Repository Capital LLC Client Questionnaire

Repository Capital LLC Client Questionnaire

The purpose of this form is not to collect a full data room or complete diligence package. It is only intended to help us screen whether a company is: 1. Ready for a potential direct capital raise review. 2. Better suited for Capital Raise Readiness first. 3. Not ready / not a fit at this time.
Company and Contact Information
Referral Source
Company Legal Name
Other DBA Names
Company Website
Direct Point of Contact
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Advisors and Authorization / Engagement Consents
Principals and beneficial owners owning more than 20%
Legal Advisor / Counsel
Accounting / CPA
Wealth Advisors
Fund Administrator
Other Advisors of Significance
Authorization to engage with Repository Capital for services
Registration and Formation Details
Registration/ formation type

Other
Registration/formation - Other (describe)
Date formed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
State formed
Business Overview
Describe your company, product, and/or service
Who are your customers/clients?
What is your competitive advantage? What makes you unique?
What structural advantages or barriers to entry protect your business from competition? (Examples may include proprietary technology, data ownership, exclusive relationships,contracts, regulatory advantages, location, brand, operational complexity, other factors.) If applicable, how does technology or AI enhance or defend your business model?
Why are you seeking capital? What will this capital allow you to accomplish? (Be concise: e.g., extend runway 12 months, fund acquisition, refinance debt, scare sales, etc.)
When did you start the company? How long have you been operating?
Desired timing to secure this capital
Describe your long-term goals (3–5 years) and eventual exit strategy
Financial Reporting and Performance
Is financial reporting available?
Which fiscal years?
When is fiscal year end?
Accounting basis used
Accounting basis - Other (describe)
Level of reporting
Do you have a pro forma statement or projections for the coming year?
Do you have existing debt or other fixed obligations?
Are you currently generating revenue?
Have you been profitable in prior years?
Do you expect to be profitable this year?
Describe your sources of revenue. Note contracted or subscription revenue.
Describe your current cash position, access to additional cash, monthly cash generation or burn rate.
Current monthly cash burn (if applicable)
How many months of runway do you currently have?
Capital Planning
Type(s) of funding sought

Other
Type of funding sought - Other (describe)
Capital raised to date (amount, type, and source)? (Examples may include proprietary technology, data ownership, exclusive relationships,contracts, regulatory advantages, location, brand, operational complexity, or other factors.)
Have you ever engaged a 3rd-party fundraiser to source capital?
Do you have existing agreements or arrangements with other fundraising entities?
Targeted funding amount (USD)
Minimum amount required for this raise to be successful (USD)
Valuation, if seeking equity (USD)
Reasoning or method used for this valuation
What happens if this capital is not secured?
Investor types you are interested in targeting (select all that may apply):

Other
Investor type - Other (describe)
How will this funding be used to increase cash flow?
Use of funds - Working capital (USD)
Use of funds - Growth or expansion (USD)
Use of funds - Debt refinance (USD)
Use of funds - Acquisition (USD)
Use of funds - Other (USD)
If applicable, how/ when do you anticipate funding distributions to investors or otherwise returning capital to shareholders or investors?
SEC Exemption and Prepared Materials
If issuing securities, under which SEC exemption are you raising capital?

Other
If other, please describe the SEC exemption
Has the company considered any alternative capital structure, platform-based offering, or tokenized securities pathway?
Which of the following do you currently have prepared?
What is the biggest challenge you have encountered in securing capital to date?
Are you open to engaging in a Capital Raise Readiness process if required prior to raising capital?
Capital Raise Readiness Screening

Please answer the following questions based only on what is currently available today. This section helps Repository Capital determine whether the company may be ready for a formal capital raise review or whether a Capital Raise Readiness process may be recommended before investor outreach.
How would you describe the current status of your investor materials?
How would you describe your current financial model or projections?
Which of the following traction or proof items can you provide today? Select all that apply.
Please describe the other traction or proof items available.
How organized are your key company documents today?
Has legal counsel or securities counsel reviewed the proposed capital raise structure, investor eligibility, exemption, or offering materials?
In one paragraph, explain why an investor or lender should provide capital now. What has been proven, what will the capital accomplish, and how will it improve revenue, cash flow, value, repayment capacity, or investor return potential?
If Repository Capital determines that additional preparation is needed before investor outreach, would you be open to a paid Capital Raise Readiness process?
Preliminary Review Acknowledgement
I understand that submitting this questionnaire does not create an engagement, commitment, securities offering, investor solicitation, or guarantee that Repository Capital or any affiliated party will raise capital for the company. Repository Capital may recommend no engagement, a Capital Raise Readiness engagement, or a formal capital raise engagement depending on the company’s documentation, readiness, legal structure, financial condition, and investor suitability.
Marketing & Competitive Landscape
Describe your target end user, clientele, and/or customer base:
How large is the total addressable market? Describe:
List any competitors in your industry:
Describe the timing of your fundraise in the context of the current market and competitive environment. In other words, why your company and why now?
Optional: Attach any currently available supporting documents. Examples may include pitch deck, financial model, historical financials, cap table, use-of-funds summary, customer contracts, purchase orders, LOIs, or other materials that support the capital request. Full diligence materials are not required at this stage

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Repository Capital LLC Client Questionnaire

Company and Contact Information

Advisors and Authorization / Engagement Consents

Registration and Formation Details

Business Overview

Financial Reporting and Performance

Capital Planning

SEC Exemption and Prepared Materials

Capital Raise Readiness Screening

Preliminary Review Acknowledgement

Marketing & Competitive Landscape