Investor Questionnaire

PERSONAL INFORMATION

FINANCIAL INFORMATION

FURTHER REPRESENTATIONS AND WARRANTIES

The undersigned is willing and able to bear the economic risk of an investment in oil and gas. Additionally, the undersigned agrees to protect and safeguard all information and materials obtained from Glacier Financial Partners, Ltd. Co. and its affiliates and treat such information and materials as proprietary and confidential. Any unauthorized dissemination, disclosure, distribution or copying of any materials provided to the undersigned by Glacier Financial Partners, Ltd. Co. or its affiliates is strictly prohibited and will be prosecuted to the full extent allowable by law.

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