AGAP Life Offerings - Investor Password Request

Investor Password Request

(*) = Required Field

If applicable, enter your Investor Account # here:

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First Name (*)

Please type your first name.
Last Name (*)

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E-mail (*)

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Otherwise you will not receive your confirmation email.

State of Residence (*)

Please tell us how big is your company.
How did you find this site? (*)

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INVESTOR QUESTIONS

Do you qualify as an: (Select all that apply)
Accredited Investor
Sophisticated Investor
Institutional Investor
None of the Above

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Have you invested in any type of life settlement investment before?
Yes No
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Please state your current level of interest in investing in life settlements?

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Do you currently have an AGAP Life Offerings agent working with you?
Yes No
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Would you like to be contacted by an authorized AGAP Life Offerings agent in your area? You will NOT be contacted if you select NO.
Yes No
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Tell us how you would like to be contacted...

Contact me by this email:

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Contact me by this phone:

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Contact me at this address:

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Have you ever been charged, convicted or named in any financial crime, including wire fraud and mail fraud within the past 5 years? (*)
Yes No
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Have you worked for, been employed by, been contracted through or had any association with a federal or state level agency in the past 5 years? (*)
Yes No
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Acknowledgements (*)
I attest that I have read and understand the disclosure statement written on the Welcome Page of this site.

I am fully aware that by being granted access to this site that this access does NOT represent the authority to represent AGAP Life Offerings as an agent; nor does access to this site constitute a solicitation or sale. This site is for educational purposes ONLY and should not be used in any other manner.

I agree that by being given access to this site I will NOT utilize this access for any other purpose other than what I have attested to in this questionnaire. This includes, but is not limited to:

Gaining access for or to anyone other than myself
Stealing or copying intellectual property
Stealing or copying proprietary information

Any use of this website other than its intended use is considered unlawful and will be prosecuted to the full extent of any state and/or federal laws.

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Upon submitting this questionnaire you will receive a return email with the username and password for access. For inquiries or if you are denied access and you want to challenge the denial, please contact our office (888) 447-0050 or write to 2120 Bert Kouns, Suite H, Shreveport, Louisiana, 71118. All information requested in this questionnaire will be kept strictly confidential and will not be sold or otherwise distributed in any manner.