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?

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?

What structure do you use for capital raising? Please select all that apply:

How many investors are in your investor network?

Do you work with registered Broker-Dealers or Registered Investment Advisors to find new investors?

Do you use 506b, 506c, or 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?

Do you have international investors?

Do you take investors under the EB5 Investor Program?

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?

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?

Do you currently use an escrow provider?

Do you currently manage distributions or capital calls either internally or outsourced?

Do you use a 3rd party fund administrator?

Do you currently have an in-house engineering or technical team?

Do you currently have a dedicated marketing or investor relations team in place?

What do you do for outbound marketing? Please select all that apply:

Please provide any additional information about your company that you feel is important for WealthForge to know: