Name of Representative *
Business Address *
City *
State *
Zip *
Primary Phone *
Mobile Phone *
Email *
Contact Person *
Age of Representative * Under 18
18 - 29
30 - 39
40 - 49
50 - 59
Over 60
Present Occupation *
Years at Present Occupation * 0 - 4
5 - 9
10 - 14
Over 15
Field of Practice or Specialization *
List Colleges or Universities Attended *
Degrees or Certifications Received * Associates
Bachelors
Masters
Doctorate
Law
Other Post-Graduate
Certified Financial Analyst
Certified Financial Planner
Professional Licenses or Registrations Currently Held * State Bar Admission
Certified Public Accountant
Real Estate Agent or Broker
Securities Broker/Dealer
Insurance Agent
Mortgage Broker or Banker
Other
Describe any Real Estate Securities Experience *
Attach Resume *
Name(s) of Supreme Hotels' Investor(s) You Represent *
Indicate Compensation From Investors in This Offering *
Type Name of Representative *
  


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