Accredited Investor Disclosure Form

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This form is to gather information on anyone wishing to receive information about private offering investments. The General Partner will verify the information. If he is satisfied that you meet the requirements of an "Accredited Investor", then information will be provided.

The information collected is kept strictly confidential. Please review the privacy policy if you have any concerns about how the information will be used.

Name
Street
City
State
Zip
Phone
Net Worth Certification	I am a natural person whose individual net worth, or joint net worth with my spouse, at this time exceeds $1,000,000.
Income Certification	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.
Certification of Accredited Investor Status	I have read and understand the meaning of "accredited investor" as described above and certify that I met the requirement as defined in Regulation D of the Securities & Exchange Commission.
Certification of Information Submitted	I certify that all the information submitted is true and correct.
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	I am interested in information on the following
	Investment in Partnerships
	Please Contact Me

Valcour, Inc.

140 Roosevelt Avenue, Suite 209

York, Pennsylvania 17401

717-852-7702 voice

717-852-7122 fax

generalinfo@valcourinc.com