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Private Equity Direction of Investment

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Private Equity Direction of Investment PRIVATE EQUITY DIRECTION OF INVESTMENT WHEN TO USE THIS FORM IMPORTANT! The purpose of this Private Equity Direction of Investment form is to Equity Trust Company does not investigate, sponsor, or endorse any initiate an investment within your retirement account at Equity Trust investment product. You assume sole responsibility for the success Company for one of the following: or failure of your investments. You are responsible for directing the investment of assets in your account. Equity Trust Company does not provide any investment advice, or recommend or evaluate the • Limited Partnerships • Private Stocks merits or suitability of any investment. • Limited Liability • C-Corporations Companies If Equity Trust Company’s services were suggested by a financial rep- • Joint Venture resentative, such person is not an agent, employee, representative, or • Land Trusts affiliate of Equity Trust Company. Equity Trust Company is not responsi- If the investment that you are purchasing is not listed above, this ble for and is not bound by any representations, warranties, statements may not be the correct form for your purchase. For assistance please or agreements made by any financial representative. contact a Client Service Representative at 877-693-8208. INSTRUCTIONS & GUIDELINES SUPPORTING DOCUMENTATION This Direction of Investment form provides all of the information Submit the following required documents with your Direction of In- necessary to make a formal investment request. This request is vestment packet: (Sorted by Investment Type) necessary before an investment can be made using a self-directed retirement account. Please be sure the following three items are in • Limited Partnerships – Completed Private Equity effect before this Direction of Investment is returned to Equity Trust Representation Letter, copy of signed Limited Partnership Company: Agreement, filed certificate of Limited Partnership, Private Placement Memorandum and signed Subscription Agreement • The Equity Trust Company retirement account has been estab- with Investor Questionnaire, if applicable. lished. • Funds are available to make an investment. • Limited Liability Company – Completed Private Equity Representation Letter, copy of filed Articles of Organization, • An investment has been selected. signed Operating Agreement, Private Placement Memorandum and signed Subscription Agreement with Investor Questionnaire, if applicable. • Land Trust – Completed Private Equity Representation Letter, copy of the signed Land Trust Agreement. • Private Stock/C-Corporation – Completed Private Equity SUBMISSION OPTIONS Representation Letter, C-Corporation’s filed Articles of Incorporation, copy of signed By Laws, Private Placement OVERNIGHT REGULAR MAIL Memorandum and signed Subscription Agreement with Equity Trust Company Equity Trust Company Investor Questionnaire, if applicable. If the corporation issues 1 Equity Way P. O. Box 451340 actual stock certificates, these must be physically held by Westlake, OH 44145 Westlake, OH 44145 Equity Trust Company. • Joint Venture – Completed Private Equity Representation BY FAX BY E-MAIL Letter, copy of signed Joint Venture Agreement and Private 440-366-3752 [email protected] Placement Memorandum and signed Subscription Agreement *If submitting an Expedited request via with Investor Questionnaire, if applicable. E-mail please include “Expedited” in the subject line. DO NOT FAX OR MAIL THIS COVER PAGE INVESTMENT PRODUCTS: NOT FDIC INSURED - NO BANK GUARANTEE - MAY LOSE VALUE ©2019 EQUITY TRUST COMPANY CL110F, REV 09/2019 PRIVATE EQUITY DOI page 1 of 4 1 ACCOUNT HOLDER INFORMATION ACCOUNT HOLDER NAME ACCOUNT NUMBER EMAIL ADDRESS DAYTIME PHONE NUMBER 2 PROCESSING (CHECK ONE OPTION) c EXPEDITED PROCESSING SERVICE* c NORMAL PROCESSING SERVICE Expedited processing requests will be processed before other non-expedit- Normal processing is the default if no selection is made. ed requests. Fax expedited requests to (440) 366-3756. PLEASE NOTE: The Custodian may require verbal verification from you before processing the purchase. Obtaining such verbal verification may delay the expedited and normal processing times. Funds must be available for processing fees. *Additional fees may apply, see current fee schedule. 3 INVESTMENT INFORMATION ENTITY TYPE: c LLC c C-Corporation c Land Trust c Limited Partnership c Joint Venture c Capital Call c Other_______________________________________ INVESTMENT NAME PHONE NUMBER ADDRESS CITY STATE ZIP CODE AMOUNT OF INVESTMENT SHARES/UNITS BEING PURCHASED PRICE PER UNIT/SHARE What percentage of the Entity will be owned by this IRA?