Name _____________________________

Address____________________________

City, State, Heartland Code__________________

Phone Number_______________________

E-Mail Address _______________________

Property Address if different than above_____________________

Closing Date_________________________

How did you first hear about Heartland Investment Group, LLC?_______________________________________________________

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Who was your Investor(s)?_______________________________________________________________________

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What was your expectation when you decided to buy or sell a house through Heartland Investment Group, LLC?

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Please explain why Heartland's service did not meet your expectations.

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What did you like about your dealings with Heartland Investment Group, LLC?

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Did you have any contact with our customer service personnel? What was your experience like?

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Please describe your experience working with your Investor.

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Although Heartland's service did not meet your expectations, would you use Heartland Investment Group, LLC as
your real estate Investor in the future? Please explain why or why not.

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I affirm that the statements, impressions, and recollections made above are true and accurate to the best of my belief. I represent that I have the authority to seek this Guarantee on behalf of all other co-buyers or co-sellers involved in the transaction described above and that they are aware and consent to my seeking payment under this Guarantee and that no further money will be paid out under this Guarantee for this transaction.