Entity Enrollment

Sports Gaming Media, LLC
Entity Enrollment Questionnaire

Thank you for your interest in Sports Gaming Media. As part of our efforts to remain compliant with the Securities Act, we must vet all potential investors for accredited status. Please complete and submit the following enrollment questionnaire to receive access to our business documents.

The Purpose of this Questionnaire is to solicit certain information regarding your financial status to determine whether you are an “Accredited Investor,” as defined under applicable federal and state securities laws, and otherwise meet the suitability criteria established by the Company for purchasing Shares.  This questionnaire is not an offer to sell securities.   Your answers will be kept as confidential as possible. You agree, however, that this Questionnaire may be shown to such persons, as the Company deems appropriate to determine your eligibility as an Accredited Investor or to ascertain your general suitability for investing in the Shares.

Please answer all questions completely.

Entity Name *

List the registered name of your business, trust, etc

Street Address 1 *

Street Address 2

City *

State *ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPAPRRISCSDTNTXUTVTVAWAWVWIWY

Zip Code *

Company Representative *

Representative Phone *

Representative Email *

Preferred Contact Method *

• Phone
• Email

List your preferred contact method.

Are you a Trust, with assets totaling at least $5,000,000? *

• Yes
• No

Are you a Bank or Savings & Loan? *

• Yes
• No

Are you a registered Broker Dealer? *

• Yes
• No

Are you an Insurance Company? *

• Yes
• No

Are you an Investment Company, under the Investment Company Act? *

• Yes
• No

Are you a Small Business Investment Company under the Small Business Investment Act? *

• Yes
• No

Are you a Plan maintained by a State or one of it's Political Subdivisions? *

• Yes
• No

Are you an Employee Benefit Plan under the Employee Retirement Income Security Act (ERISA)? *

• Yes
• No

Are you a Private Business Development Company, as defined by the Investment Advisors Act? *

• Yes
• No

Are you a Corporation, Limited Liability Company, Partnership or similar Business Trust, with assets totaling at least $5,000,000 *

• Yes
• No

Are you another type of entity, with all equity owners being "accredited investors"? *

• Yes
• No

Describe any relevant investment experience you may have. *

Describe any relevant publishing and broadcasting experience you may have. *

Do you have any additional comments? *

Sports Gaming Media Updates

• Yes, I would Like to Receive Updates from Sports Gaming Media

Review Information and Certify *

• I certify, under penalty of law, that the information I have provided is truthful and accurate

Digital Signature *

Please type your name to digitally sign the document.

Date: *

Submit