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CRUXEON ENERGY+
Registered Investor Access Form
Fill out the form below and we will contact you as soon as possible.
Name (Individual or Entity)*
Contact Email*
Phone*
Country of Residence*
United States of America
Other - not permitted
State*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
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
Mailing Address*
Are you an Accredited Investor in accordance with SEC REG D 506(C)?*
No
Yes
Accreditation Basis*
Income over 200k/300k joint
Net worth over 1M
Licensed Professional (Series 7, 65, 82)
Institutional or Entity Investor
Other
If "Other" please explain
Estimated Net Worth*
0k - 1M
1M - 5M
5M - 10M
10M - 50M
50M +
Estimated Annual Income*
100k - 200k
200k - 500k
500k - 1M
1M+
Comments/Questions
By checking this box, I confirm that all information entered is true and correct.
Unreadable? Regenerate
Submit
