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Offeree Questionnaire
1
Instructions for Completing Questionnaire
2
Investor Questions
1. Instructions for Completing Questionnaire
This Questionnaire should be completed by each investor interested investment opportunities of Hedgehog (the Company), who has not previously supplied or made such information available to the Company in writing, or if there has been a material change in the information since last submitted. The purpose of this Questionnaire is to assure the Company that each investor will meet the standards established by the Securities Act of 1933 as amended (the Act), and/or the rules of all other applicable regulatory agencies in the States in which these interests are offered.
If the answer to any question is "None" or "Not Applicable," please state so. Your answers will, at all times, be kept strictly confidential. However, by completing this Questionnaire, you agree that the Company may present this Questionnaire to such government regulatory agencies, not including the Internal Revenue Service, as it deems appropriate if called upon to establish the availability under any law of an exemption from registration of the securities offered hereby.
Name
Address
Occupation
Business Address
2. Investor Questions
1) Please indicate the state(s) in which you have maintained your principal residence during the past two years and the dates during which you resided in each state.
Choose a state
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
From
MM slash DD slash YYYY
Until
MM slash DD slash YYYY
Have you maintained your principal residence in more than one state over the past two years?
Yes
No
Please indicate the other state where you have mantained your principal residence over the past two years, along with the dates of residence.
Choose a state
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
From
MM slash DD slash YYYY
Until
MM slash DD slash YYYY
2) Do you maintain a house or apartment in any other state? If yes, in which state(s)?
Choose a state
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
3) In which state, if any, do you pay state income taxes?
Choose a state
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
4) What is your present age?
Under 21
21-30
31-40
41-50
51-64
Over 64
NOTE: Questions 5, 6 and 7 are intended to determine whether or not you qualify as an Accredited Investor pursuant to SEC Regulation D under The Securities Act of 1933 and amendments thereto:
5) Is your net worth in excess of One Million Dollars ($1,000,000)?
Yes
No
*For purposes of this question, you must exclude the value of your primary residence Note, however, that as of February 27, 2012, any loans against your personal residence taken out within the sixty (60) days prior to a subscription and any negative equity in your personal residence must be considered in your calculation of net worth.
6) Was your individual income during the past two years in excess of Two Hundred Thousand Dollars ($200,000) or was your joint income with your spouse during the past two years in excess of Three Hundred Thousand Dollars ($300,000) and do you have a reasonable expectation of reaching the same income level in the current year?
Yes
No
*Income may be calculated by starting with Adjusted Gross Income and adding the deductions taken for long-term capital gain, depletion, Company losses allocated to you and contributions to IRA and/or Keogh plans.
7) By what other definition of Accredited Investor will you wish to qualify?
First Choice
Second Choice
Third Choice
(See Section II (C) (1), bullets 1-8 of the Subscription Agreement).
8) Please briefly describe principal positions held during the last ten years or since graduation from college (whichever is less), which will demonstrate your related experience in financial and business matters:
9) Please describe the nature, if any, of your prior personal or business relationship with Hedhehog; or any of their principals, officers, directors or Affiliates.
Choose an option
Personal
Business
Family
None
10) Investment experience:
a. Please indicate the frequency of your investment in non-marketable securities:
Often
Occasionally
Seldom
Never
b. Please indicate the frequency of your investment in limited liability companies or limited partnerships:
Often
More than once
Never
c. Please indicate in the space provided below any additional information which you think may be helpful in enabling the Company to determine that your knowledge and experience in financial and business matters is sufficient to enable you to evaluate the merits and risks of this investment.
By checking the box below, I represent and warrant that the above information supplied by me is true and correct in all respects.
By checking this box you confirm the above statement.
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