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Purchaser Registration Request
General Information Property Name: Total Equity: 1031 Funds: Non 1031 Funds: Regional Director: Broker Name (if any): Company: Agent Name (if any): Telephone: Facsimile: Email: ( ( ) )
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Qualified Intermediary * Contact Name: Company: Address: City, State, Zip Telephone Facsimile Email Down-Leg Close End of 45 Day End of 180 Day Document Delivery: ( ( ) )
Purchaser Information ** Name(s) or Entity
SSN/TIN & State ***
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Address: City, State, Zip Telephone Facsimile Email ( ( ) )
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Preferred Method of Delivery of Due Diligence/Transaction Documents:
Documentation * **
Email
Federal Express
If Purchaser is completing a 1031 exchange, a current accounting of all funds held by their QI must be provided with this reservation. If Purchaser is a Corporation, LLC, LLP, Trust or other, complete entity documents must be provided with this reservation.
*** If Purchaser is a Corporation, LLC, LLP, Trust or other, please provide and indicate the TIN and State of formation. Signature
THE UNDERSIGNED HAS THE AUTHORITY TO ENTER INTO A PURCHASE AGREEMENT (THE “TIC PURCHASE AGREEMENT”) ON BEHALF OF THE PERSON(S) OR ENTITY INDICATED ABOVE. THE UNDERSIGNED REPRESENTS AND WARRANTS THAT IT IS HIS/HER/ITS INTENT TO PURCHASE THE ABOVE NOTED PROPERTY EQUITY FROM THE OFFERING AS ABOVE DESCRIBED AND THE CONFIDENTIAL OFFERING MEMORANDUM TO BE DELIVERED TO THE UNDERSIGNED BY THE COMPANY UNDER SEPARATE COVER. THE UNDERSIGNED REPERESENTS AND WARRANTS THAT OTHER THAN THE ABOVE SPECIFICALLY IDENTIFIED BROKER(S) (IF ANY), THEY HAVE NOT DEALT WITH ANY BROKER IN CONNECTION WITH THIS TRANSACTION. THE UNDERSIGNED ACKNOWLEDGES THAT THIS FORM IS ONLY A REQUEST FOR A RESERVATION AND DOES NOT GUARANTEE THAT HE/SHE/IT WILL RECEIVE ALL OR ANY OF SAID EQUITY. THE UNDERSIGNED AGREES THAT IF GRANTED THE RESERVATION FOR PROPERTY EQUITY IN THIS PROPERTY THAT HE/SHE/IT WILL COMPLETE THE REQUIRED DOCUMENTS AND PROVIDE ADDITIONAL DOCUMENTATION AS REQUIRED BY THE SPONSOR WITHIN THE TIME FRAMES GIVEN IN THE TIC PURCHASE AGREEMENT. FAILURE TO COMPLY IN A TIMELY MANNER MAY RESULT IN THE LOSS OF RESERVED PROPERTY INTERESTS.
Executed this Purchaser 1: Name & Title
Day of
20
, at Purchaser 2: Name & Title
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Mile High Home Solutions, LLC - 5023 W 120th Ave # 265, Broom eld, CO 80020 - 303-885-5646 - 720-887-4124 fax TIC-1031@mhHomeSolutions.net EMAIL FORM PRINT FORM