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Full Name / Entity Name

First NameLast Name

Date of Birth / Incorporation Date

Date

Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

City

State/Province

Zip / Postal Code

Email Address

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Government-issued ID / EIN Upload

Country of Citizenship / Residency

Membership Status Confirmation

Declaration of Compliance with Membership Requirements

Optional Investment Experience

Understanding of SEC Regulation D Private Placement

Returns Tied to Nonprofit's QGI Bond Portfolio

Number of Tokens/Notes to Allocate

Pro-rata Rights Included

Acknowledgment that Instrument Does Not Represent Ownership

Authorization for Identity Verification and AML/KYC Compliance

Acknowledgment of Potential Tax Implications

Signature (Digital)

First NameLast Name

Date of Signature

Date

Upload Government-issued ID/EIN Document

SNAP Organization Registration Form 1-A