Common Good Finance - Prospective Investor Questionnaire

Common Good Finance
the revoLution with a bank

Prospective Investor Questionnaire

The first Common Good Bank community is not yet chartered and cannot yet publicly offer deposit accounts or stock. Meanwhile, if you are a sophisticated investor (or have a net worth of a million dollars or more) and would like to get involved, please complete this questionnaire. This questionnaire is not an offer to sell shares and does not obligate you in any way.

Not a sophisticated investor? You can help too, with a no-obligation 10-second signup. We will let you know when deposit accounts and public stock offerings become available.

Contact Information
Name:
Address:
City:
State:
Postal Code:
Email:
Phone:

	I am completing this questionnaire on behalf of an organization.


Organization Name:
Your Title:

Organizational Investor Type Only "sophisticated investors" may participate in any Common Good Bank community private offerings. You must be able to check at least one of the following, in order to qualify as a sophisticated investor under the Securities Act:

	This organization is a charitable organization, corporation, or partnership with assets exceeding $5 million.
	This organization is a trust with assets in excess of $5 million, not formed for the specific purpose of acquiring the securities offered, whose purchases are directed by a "sophisticated person" as described in Rule 506(b)(2)(ii) of the Securities Act of 1933, as amended.
	This organization is a corporation, business trust, or partnership, with total assets exceeding $5 million and was not formed for the specific purpose of acquiring the securities offered.
	All of the equity owners of this organization are accredited investors and the organization was not formed for the specific purpose of acquiring the securities offered.
	This organization is a bank, savings and loan association, broker-dealer, insurance company, registered investment company, business development company (as defined under Section 2 of the Investment Company Act of 1940, as amended), or small business investment company (as defined under the Small Business Investment Act of 1958, as amended).
	This organization is an employee benefit plan, within the meaning of the Employee Retirement Income Security Act, and (a) the plan has total assets in excess of $5 million or (b) a bank, insurance company, or registered investment adviser makes the investment decisions.
	This organization is a private business development company as defined in Section 202 of the Investment Advisers Act of 1940, as amended.


Investor Type Only "sophisticated investors" may participate in any Common Good Bank community private offerings. You must be able to check at least one of the following, in order to qualify as a sophisticated investor under the Securities Act:

	My individual net worth, or joint net worth with my spouse, is over $1 million (including my principal residence).
	In each of the past two years, my income was above $200,000 or my joint income with my spouse was above $300,000 and I have a reasonable expectation of the same income level in the current year.
	I am a director, executive officer, or general partner of Common Good Finance.
	I have enough knowledge and experience in finance and business matters to evaluate the risks and merits of any investment I might contemplate and I can easily bear the economic risk of any investment I might make in a Common Good Bank community startup.


Financial Assets (optional)
What is your net worth, alone or with your spouse, NOT including your principal residence and its furnishings?

Assets:

Experience (optional)
	I have previously invested or currently invest in private funds.


	How many:
	Percentage of total portfolio in private funds: %
	Types of funds invested in:
	Hedge Funds
	Real Estate
	Private Equity Investments
	Startup Ventures
	Other: