INVESTOR PERSONAL INFORMATION FORM

PLEASE COMPLETE & SUBMIT THE FOLLOWING FORM

The information gathered through this form is strictly confidential and is intended for internal purposes. Rest assured, it will not be shared or distributed in any manner. Its sole purpose is to facilitate the administration and management of your investments within the CitySide network.

Investor Name: *

First

Last

Title

Cell Phone Number: *

Social Security #:

Please do not enter the number the portfolio manager will call you to get it over the phone after the form was sent.

Alternative Phone Number:

Main Email *

Alternative Email

Main Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Energency Contact Info:

Have you designated an emergency contact for your investment affairs in case of unavailability or emergency situations, whether temporary or permanent?

Name *

First

Last

Main Email *

Alternative Email

Cell Phone #: *

Alternative Phone #:

If invest through a legal Entity:

Investors utilizing investment entities other than their personal name are kindly requested to fill out the following section.

Type of Entity

Entity Legal Name:

EIN Number: (TAX ID)

Entity Mailing Address:

Address Line 1

Address Line 2

City

State

Zip Code

Legal Counsel Information:

What legal firm and or legal counsel is handling your legal affairs?

Legal Firm Name:

Attorney Name: *

First

Last

Direct Phone #:

Main Email: *

CPA & Tax Advisor

Which firm or CPA firm are you utilizing as your tax advisor and for filing your tax returns?

Firm Name:

Contact Person: *

First

Last

Contact Phone #: *

Main Email: *

Custodian of Company Info

If you are investing with a self-directed IRA or Roth IRA and utilizing a custodian company, kindly furnish the requested information below.

Company Name:

Company Mailing Address:

Address Line 1

Address Line 2

City

State

Zip Code

Contact Person: *

First

Last

Or account manager

Contact Phone #: *

Main Email: *

Name that should appear on the investment documents:

Account Number:

INVESTOR PERSONAL INFORMATION FORM

PLEASE COMPLETE & SUBMIT THE FOLLOWING FORM

Energency Contact Info:

If invest through a legal Entity:

Legal Counsel Information:

CPA & Tax Advisor

Custodian of Company Info

Please confirm and submit the form