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Non-Broker-Dealer Risk Assessment Questionnaire

Entity Name
First Name
Last Name
Email Address
Email Address
Address
Phone
State of Incorporation
How long have you been operating?
How many employees are in your organization?
What industries do you focus on?
Real Estate
Energy
Private Equity
Technology
Other
Describe your business:
Do you plan to raise capital for multiple offerings over the next 12 months?
If you have a current opportunity, please upload offering documents:
How much capital do you plan to raise in the next 12 months?
What percentage of your total raise amount will you rely on being raised from an outside distribution network?
What is the average deal size?
What is your typical investment minimum?
What do you typically offer as an investment vehicle?
Debt
Equity
Hybrid
What structure do you use for capital raising? Please select all that apply:
SPV
Fund
Direct Issuer
Other
How many investors are in your investor network?
Do you work with registered Broker-Dealers or Registered Investment Advisors to find new investors?
Yes
No
Do you use 506b, 506c, or other?
506b
506c
Other
How many Regulation D deals have you done in the last 5 years?
Do you currently have a compliance or operations team in place?
Yes
No
Do you have international investors?
Yes
No
Do you take investors under the EB5 Investor Program?
Yes
No
Any special conditions with your capital raising activity? (i.e. 1031 exchange, offshore entities, etc.)
How are you compensated? (i.e. commission, fees, etc.)
Is your compensation directly tied to the success of the capital raise itself?
Yes
No
Do you use an outside law firm? If so, please list your primary outside securities counsel:
Do you use an outside CPA firm? If so, please list your primary outsourced accountant:
Do you perform your own underwriting?
Yes
No
Do you currently use an escrow provider?
Yes
No
Do you currently manage distributions or capital calls either internally or outsourced?
Internally
Outsourced
Do you use a 3rd party fund administrator?
Yes
No
Do you currently have an in-house engineering or technical team?
Yes
No
Do you currently have a dedicated marketing or investor relations team in place?
Yes
No
What do you do for outbound marketing? Please select all that apply:
Phone
Email
PR
Website
Events
Networking
Other
Please provide any additional information about your company that you feel is important for WealthForge to know:
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