |
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Job Description: |
Employment Dates: |
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3. I prefer to be contacted by and correspondence
sent to:
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| If Other,
please explain:
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4. EDUCATION: (begin with College or University and include name of
school, course of study, and date and type of any degree received): |
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5. FINANCIAL INFORMATION: |
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I have net worth, including vested pension or profit sharing plan
investments but excluding my principal residence, home furnishings and
automobiles (including joint net worth with my spouse) in excess of
(chose one): |
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6. INVESTMENT EXPERIENCE
I currently have or have previously have made investments in (check all
that apply):
Stocks
or bonds
Mutual
funds
Futures,
commodities, options or other derivative instruments
Real
estate
Private
investment funds (hedge funds, private equity funds, commodity pools,
etc)
Other
(please describe) |
| If you answered "Other", please
describe below |
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B. MISCELLANEOUS |
1. The information set forth above is accurate and complete as of the
date hereof, and you agree to promptly notify Pentagram Investment
Partners, LLC of any material change in such information. You hereby
consent to the disclosure of any such information, and any other
information furnished to Pentagram Investment Partners, LLC, to any
governmental authority, self-regulatory organization or, to the extent
required by law, to any other person.
2. You agree that your rights and interests in gaining access to the
information posted in the Pentagram Investment Partners, LLC website are
not transferable or assignable.
3. This Agreement shall be governed by, and construed in accordance
with, the laws of the state of Massachusetts. |
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