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Partner / Financial Intermediary Sign-Up Form

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Thank you for your interest in utilizing the Alpha Energy Partners website. We are permitted under federal law to share information on our partnerships only with accredited investors who are partners in our investments and their financial fiduciaries. If you are a partner, please complete the form directly below. You will be notified by a representative from our Partner Services department to verify information and provide access to our site. If you are a financial intermediary, please complete the additional information as requested

I am a partner*
I am a financial intermediary*
Contact information
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Accredited Investor Information
Are you a U.S. Person? (See full definition of U.S. person below)*

Do you meet at least one of the three criteria of an accredited investor listed below? (See full definition of accredited investor, net worth, and income below)*

  1. Your individual net worth, or joint net worth with spouse, at the time of investment purchase exceeds $1,000,000;
  2. You had an individual income in excess of $200,000 in each of the two most recent years and reasonably expect an income in excess of $200,000 in the current year.
  3. You and your spouse have had joint income for the two most recent years in excess of $300,000 and expect your joint income to be in excess of $300,000 for the current year.

By electronically signing below, you are affirming that all the information contained herein is true and correct to the best of your knowledge and belief. Furthermore, your signature in compliance with ESIGN (see description of ESIGN below) legally binds you to the document above, and a complete record of each signature is kept.


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Financial Intermediary Information
I have a securities license:*
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As an Intermediary, which type are you? (Please mark the appropriate designation)*
How many years experience investing in oil and gas partnerships do you have?*
years

Do you believe that you and/or your clients have sufficient knowledge and experience in financial and business matters to evaluate the merits and risks of oil and gas partnerships?*

By electronically signing below, you are affirming that all the information contained herein is true and correct to the best of your knowledge and belief. Furthermore, your signature in compliance with ESIGN (see description of ESIGN below) legally binds you to the document above, and a complete record of each signature is kept.

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Definitions

Annual Earnings:

Annual earnings means adjusted gross income, as reported for federal income tax purposes, less any income attributable to a spouse or to property owned by a spouse, increased by the following amounts:

  1. The amount of any loses claimed as a partner in a partnership.
  2. Any deductions claimed for depletion.
  3. Amounts contributed to an IRA or KEOGH retirement plan.
  4. Amount of any tax exempt interest income received.
  5. Alimony paid.
  6. Any amount by which income from long-term capital gains has been reduced in arriving at djusted gross income pursuant to the provisions of section 1202 of the Internal Revenue Code of 1954, as amended.

Accredited Investor:

You are an accredited investor if any one of the following is true:

  1. Your individual net worth or joint net worth with spouse, at the time of the investment purchase exceeds $1,000,000.
  2. You had individual income in excess of $200,000 in each of the two most recent years and reasonably expect an income in excess of $200,000 in the current year.
  3. You and your spouse have had joint income for the two most recent years in excess of $300,000 and expect your joint income to be in excess of $300,000 for the current year.

Net Worth:

The fair market value of all assets, excluding home, furnishings and personal automobiles.

Qualified Purchaser:

The fair market value of all assets, including home, furnishings and personal automobiles is or exceeds $500,000.

U.S. Person:

A U.S. person is defined as an individual who is a national or permanent resident alien of the US and any corporation, business association, partnership, trust or other judicial entity incorporated or permanently residing in the U.S.

ESIGN:

The Electronic Signatures in Global and National Commerce Act (ESIGN) was enacted by Congress on June 30, 2000. ESIGN was enacted to facilitate the use of electronic records and signatures in interstate and foreign commerce by ensuring the validity and legal effects of contracts entered into electronically. ESIGN gives the same legal protection to online signing as to traditional pen-and-paper signing.