PELICAN HILL VINEYARDS LP

Please fill out completely and fax entire document along with the additional proof of identity documents required on page 14 to (888) 878-3042 attention Investor Relations or scan and email to info@pelicanhillpartners.com.

This form will be reviewed and if approved, will grant you a subscription to PELICAN HILL VINEYARDS LP. An additional purpose of this Form is to help PELICAN HILL ASSET MANAGEMENT LLC determine that the proposed investor is qualified to invest in PELICAN HILL VINEYARDS LP, and also to help determine if PELICAN HILL VINEYARDS LP is a suitable investment for the proposed investor. By Completing and signing this form you acknowledge that you have read and understand all of the Fund Documents, including Fact Sheet, Investor Presentations and Offering Memorandum.

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6. Do you and each other Subscriber (if any) make your own investment decisions?
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Do you and each other Subscriber (if any) have prior experience in private real estate investments?
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Are you or any other Subscriber (if any) subject to any civil, criminal, regulatory or other constraint or are you aware of any impediment or other reasons which may preclude or limit your participation in any Company investment?
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Your signature:
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