EX-4.1
from 10-K
7 pages
1. Investment Information 2. Type of Ownership ¨ I Have an Existing Account at Wells. My Account Number Is Investment Type (Please Check One) Dollar Amount $ ¨ Initial Investment (Minimum $5,000) in the Event of a Discrepancy Between the Dollar Amount Indicated Above and That of the Actual Check(s) Received, the Check Amount(s) ¨ Additional Investment (Minimum $100) Will Govern. State in Which Sale Was Made if Other Than State of Residence Method of Payment ¨ Check Enclosed ¨ Wire ¨ Transfer Request ¨ Check Under Separate Cover (Check Under Separate Cover May Delay the Processing of Your Investment) Please Make Check(s) Payable To: Wells Timberland REIT, Inc. ¨ Individual ¨ Transfer on Death Requires “Designation of Tod Beneficiary Form” ¨ Joint Tenants With Right of Survivorship ¨ Transfer on Death Requires “Designation of Tod Beneficiary Form” ¨ Ira Type ¨ Trust/Trust Please Specify Family, Living, Revocable, Etc. ¨ Ugma State ¨ Utma State ¨ Community Property ¨ Tenants-In-Common ¨ Qualified Plan Type ¨ Other We Do Not Accept Cash, Cashier’s Checks Under $10,000, Third-Party Checks, Money Orders, Traveler’s Checks, Starter Checks, or Counter Checks, Due to Anti-Money Laundering Considerations
12/34/56
