Set Up a New Investment With Midland

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COMPLIMENTARY ONEPATH FOR APPLICABLE INVESTMENT TYPES

To set up a new investment, Midland requires this form to be completed before onboarding IRA investors. This form helps us better understand the nature and expectations of the investment. We will determine the administrative feasibility and tailor our excellent customer experience. Midland does not perform due diligence on any investment offering. We do not need performance reporting or audited financials. Midland does not review for investment viability or suitability.

Set up a new investment with Midland by completing the form below.

Step 1 of 5

Issuer Information
Company*
Company EIN*
Main Office Address*
City*
State*
Zip Code*
Do you have additional offices in other locations?
- Yes
- No
If so where?
Phone*
Company Website
Principal/Owner Name*
Direct Phone
What Midland representative or IRA investor you are working with?

FUND ADMINISTRATOR INFORMATION (IF APPLICABLE)
Company
Contact Name
Phone
Email

INVESTMENT INFORMATION
Offering Type*
Describe
INVESTMENT NAME
Tell us about this investment. Describe what investors are buying and what funds will be used for:*
List all documents required for investment to be completed. (Attach blank copy of all documents)
Drop files here or

Accepted file types: pdf, doc, docx.
File size limit: 10MB. Acceptable file types: .doc | .docx | .pdf
Are there any key dates that we should be aware of for this investment, such as deadlines?*
How long do you expect investors to hold this investment?
After initial investment, do you expect additional capital calls or investment fundings? If so, how often?
Expected investment amount $
Minimum $*
Average Range $
Is this an investment where investors can or will easily request withdrawals or payoffs on demand?
How many IRA investors do you expect to invest into this offering?
Are income payments expected from this investment?
If Yes, please provide details
Expected Frequency
Payment Method
Does your offering currently use leverage or plan to obtain leverage? If yes, Midland IRA will notify clients that they may need to file IRS Form 990T.*
Do you provide a statement to the investor?* If so, how frequently and by what delivery method (email, mail, etc)?*
Frequency and Delivery Method
Federal regulation requires Midland to receive a valuation on all assets for reporting purposes. Valuations must be submitted at least annually no later than January 15th for prior year. The requirements vary based on asset type. If you provide statements, the statement may be sufficient for this requirement. If you do not provide regular statements, who will be providing valuation for this asset? Include company name, contact name, phone, email:
What type of supporting documentation will you be able to provide for this valuation purposes?
In order to obtain information about your investors’ IRA account, including status information, each investor will need to sign an “Interested Party Form”. This form will also permit you to view accounts online.
Do you want us to set you up with online access?
List names, email addresses, and phone numbers of representatives that will be working with Midland in regards to this investment:
Name*
Email*
Phone*
Describe any further information not already covered that is pertinent to this investment:

WIRE INSTRUCTIONS
Bank Name
Account Holder Name
ABA Routing Number
Account Number
Price Per Unit/Share

In order for Midland Trust Company (“Midland”) to administer this asset, the investment issuer agrees to the following:
1. Issuer agrees to register ownership of investment to:
  Midland Trust Company, As Custodian FBO (Client Name) (Client Account Number) P.O. Box 07520, Fort Myers, FL 33919
2. Issuer understands that the Taxpayer EIN for all Midland investments held in Traditional, Roth, SEP, Simple,HSA, and ESA accounts is 47-5560347. The IRA investors’ SSN should never be used for reporting purposes for retirement account investments. Employer plans such as 401k plans have a unique Tax ID for the plan.
3. Issuer agrees to issue all payments, income, dividends, distributions and/or payoffs directly to Midland IRA.Due to regulation, it is not acceptable to send funds directly to an IRA holder.
4. Issuer understands that Midland has not performed any due diligence on this investment, and understands that Midland IRA does not endorse this investment.
5. Issuer agrees that the investments offered are not directly or indirectly related to any asset class deemed illegal by the Federal Government.
6. Issuer agrees to provide Midland with annual valuation information as defined by IRS Publication 590
7. Issuer agrees to provide Midland with evidence of ownership of each investment including original stock certificates, or written confirmation.
8. Issuer acknowledges that IRAs are restricted from making mandatory capital calls if the capital call results in a prohibited transaction. Any additional investment will be done so on the account holder’s discretion.
9. Issuer agrees to inform Midland if they become aware of any prohibited transaction as defined in IRC 4975.This would include IRA transactions with prohibited parties, transactions that personally benefit the IRAholder, and/or investments in life insurance or collectibles, which are prohibited by IRC 4975.
10. Issuer agrees to notify Midland of any changes in address contact, or company status.
11. Issuer understands that Midland does not promote, sell, or distribute any investment, including the investment described in this document. Additionally, Midland will not provide investment, tax, or legal advice to any party,including the issuer and/or IRA holders. Issuer understands that Midland IRA is a self-directed IRA administrator not an investor.
12. Issuer agrees to not make any representations to any party that may contradict the language in this document.
READ, UNDERSTOOD, AND AGREED TO BY:
Signature*
Printed Name*
Company*
Title
Phone*
Email*

DOES YOUR INVESTMENT OFFERING HAVE A SUBSCRIPTION AGREEMENT? IF SO, CONSIDER MIDLAND ONEPATH.

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Set Up a New Investment With Midland

Step 1 of 5

Issuer Information

FUND ADMINISTRATOR INFORMATION (IF APPLICABLE)

INVESTMENT INFORMATION

INVESTMENT NAME

WIRE INSTRUCTIONS

READ, UNDERSTOOD, AND AGREED TO BY:

DOES YOUR INVESTMENT OFFERING HAVE A SUBSCRIPTION AGREEMENT? IF SO, CONSIDER MIDLAND ONEPATH.

Why Choose Midland

Responsive
Service

Cutting-Edge
Technology

Stands the
Test of Time

Call Us Nationwide (239) 333-1032

Quick Links:

Stay in the Know:

Set Up a New Investment With Midland

Step 1 of 5

Issuer Information

FUND ADMINISTRATOR INFORMATION (IF APPLICABLE)

INVESTMENT INFORMATION

INVESTMENT NAME

WIRE INSTRUCTIONS

READ, UNDERSTOOD, AND AGREED TO BY:

DOES YOUR INVESTMENT OFFERING HAVE A SUBSCRIPTION AGREEMENT? IF SO, CONSIDER MIDLAND ONEPATH.

Why Choose Midland

Responsive Service

Cutting-Edge Technology

Stands the Test of Time

Call Us Nationwide (239) 333-1032

Quick Links:

Stay in the Know:

Responsive
Service

Cutting-Edge
Technology

Stands the
Test of Time