EB-5 INVESTOR INTAKE FORM:

SERIES B PREFERRED EQUITY CAPITAL SUSCRIPTION AT:

ARCHER PLACE EB5 PREFERRED EQUITY, LLLP

Please fill the following form and send it back to your consultant together with copy of the
petitioner passport first page.

1) Investor information:

___________________________________________________________________________
Name as indicated in the passport (Please include copy from the first page of passport)

2) Spouse information (if married):

___________________________________________________________________________
Name as indicated in the passport (Please include copy from the first page of passport)

3) Number of children under 21 years old:

___________________________________

4) Actual USA Visa status:

___________________________________

Investor Address:

______________________________________________________________________
Address of the Investor Line 1

______________________________________________________________________
Address of the Investor Line 2

______________________________________________________________________
Email of the investor

______________________________________________________________________
Telephone including country code

Series B Preferred Equity Client intake Form at Archer Place EB5 Preferred Equity, LLLP
 ACCREDITED INVESTOR PROFILING:

PLEASE MARK ONLY ONE OPTION, EITHER OPTION 1 OR OPTION 2:

1) Investor current “Net worth” is higher than USD 1,000,000?

YES ________ NO ________

2) Investor Gross Income on the past 2 years be:

If investing on Personal Basis: If Investing joined with wife / husband

Over: USD 200,000 _______ Over USD 300,000 __________

Below USD 200,000 _______ Below USD 300,000 _________

Bad Actor Profiling:

Have you been convicted of any crime on the past 10 years?

YES ______ NO _________

If yes please explain:

NOTES:

To be able to invest in Archer Place EB5 Preferred Equity, LLLP the investor needs to be an
accredited investor by either have a current net worth superior of USD 1,000,000 or have made a
gross income superior of USD 200,000 on personal basis or USD 300,000 if joined with spouse /
husband.

Series B Preferred Equity Client intake Form at Archer Place EB5 Preferred Equity, LLLP