Send Printed Forms to:
Univest, Inc.
ATTN: Patrick Womack, President
11805 E Fair Avenue
Greenwood Village, CO 80111
Please be sure to Fax a Copy to: 1-720-746-2899
2 .
Fill out our form online.
By filling out this form online, you understand that:
The information contained herein is being furnished to you in order for you to determine whether the undersigned's Subscription Agreement to purchase an interest (one or more shares) in Univest, Inc. may be accepted by you in light of the requirements of Section 4 (2) of the Securities Act of 1933, as amended and Rule 504 of Regulation D promulgated thereunder, and an exemption in the securities laws of certain states. The undersigned prospective investor understands the information is needed in order to satisfy various suitability as provided in the Memorandum and Subscription Agreement provided herewith, and that the Investor and/or his or her financial or other advisors (?Purchaser Representative?) has knowledge and experience in financial and business affairs such that the Investor is capable of evaluating the merits and risks of the of the proposed investments. The Investor understands the (a) you will rely on the information herein contained for proposes of such determination; (b) the Shares will not be registered under the Securities Act in reliance upon the exemption form registration afforded by Section 4 (2) of the Securities Act and Rule 504 of Regulation D; (c) the Shares will not be registered under the securities laws of any state in reliance on similar exemptions; and (d) this Questionnaire is not an Offer of shares or any other securities.
The Investor also understands that, although this Questionnaire and the responses provided herein will be kept confidential, you may need to present it to such parties as you deem advisable in order to establish the applicability under any federal or state securities laws of an exemption from registration.
It is in accordance with the foregoing, the following representations and information are hereby furnished
By clicking the "Submit to images" button, I am signing the form as I would affix my signature to any other physical documentation wherein my signature represents my understanding the format, language and purpose of the document and the information provided in the document.