Step 1 of 6 16% Midland requires this form to be completed before onboarding investors. This helps us to better understand the nature and expectations of the investment and determine its administrative feasibility. Midland does not perform due diligence on any investment offering. We do not need performance reporting or audited financials. Midland does not review for investment viability or suitability. Issuer InformationHiddenContact Id Company* Company EIN* Is this your first time filling out this form?* No Yes Main Office Address* City* State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip Code* Phone*Company Website Which Midland representative are you working with?*---Adam SypniewskiBrad JanitzDan HanlonKelsey DineenMatt CalhounRep not listed Investment InformationInvestment Type*--Private PlacementNotes / Private Debt / Private LendingPrivate Placement Type*--Private EquityVenture CapitalReal Estate SyndicationSPV (Special Purpose Vehicle)Goods/services companyHedge FundPromissory NoteOtherNotes / Private Debt / Private Lending Type*--Secured By MortgageSecured by another assetNo collateral - UnsecuredNumber of current creditors with the same or similar structureFund Strategy--Digital AssetsEquitiesCreditFutures/CommoditiesOtherEntity Structure*--LLCLPC-CorpForeign CorporationOtherName of Investment* Investment Contact Name* Contact Email Contact Phone Upload documents required for investment to be completed Drop files here or Select files Accepted file types: pdf, doc, docx, Max. file size: 10 MB. File size limit: 10MB. Acceptable file types: .doc | .docx | .pdf Investment: Additional Information This will help us better service your investorsWhat is the minimum investment amount for this offering? Is the investment call-based?*---YesNoWill the initial call be for the total commitment?*---YesNoTell us more* Please provide any key dates including funding deadlines* Is there a minimum lockup period? Please provide any comments on liquidity Please provide your Fund Administrator if applicable along with contact details Do you provide a statement to the investor?--YesNoWhat is the frequency of these statements? Federal regulation requires Midland to receive a value on all investments for reporting purposes. The requirements vary based on asset type. If you provide statements, the statement may be sufficient for this requirement.* I understand Investment: Additional Information This will help us better service your investorsWhat is the average loan amount? Are income payments expected from this investment?---NoUnknownYesIf Yes, please provide details Expected Frequency---MonthlyQuarterlyAnnuallyOtherPreferred Payment Method---CheckWire TransferMidland requires receipt of the original hand-signed note signed by the borrower prior to releasing funds for investment.* I AcknowledgeFederal regulation requires Midland to receive a value on all investments for reporting purposes. The requirements vary based on asset type. If you provide statements, the statement may be sufficient for this requirement.* I understand Wire InstructionsBank Name Account Holder Name ABA Routing Number Account Number Price Per Unit/Share In order for Midland Trust Company (“Midland”) to administer this asset, the investment issuer agrees to the following: Issuer agrees to register ownership of investment to: Midland Trust Company, As Custodian FBO (Client Name) (Client Account Number) P.O. Box 07520, Fort Myers, FL 33919 Issuer understands that the Taxpayer EIN for all Midland investments held in Traditional, Roth, SEP, Simple, HSA, and ESA accounts is 47-5560347. The IRA investors’ SSN should never be used for reporting purposes for retirement account investments. Employer plans such as 401k plans have a unique Tax ID for the plan. Issuer agrees to issue all payments, income, dividends, distributions and/or payoffs directly to Midland IRA. Due to regulation, it is not acceptable to send funds directly to an IRA holder. Issuer understands that Midland has not performed any due diligence on this investment, and understands that Midland IRA does not endorse this investment. Issuer agrees that the investments offered are not directly or indirectly related to any asset class deemed illegal by the Federal Government. Issuer agrees to assist IRA holder in obtaining an annual fair market valuation. Issuer agrees to provide Midland with evidence of ownership of each investment including original stock certificates, or written confirmation. Issuer acknowledges that IRAs are restricted from making mandatory capital calls if the capital call results in a prohibited transaction. Any additional investment will be done so on the account holder’s discretion. Issuer agrees that it has a conforming due diligence policy in place. Issuer agrees to notify Midland of any changes in address contact, or companystatus. Issuer understands that Midland does not promote, sell, or distribute any investment, including the investment described in this document. Additionally, Midland will not provide investment, tax, or legal advice to any party, including the issuer and/or IRA holders. Issuer understands that Midland IRA is a self-directed IRA administrator not an investor. Issuer agrees to not make any representations to any party that may contradict the language in this document. READ, UNDERSTOOD, AND AGREED TO BY:Signature* Company* Title Phone*Email*