INSTRUCTIONS: IN ORDER TO INVEST IN THE SERIES A FINANCING OF BLACK BUFFALO 3D CORPORATION, A DELAWARE CORPORATION (THE “CORPORATION”), YOU MUST COMPLETE THIS INVESTOR QUESTIONNAIRE BY FILLING IN THE INFORMATION CALLED FOR, CHECKING THE APPROPRIATE BOXES, AND SIGNING AT THE BOTTOM OF THIS FORM. PLEASE SUBMIT THE COMPLETED QUESTIONNAIRE TO THE CORPORATION AS SOON AS POSSIBLE.
This financing is limited to Accredited Investors only
Ladies and Gentlemen:
In connection with the proposed purchase of Series A Preferred Stock of Black Buffalo 3D Corporation, a Delaware corporation (the “Corporation”), the undersigned hereby represents as follows:
The contact information for the undersigned is as follows:
Rule 501.Definitions and Terms Used in Regulation D. As used in Regulation D, the following terms have the meaning indicated: (a) Accredited Investor. “Accredited investor” shall mean any person who comes within any of the following categories, or who the issuer reasonably believes comes within any of the following categories, at the time of the sale of the securities to that person:
I have read and agree to the Definitions and Terms Used in Regulation D as displayed in Exhibit A section above.
I acknowledge that the foregoing representations contained above are true and accurate as of the date hereof and shall be true and accurate as of the date of Closing. If in any respect such representations shall not be true and accurate prior to Closing, the undersigned shall give immediate notice of such fact in writing to the President of the Corporation.
Dated: