EIP - Energy Income Partners, LLC

Access Request Form

Please provide us with the following information. Items marked with * are required. We will then provide you with a username and password via email.

* Name:
*Company:
*Telephone: do not use dashes
* Email Address
*Mailing Address:
*City:
*State
*Zip Code:
How did you hear about us?
*I confirm that the undersigned is (check at least one - if applicable)
	a natural person who meets at least one of the following criteria: has an individual net worth, or joint net worth with the person's spouse, that exceeds $1 million; and/or has income exceeding $200,000 in each of the two most recent years, or joint income with a spouse exceeding $300,000 for those years and a reasonable expectation of the same income level in the current year.
	a trust with assets in excess of $5 million, not formed to acquire the securities offered, whose purchases a sophisticated person makes.
	a charitable organization, corporation, or partnership with assets exceeding $5 million.
	an employee benefit plan, within the meaning of the Employee Retirement Income Security Act, if a bank, insurance company, or registered investment adviser makes the investment decisions, or if the plan has total assets in excess of $5 million.
	a bank, insurance company, registered investment company, business development company or small business investment company.
	a business in which all the equity owners meet at least one of the definitions listed above.
	None of the above.
*Type of investor (please select one)	US Taxable US Non-Taxable Non-US
Comments:

49 Riverside Avenue • Westport, CT 06880 • 203.349.8232 • ir@energymlp.com