Purchaser Questionnaire Clause Samples

Purchaser Questionnaire. The Company shall have received a completed Purchaser Questionnaire in the form attached hereto as Exhibit A from the Subscriber, which questionnaire shall have responses thereto acceptable to the Company, in its reasonable discretion.

Purchaser Questionnaire. Pursuant to Section 1 of Annex I to the Agreement, please provide us with the following information:

Purchaser Questionnaire. You are being requested to answer questions in connection with the proposed offer and sale, pursuant to an exemption from the registration provisions of the Securities Act of 1933, as amended (the "Act") and in particular, Rule 505 of Regulation D, of shares of the Common Stock, $.002 par value per share (the "Shares') of American Film Technologies, Inc, a Delaware corporation (the "Company"). The availability of the exemption depends, in part, on a determination that each purchaser is an "accredited investor" as defined in Rule 501(a) of Regulation D. The information supplied will be used in determining whether the sale of the Shares meets such criteria. The information will be kept confidential and will not be disclosed except to the Company, its counsel, and if required, to governmental and regulatory authorities. Please PRINT your response to each question; and, where the answer to any question if "None" or "Not Applicable" please so state. I, (we), __________________________________, understand the Shares are being issued WITHOUT registration under the Act in reliance upon the private offering exemption contained in Rule 505 of Regulation D promulgated under Section 4(2) of the Securities Act, and that such reliance is based in part on the information herein supplied. For the foregoing reasons, and to induce the Company to issue and deliver the Shares to me, I represent and warrant that the information stated herein is true, accurate and complete to the best of my knowledge and belief, and I agree to notify and supply corrective information promptly if, prior to the consummation of my purchase of the Shares, any of such information becomes inaccurate and incomplete. INDIVIDUAL AND JOINT PURCHASERS SHOULD COMPLETE SECTION A CORPORATIONS, BUSINESS TRUSTS AND PARTNERSHIPS SHOULD COMPLETE SECTION B

Purchaser Questionnaire. Each subscriber must read carefully, complete and sign the Purchaser Questionnaire attached as Exhibit A. For purposes of this offering, you must demonstrate that you meet the investor suitability standards set forth below: Investment in the Company involves certain risks and is suitable only for persons of adequate financial means who have no need for liquidity with respect to this investment and who can afford the risk of a complete loss of their investment.

Purchaser Questionnaire. Such Purchaser has completed or caused to be completed the Purchaser Questionnaire in substantially the form as set forth on Exhibit B, or in another form acceptable to the Company and the information provided by each Purchaser in such Purchaser’s Purchaser Questionnaire is true and correct as of the date of this Agreement and shall be true as of the Effective Date.

Purchaser Questionnaire o All Purchasers should complete the relevant portions of Part I of Appendix A. o Please answer all questions in Part II, III and IV of Appendix A. If the Purchaser believes that certain questions in Part III are not applicable, please fill out “N/A” as answers to such questions. o All Purchasers who potentially will hold 20% or more in Interests in the Fund should complete Part V of Appendix A, and Purchasers should contact the General Partner if they are not certain whether they should be completing Part V of Appendix A.

Purchaser Questionnaire. The undersigned represents and warrants as to the domicile and formation information provided below and that it comes within each category marked below, and that for any category marked, it has truthfully set forth the factual basis or reason the undersigned comes within that category. The undersigned agrees to furnish any additional information which Auxilio, Inc. (the “Company”) deems necessary in order to verify the answers set forth below. All terms not otherwise defined herein shall have that same meaning ascribed to such term in that certain Asset Purchase Agreement by and between the Company and Redspin, Inc., dated as of March ___, 2015.

Purchaser Questionnaire. All Purchasers should complete the relevant portions of Part I of Appendix A. · Please answer all questions in Parts II, III and IV of Appendix A. If the Purchaser believes that certain questions in Part III are not applicable, please fill out “N/A” as answers to such questions. · All Purchasers who may potentially hold 20% or more in Interests in the Fund should complete Part V of Appendix A, and Purchasers should contact the General Partner if they are not certain whether they should be completing Part V of Appendix A. · Each Purchaser who is a Hong Kong Investor (as defined herein) and/or indirectly owned by one or more Hong Kong Investor should complete Part VI of Appendix A.

Purchaser Questionnaire. (Individual)