JV Interest Form

Prospective Shareholder Profile

Personal Information: Please complete your personal information including the address where you choose to receive written documents involving the subject joint venture.

First Name *

Last Name *

Email *

Phone *

Residential Address *

City *

State *

Postal code *

Date of Birth (MM/DD/YYYY) *

Social Security # (no dashes) *

Business Entity Holding Shares: Please complete this section if your intention is to have shareholder ownership registered under an LLC, Inc., Partnership, or other form of business entity ownership other than personal ownership.

Business Entity Name

State Business Entity is Registered

Date Bus. Entity Registered with State

Business Tax ID Number

Investment Status:

Please check the appropriate box. *

Accredited Investor: Have earned greater than $200K annually for previous 2 years or $300K annually including a spouse and is believed to be sustainable in future years.

Qualified Purchaser: Is an individual or closely held business entity that owns at least $5M in investments.

Non-Qualified Investor: Neither qualifies as an accredited investor or qualified purchaser of non-registered securities.

All prospective shareholders are encouraged to seek the counsel of professional representation of an attorney and/or certified accountant, and/or certified financial planner to determine the legal merits and potential tax consequences of an investment in subject joint venture entity.

Affiliated Business Entity Interest: If you are a member of the real estate brokerage, mortgage servicing, financial services, insurance services, or attorney counsel industries, please indicate your related entity business interest.

Affiliated Business Entity Company Name

Affiliated Business Entity Company Address

Affiliated Business Entity Company City

Affiliated Business Entity Company State

Affiliated Business Entity Company Zip Code

Affiliated Business Co. State License ID#

Affiliated Business Company Phone Number

Affiliated Business Company Email Address

Is this business a franchise?

Yes

Are you the business owner?

Yes

Real Estate Sales Transaction Performance (in 2023):

Total Volume Closed (USD)

Total Closed Units

Total Volume Closed Listing Side

Closed Units Listing Side

Closed Units Buy Side

Mortgage Servicers Performance (in 2023):

Mortgage Services Total Volume Closed

Mortgage Servicers Total Units Closed

Mortgage Servicers Total Purchase Units

Mortgage Servicers Total Purchase Volume

Mortgage Servicers Total Refinance Units

Mortgage Servicers Total Refinance Volume

Investment Experience:

Please provide a brief summary of your real estate investment experience, including any relevant achievements or notable transactions.

Declaration: I, the undersigned, hereby declare that all the information provided in this shareholder profile document is true and accurate to the best of my knowledge. I understand that as a shareholder, I may be subject to certain qualifications and restrictions under applicable state and federal laws.

Signature *

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By submitting this form, you agree to receive phone calls and text messages from AllTech National and its authorized representatives as it relates to the joint venture discussion.