Name *

First Name

Last Name

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

What is your annual income? *

Less than $150,000

$160,000 - $400,000

$500,000 - $1 Million

$2 Million - $10 Million

What is your net worth (excluding your primary residence)? *

Less than $250,000

$350,000 - $1 Million

$1 Million - $6 Million

$7 Million +

Have you invested in private equity, hedge funds, or other alternative investments before? *

No

Yes, but less than $100,000

Yes, between $200,000 and $750,000

Yes, $ 1 Million +

Business Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you familiar with the risks associated with investing in private funds and alternative investments? *

Not at all

Somewhat

Moderately

Very familiar

How would you describe your investment goals with Alpine Capital? *

Preservation of capital

Steady income

Capital appreciation

Aggressive growth

What is your investment time horizon? *

Less than 1 year

1-3 years

3-5 years

More than 5 years

How much liquid cash or cash equivalents do you have available for investment? *

Less than $250,000

$350,000 - $500,000

$550,000 - $ 1M

$ 2M - $ 5M+

Are you interested in short-term or long-term investment strategies? *

Short-term

Long-term

How did you hear about Alpine Capital's investment program? *

Referral

Online search

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Other

Do you understand that Alpine Capital may require a minimum investment amount? *

Yes, I understand.

No, I do NOT understand.

Are you prepared to undergo additional due diligence and provide financial documentation if necessary? *

Yes

No