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The investment funds described in this website have not been registered under the federal securities laws of the United States, the securities laws of any state, or the laws of any other jurisdiction. This website shall not constitute an offer to sell or the solicitation of an offer to purchase shares of any such funds in any jurisdiction. Such an offer may only be made by the private placement memorandum for the relevant fund and only to investors who meet certain eligibility requirements. This registration form is not an application to subscribe for interests in or shares of any of the funds.

All information provided on this questionnaire will be held in confidence in accordance with Basswood Capital Management LLC's Privacy Policy as in effect from time to time.



Personal Information
*First Name:
*Last Name:
*E-mail Address:
*Password:
Company Name:
*Address 1:
Address 2:
*City:
*State:
*Zip:
*Country:
*Phone:
Cell Phone:
Title:


1. You are completing this information on behalf of:
Yourself
Your Organization (Name of Organization)
Both
2. Please choose the category that best describes you:
Individual Bank
Fund-of-Funds Family Office
Consultant Multi-Family Office
Trust Pension plan
Endowment Foundation
Investment adviser Insurance company
Sovereign Wealth Fund Service Provider
Other (please specify type):
3. Are you/your organization an "accredited investor" in accordance with Rule 501(a) of Regulation D of the Securities Act of 1933?
Yes No
If yes, please select one:
Individual - I am a natural person whose individual net worth, or joint net worth with my spouse, as of the date hereof exceeds $1,000,000 excluding the individual’s primary residence AND/OR I am a natural person who had an individual income in excess of $200,000 in each of the two most recent years or joint income with my spouse in excess of $300,000 in each of those years and I have a reasonable expectation of reaching the same income level in the current year.

Entity Not Formed For The Specific Purpose Of Acquiring The Security Offered - I am an organization described in Section 501(c)(3) of the Internal Revenue Code of 1986, as amended, a corporation, a similar business trust, or partnership, not formed for the specific purpose of acquiring any specific security, with total assets in excess of $5,000,000.

Regulated Entity - I am (i) a U.S. bank or any banking institution organized under the laws of any state, territory or the District of Columbia, the business of which is substantially confined to banking and is supervised by the State or Territorial banking commission or similar official agency, (ii) a U.S. savings and loan association or other similar institution, whether acting in its individual or fiduciary capacity; (iii) a broker or dealer registered pursuant to Section 15 of the Securities Exchange Act of 1934; (iv) a U.S. insurance company; or (v) an investment company registered under the Investment Company Act of 1940.

Business Development Company - I am a "business development company" as defined in the Investment Company Act of 1940.

Private Business Development Company - I am a "private business development company" as defined in the Investment Advisers Act of 1940.

Small Business Investment Company - I am a "small business investment company" licensed by the U.S. Small Business Administration under Section 301(c) or 501(c)(3) of the Small Business Investment Act of 1958.

Employee Benefit Plan - I am an "employee benefit plan" within the meaning of Title I of the Employee Retirement Income Security Act of 1974, as amended ("ERISA"), and either (i) the investment decision to invest is made by a plan fiduciary, as defined in ERISA, which is either a bank, savings and loan association, insurance company, or registered investment adviser; or (ii) the employee benefit plan has total assets in excess of $5,000,000; or (iii) if a self-directed plan, the investment decisions are made solely by persons that are "accredited investors".

State Plan - I am a plan established and maintained by a State, its political subdivisions, or any agency or instrumentality of a State or its political subdivisions, for the benefit of its employees, if such plan has total assets in excess of $5,000,000.

Trust - I am a trust with total assets in excess of $5,000,000, not formed for the specific purpose of acquiring any specific security, whose purchase is directed by a sophisticated person as described in Regulation D.

Revocable Trust - I am a "revocable trust" that may be amended or revoked at any time by the grantors thereof, an all of the grantors are "accredited investors".
4. Are you/your organization a "qualified purchaser" in accordance with Section 2(a)(51)(A) of the Investment Company Act of 1940?
Yes No
If yes, please select one:
Individual - I own, either personally or jointly with my spouse, not less than $5,000,000 in "investments."

Individual - The sum of the investments that I own plus investments that I invest on a discretionary basis is not less than $25 million.

Family Company - I am a company, partnership, trust or other entity that is owned directly or indirectly by or for two or more natural persons who are related as siblings or spouse (including former spouses), or direct lineal descendants by birth or adoption, spouses of such persons, the estates of such persons, or foundations, charitable organizations, or trusts established by or for the benefit of such persons (“Family Company”), was not formed for the specific purpose of investing in the Partnership, and owns not less than $5 million in "investments."

Trust - I am a trust (other than a Family Company) that was not formed for the specific purpose of investing in the Partnership, as to which each trustee or other person authorized to make decisions with respect to the trust and each settlor or other person who has contributed assets to the trust is a qualified purchaser.

Entity Not Formed For The Specific Purpose Of Acquiring The Security Offered - I am a company, partnership, trust or other entity that was not formed for the specific purpose of investing in the Partnership, acts for its own account or the accounts of other “qualified purchasers,” and in the aggregate owns and invests on a discretionary basis not less than $25 million in investments.

Qualified Institutional Buyer - I am a “qualified institutional buyer” (as defined in SEC Rule 144A) that meets, if applicable, the dealer and employee benefit plan requirements described therein.

Charitable Corporation (Family Company) - I am a “charitable corporation” of which all of the persons who have contributed assets are related in one or more of the ways enumerated above, that owns not less than $5 million in investments, and was not formed for the specific purpose of investing in the Partnership.

Charitable Corporation - I am a “charitable corporation” of which each person authorized to make investment decisions, and each person who has contributed assets, is a qualified purchaser and was not formed for the specific purpose of investing in the Partnership.

Entity’s Securities - I am an entity in which all of the beneficial owners of the entity’s securities (i.e., all partners (including limited partners) of a partnership, shareholders of a corporation) are qualified purchasers.
5. How did you hear about Basswood Capital Management (e.g., News article, Conference, Current investor)?


Thank you very much for your time.

By pressing the “Submit/I Agree” button below, you agree that you have filled in this questionnaire completely and, to the best of your knowledge, the responses provided in this questionnaire are accurate and truthful. Additionally, you acknowledge that you have read and agree to the Terms and Conditions of Use, which should be reviewed carefully.