First Name *

Last Name *

Address One *

City *

State *

Zip *

Daytime Phone *

Email *

What is your primary motivation for investing in Oil & Gas? * Tax Write-Off Monthly Income Diversify Portfolio

Describe your experience with investing. * Very Experienced Somewhat Experienced No Experience

What is your typical investment risk level? High Moderate Low

Are you married? * YesNo

What is your occupation? *

How did you hear about us? * Email Google Ads Internet Search Wall Street Journal LinkedIn Money Show Virtual Money Show Referral Other

Are you an accredited investor? * YesNo I certify that I have an individual income of over $200,000 (or joint income with my spouse of over $300,000) in each of the past two years and reasonably expect to reach the same level in the current year, AND/OR I have an individual net worth in excess of $1,000,000.

Are you a U.S. citizen? * YesNo

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