Your Information

This questionnaire is required by Planet ReGen, Inc. to confirm that you qualify as an Accredited Investor under Rule 501(a) of Regulation D. All information is confidential.

Full Legal Name*

Entity Name (if investing as entity)

Email Address*

Phone Number (optional)

Mailing Address*

City*

State / ZIP*

Investor Type*

Individual

Investing in my own name

Joint (spouse / domestic partner)

Both parties must qualify as Accredited Investors

Entity

Corporation, LLC, partnership, trust, or other entity

IRA / Self-Directed Retirement Account

Investor controls investment decisions

Referred By (optional)

🔒 All submissions are encrypted and confidential. Used solely to confirm accreditation status.

Step 2 of 4 · Accreditation Basis

Accreditation Basis

Select all categories that apply to you. You must qualify under at least one category to proceed.

Individual Categories

Income — Individual

I have had individual income exceeding $200,000 in each of the two most recent calendar years and reasonably expect the same in the current year.

Income — Joint

My spouse/domestic partner and I have had joint income exceeding $300,000 in each of the two most recent calendar years and reasonably expect the same in the current year.

Net Worth

My individual or joint net worth (with spouse/domestic partner) exceeds $1,000,000, excluding the value of my primary residence.

Licensed Professional

I hold in good standing a Series 7, Series 65, or Series 82 license issued by FINRA.

Entity Categories

Entity with Total Assets > $5,000,000

The entity was not formed for the specific purpose of making this investment and has total assets exceeding $5,000,000.

All-Accredited-Investor Entity

All equity owners of the entity are themselves Accredited Investors.

Registered Investment Adviser / Broker-Dealer

The entity is a registered investment adviser or broker-dealer.

Family Office

The entity is a family office with assets under management exceeding $5,000,000, not formed for the specific purpose of making this investment.

None of these apply to me

I am not currently an accredited investor.

Your Information

Accreditation Basis

Investment Experience

Review & Submit

Application Received.