Baron Point Financial

Accredited Investor Questionnaire

* Please fill in all mandatory fields.

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	User registration:

	Prefix:
	First name:*
	Middle name:
	Last name:*
	Suffix:
	Will you be registering for yourself or on behalf of an entity?*	Self Entity
	Home address:
	Address 1:*
	Address 2:
	Address 3:
	City/Town:*
	Country*, State/Province:
	Postal code:
	Home/cell telephone:*
	Fax:
	Email:*
	Confirm email:*
	Date of birth:* (DD.MM.YYYY)	Format (Day/Month/Year)
	Marital status:
	Company:*
	Company position:*
	Function:
	Company location:
	Address 1:*
	Address 2:
	Address 3:
	City/Town:*
	Country*, State/Province:
	Postal code:
	Business telephone:*
	Preferred method of contact for qualification:	Business telephone Home telephone Please provide appropriate telephone number
	Preferred time of contact for qualification:	Morning Midday Evening

This is not an advertisement. Nothing on this informational web site shall be construed as a security that is offered to buy or sell. Offer of securities is by prospectus only. Please read all offering materials carefully before investing.