Smith Capital

The information you provide in this Investor Registration form is highly private and confidential at all times and will never be shared with any other individual or group other than Smith Capital. and yourself. We will only use the registration information you provide us below to share information regarding companies (private and public) that you request information about and are possibly interested in making an investment.

For email listings from companies, please complete the form below.

Contact Name:

Company Name:

Address:

City:

State:

Zip:

Phone:

Mobile Phone:

E-mail:

Preferences/Industries:
Preferred Investment Size:
Within the last 5 years, how many investments have you made?
Estimated Net Worth in U.S. Dollars:

	I wish to be on the mailing list for future Equity Investment.
	I wish to receive information on companies being considered for an investment
	I confirm my qualification in Rule 501(a) under the Securities Act of 1933 as amended.
	I wish to receive information on later-stage companies raising capital.