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ACCREDITED INVESTOR QUESTIONNAIRE
*All required

Information regarding securities investments offered by ORC I, LLC is available to individuals and entities qualifying as Accredited Investors within the meaning of Rule 501 of Regulation D under the Securities Act of 1933, as amended (the "Securities Act").

Each prospective investor must complete the following questionnaire and return it to ORC I, LLC. The prospective investor will be given access to information upon determination of Accredited Investor status based upon the facts disclosed in this questionnaire and any other facts about the investor known by ORC I, LLC.

Your Name:
Date of Birth:
(yyyy-mm-dd)
Occupation:
Street Address:
City:
Country:
State:
Postal Code:
Daytime Phone Number:
Private Fax Number:
E-Mail Address:

 

Check the box or boxes below, which are next to the categories, under which the prospective investor qualifies as an accredited investor.
You must check at least one selection below in order to complete this questionnaire.

FOR INDIVIDUALS
A natural person with individual income (without including any income of the Investor's spouse) in excess of $200,000, or joint income with the Investor's spouse of $300,000, in each of the two most recent years and who reasonably expects to reach the same income level in the current year.
A natural person with individual net worth (or joint net worth with spouse) in excess of $1 million. For purposes of this item, "net worth" means the excess of total assets at fair market value, including home, home furnishings and automobiles (and including property owned by a spouse), over total liabilities.
ASSETS
Cash - bank and savings accounts:
Public Securities:
Privately held company interests:
Real Estate:
Retirement accounts:
Personal Property:
Other Assets:
TOTAL ASSETS 0
LIABILITIES
Short Term Debts - Credit Cards:
Notes Payable:
Real Estate Mortgage Debt:
Taxes Payable:
Other Liabilities:
TOTAL LIABILITIES 0
PERSONAL NET WORTH:
I agree that the foregoing statements are true and accurate as of the date hereof, and that you will promptly notify us if any of the responses to the foregoing questions should be changed.
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