Welcome!

	We have a one-of-a-kind investment opportunity, available to a limited number of investors. After reviewing your preliminary information we will contact you with details and a complete investors packet. Thank you for visiting and we look forward to welcoming you in person soon. If you have specific questions, comments or suggestions please write directly to: carlos@hispanos-usa.com

Investor's Questionnaire

Are you familiar with Hispanos USA by looking at the current website?	Yes No
Please briefly describe why you are interested in Hispanos USA, any previous investment experience or expertise you have in the industry and/or tell us about someone you know personally who may also be interested in this opportunity:
What is your current investment interest level?	$100,000 $250,000 $500,000 $1,000,000+
Are you currently liquid for this amount right now?	Yes No
Do you have an IRA or similar retirement account you might wish to use for investing purposes?	Yes No
Hispanos USA is poised for healthy growth in the communications industry. This investment opportunity questionnaire is part of the qualifing process, confidential and due to increased interest will resume with a second round expected in 2012. Provide us with your contact information below.

Contact Information

Privacy Statement

Information we collect from you will be used only to inform you about this investment opportunity and kept in strict confidentiality.

First Name:
Last Name:
Email Address:
Home Phone:
Alternate Phone:
Mailing Address:
Address line 2: (Optional)
City:
State/Province:
Postal Code:
Country: