Completing this form may be time consuming. We recommend you create a login when you start the form so you can save your progress and return to complete or edit the form later. Waiting to create a login may cause you to have to re-input data.

Oil & Gas Lending - Request for Documents

Is the Lender an Individual or a Lending Entity (Trust, LLC, etc.)? *

Please enter full vesting name (how you want this opportunity listed on your paperwork) *

Please enter the name of the person who informed you about this lending opportunity. *

Please enter the email address of the person who informed you about this lending opportunity.

Please enter today's date * +

Joint Lender? *

Yes

No

Primary Lender Information

Primary Lender First Name *

Middle Name

Primary Lender Last Name *

Primary Lender Preferred name (i.e. nickname)

Salutation

Suffix

Primary Lender SSN (without dashes) *

Primary Lender DOB * +

Primary Lender Email Address: (Primary Manager or Trustee, if applicable) *

Primary Lender Telephone Number *

Secondary Lender Information

Secondary Lender First Name *

Secondary Lender Last Name *

Secondary Lender SSN (without dashes) *

Secondary Lender DOB * +

Secondary Lender Email Address *

Secondary Lender Telephone Number *

Please enter your physical address below, may not be a P.O. Box

Mailing Street *

Mailing City *

Mailing State *

Mailing Zip/Postal Code *

Mailing Country *

Trust / LLC Information

EIN

Date Entity Established +

Identification

Please Upload Primary Lender / Trustee or Manager Photo ID *

Please Upload Secondary Lender Photo ID

Please Upload Trust Documentation

Please upload current Custodian account statement to verify funds are available

Accredited

To be eligible as a Lender in this transaction, you must either be “Accredited” according to the first three statements below or, if you are not yet accredited, you can also qualify as a lender by being “Sophisticated” according to the fourth statement below.

Please select the most appropriate attestation statement.

---------------------------------------------------

FIRST STATEMENT: The Lender is “accredited” because he/she/it has:

Net worth, excluding principal residence, of $1,000,000 or more; or
Income of at least $200,000 for each of the last two years and it is expected to continue at that level this year; or
Combined income with a spouse of at least $300,000 for each of the last two years which is expected to continue at that level this year.

---------------------------------------------------

SECOND STATEMENT: The Lender is (otherwise) “accredited” within the meaning of 17 CFR §230.501. To include:

An entity, in which all of the equity owners are accredited; or
A trust, or corporation or partnership (within the meaning of Section 501(c)(3) of the Internal Revenue Code), with total assets in excess of $5,000,000, which is not formed for the specific purpose of acquiring the securities offered.

---------------------------------------------------

THIRD STATEMENT: The Lender is “accredited” under a least one of the above two categories; however, for reasons of financial privacy, elects not to specify the precise basis for eligibility.

---------------------------------------------------

Is the Lender Accredited?

Yes

No

Informed Lending Statement

It is important to us your client is making an informed decision regarding participating in Choice Energy Holdings. As the agent please make sure your client has been provided with the educational material on your affiliate link. All disclosure documents can be found in the flipping book linked to the Choice Energy Holdings opportunity page on your affiliate link.

I have provided the disclosure documents to my clients. They have read and understood the risks associated with lending to Choice Energy Holdings.
* 🛈

My clients have read and understand the disclosure documents.

Loan Options

Loan Amount (Please enter with a decimal and comma separators (example: $300,000.00)

If the lender is Sophisticated they are limited to lending no more than 10% of their net worth. For sophisticated lenders, the largest loan amount permissible is $99,000.00.

Sophisticated Lending Option *

Accredited Lending Option *

Interest Option *

9 Month Interest Option *