Marketfield Asset Management

MARKETFIELD ASSET MANAGEMENT, LLC

	Accredited Questionnaire

	Enter Contact Information Below. Asterisk denotes required field.

	*First Name			*Last Name
	*Address 1			*Firm
	Address 2			Title
	*City - State - Zip			*Telephone
	*Country			Mobile
	*Email			Fax


What description would best suit you?	Individual Corporation Family Office Profit Sharing Trust	Pension Endowment or Foundation U.S. Tax-Exempt Entity Other
Corporate Entities

Describe your Company
Founded or Incorporated on:
State of Jurisdiction of Formation
Do your Net Assets exceed $ 5 million?	Yes	No
Are you Affiliated with a U.S. Based Financial Securities Firm?	Yes	No

Individuals

My net worth. or joint net worth with spouse exceeds $1,000,000	Yes	No
Either I or a member of my household is affiliated with a U.S. Based financial securities firm.	Yes	No
Years of Investment Experience

Qualified Purchasers

I act for my own account or the accounts of other “qualified purchasers” who in the aggregate own and invest on a discretionary basis at least $25 million in investments.	Yes	No

By clicking “I Agree” you represent that the answers to the foregoing questions are true and accurateto the best of your knowledge. You also acknowledge that Marketfield Asset Management is using this questionnaire to determine the eligibility of the individual/entity as a potential investor. Marketfield Asset Management is not using this questionnaire to solicit the purchase or sale of any security.