_____________________% WARRANT INFORMATION (IF APPLICABLE) ID OR CERTIFICATE NUMBER SHARES/UNITS BEING ISSUED CUSIP EXCERCISE PRICE EXCERCISE DATE 4 EXCHANGE OF ASSET (IF APPLICABLE) If you choose this option, this asset will be REMOVED from your account and a NEW asset for this investment c Full Exchange will be posted in your account until the funds are received. If you choose this option, only the value of the asset will be adjusted. The asset will NOT be removed from your c Partial Exchange account until full sale of the asset occurs. ASSET NUMBER (IRN) A NEW Asset Value is required for a Partial Exchange: ____________________________________ O Account Holder’s Signature Date P. O. BOX 451340 | WESTLAKE, OH 44145 | PHONE: 877-693-8208 | FAX: 440-366-3752 | WWW.TRUSTETC.COM | EMAIL: [email protected] ©2019 EQUITY TRUST COMPANY CL110F, REV 09/2019 PRIVATE EQUITY DOI page 2 of 4 Account Number ____________________ 5 INVESTMENT FUNDING INFORMATION AVAILABLE CASH FUNDS Cleared funds must be available in order to make an investment. Funds will be sent via check and sent in accordance to the Subscription Document/Investment Paperwork if no option is chosen. SEND FUNDS BY WIRE* BANK NAME BANK PHONE NUMBER ABA ROUTING # (9 DIGITS) ACCOUNT NUMBER FOR CREDIT TO FOR FURTHER CREDIT TO SEND FUNDS BY CHECK* MAKE CHECK PAYABLE TO MAIL CHECK TO ADDRESS CITY STATE ZIP CODE c CASHIER’S CHECK* c REGULAR CHECK OVERNIGHT MAIL* c REGULAR CHECK REGULAR MAIL c Bill to Third Party: THIRD PARTY ACCOUNT NUMBER THIRD PARTY ZIP CODE c FedEx c UPS *Additional fees may apply, see current fee schedule. 6 DOCUMENTS REQUIRING SIGNATURE c YES, this investment has documents that require signing. c NO, this investment does not have any documents that need to be A list of documents is attached, please remember to sign and date. signed. DOCUMENT PROCESSING FEES may apply see current fee schedule 7 DOCUMENT TITLING INSTRUCTIONS The following examples are provided to ensure supporting documentation is properly titled. (Investment titling shown in “quotations”) • I am making an investment titled directly to my IRA. “EQUITY TRUST COMPANY CUSTODIAN FBO (ACCOUNT HOLDER’S NAME) IRA” • I am making an investment titled directly to my account and my account will be less than 100% owner. “EQUITY TRUST COMPANY CUSTODIAN FBO (ACCOUNT HOLDER’S NAME) IRA, (PERCENTAGE OF INVESTMENT OWNED BY ACCOUNT) %, UNDIVIDED INTEREST” TITLING When purchasing an asset for your account it is imperative that it is properly titled. Equity Trust Company will not accept any investments which are not properly titled. Please contact a Client Service Representative with any questions regarding proper titling. O Account Holder’s Signature Date P. O. BOX 451340 | WESTLAKE, OH 44145 | PHONE: 877-693-8208 | FAX: 440-366-3752 | WWW.TRUSTETC.COM | EMAIL: [email protected] ©2019 EQUITY TRUST COMPANY CL110F, REV 09/2019 PRIVATE EQUITYpage DOI 3 of 4 Account Number ____________________ 8 DELIVERY INSTRUCTIONS HOW WOULD YOU LIKE DOCUMENTS SENT? All processed documents will be mailed to the address listed below. If you would like to have the documents faxed or emailed before they are mailed, please complete the fax* and/or e-mail* section in addition to the mail section. Equity Trust Company can retain the processed documents in our safekeeping vault in lieu of mailing, but all documents must be completed and signed by all parties. *Verify with Investment sponsor to determine if original documents are required. FAX NUMBER ATTENTION FAX MAIL TO ADDRESS CITY STATE ZIP CODE MAIL c Send Overnight Mail* c Send Regular Mail c Mail Documents with the Check c Bill to Third Party: THIRD PARTY ACCOUNT NUMBER THIRD PARTY ZIP CODE c FedEx c UPS EMAIL ADDRESS ATTENTION EMAIL *Additional fees may apply, see current fee schedule. 9 PAYMENT OF FEES How would you like to pay for any service-related fees associated with this transaction? Choose a payment method: c Deduct Fees from Account c Check Enclosed c Credit Card on file NOTE: By checking Credit Card on file, you authorize Equity Trust Company to charge your credit card for all service-related fees associated with this transaction (if applicable). To add, change, or update a credit card, please visit www.myequity.com. If a payment method is not selected, fees will be deducted from the account. 10 IMPORTANT! ACCOUNT OWNER MUST CHECK ONE OF THE FOLLOWING: c I represent that I am not an officer or director of the offering entity or any affiliate thereof, nor am I related to any officer or director of the offering entity or any affiliate thereof. I also represent that my ownership of this entity (combined with any family member or disqualified person) will be less than 50%. c I represent and disclose that I am an officer or director of the offering entity or its affiliate, or that I am related to an officer or director of the offering entity or its affiliate. The nature of the relationship and the combined percentage of
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