As an Accredited Investor, you recognize this as an SEC Model Accredited Investor Exemption (MAIE)
offering. You realize that the SEC rules require that in order to see the Private Placement Memorandum for MEDfx Corporation, a Rhode Island Corporation, you must gain access via a secure User ID and Password. The prescribed SEC procedure for having the Company issue a User ID and Password to you is: (1) you complete and submit the Accredited Investor Questionnaire below, and (2) the Company evaluates the information presented. If in the company's sole opinion you qualify under the SEC guidelines as an Accredited Investor, you will promptly be assigned a User ID and Password via email or via phone.
The purpose of this Questionnaire is to determine whether you meet the standards for participation in a nonpublic offering under Section 4(2) of the Securities Act of 1933, as amended ("Act"), and under the laws of the various States
All information contained in this Investor Questionnaire will be treated confidentially. However, you agree that the Company may present this questionnaire to parties deemed appropriate if called on to establish that the proposed offer and sale of the Shares is exempt from registration and/or qualification under the Securities Act of 1933, as amended (the “Act”), or any other state securities laws (collectively, “Blue Sky Laws”).
1. “Accredited Investor” Conditions
I certify that I meet one of the “Accredited Investor” conditions (as described in Rule 501 under the Securities Act) set forth below by checking the applicable box below:
2. Name “ Address:
3. Financial Information:
4. Representations & Warranties.
I understand that the Company will be relying on the accuracy and completeness of the responses to the
foregoing questions and I represent and warrant to the Officers of the Company as follows:
(i) The answers to the above questions are complete and correct and may be relied on by the the Company in
determining whether the offer of the Shares in connection with which I have executed this questionnaire are
exempt from registration and/or qualification under the Securities Act of 1933, as amended and applicable state