Principled Capital Management

Accredited Investor Registration Form

In accordance with Rule 501(a) of Regulation D, only accredited investors may view the information concerning Principled Capital Management, LLC. To find out if you are considered an accredited investor, read the terms and conditions.

If you are not an accredited investor, please do not fill out the following form.

How did you find out about Principled Capital Management, LLC?

Do you invest in hedge funds?

Yes

Do you invest in fund of funds?

Yes

Do you invest in CTA funds?

Yes

Do you invest in Venture Capital funds?

Yes

Please choose the option that best describes you:

In how many hedge funds are you currently invested?

Size of portfolio:

First Name:

Last Name:

Job Title:

Business Name:

Street Address:

City:

State/Province:

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Country:

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Fax:

Web Site:

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User Name:

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I hereby certify that I am an accredited investor in accordance with Rule 501(a) of Regulation D, in that (please check one)

I am a natural person whose individual net worth, or joint net worth with my spouse, at the date hereof exceeds $1 million

I am a natural person whose individual net worth, or joint net worth with my spouse, at the date hereof exceeds $5 million

I am a natural person who has individual income in excess of $200,000 in each of the two most recent years or a joint income with my spouse in excess of $300,000 in each of those years and have a reasonable expectation of reaching the same level of income in the current year; or

My organization is an entity with total assets in excess of $5,000,000; or

My organization is an entity with total assets in excess of $25,000,000

Other