Repository Capital LLC Client Questionnaire

Repository Capital LLC Client Questionnaire

The purpose of this questionnaire is not to collect a full data room or complete diligence package. It is intended to help Repository Capital understand your company’s capital needs and determine which financing or capital-markets alternatives may warrant further review. These may include debt, equity, refinancing, recapitalization, acquisition or growth financing, private credit, conventional or specialty lending, securities offerings, or other capital solutions. Where appropriate, Repository Capital may also identify emerging capital-markets structures or technologies that management may not previously have considered. Completing this questionnaire takes about 15 to 20 minutes, creates no obligation or engagement.
Company and Contact Information
Company Legal Name
Other DBA Names
Company Website
Direct Point of Contact
Contact Role
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%
Has the company, or any officer, director, or owner of 20% or more, ever been subject to a securities related sanction, a criminal conviction, or a regulatory order, or is any significant lawsuit pending?
Legal Advisor / Counsel
Accounting / CPA
Wealth Advisors
Fund Administrator
Other Advisors of Significance
Authority to submit
Registration and Formation Details
Registration / formation type
Registration / formation - Other (describe)
Date formed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
State formed
Is the company or entity currently:
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?
What are you seeking to accomplish with this financing or capital transaction? Select all that apply.
Please briefly explain what the capital will allow the company to accomplish.
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 existing debt or other fixed obligations?
If yes, briefly describe the debt (lender, amount owed, maturity date, and any personal guarantees).
Are you currently generating revenue?
Have you been profitable in prior years?
Do you expect to be profitable this year?
Approximately, what were your revenue and EBITDA (or net income) for your last full fiscal year, and for this year to date? Estimates are fine.
Describe your sources of revenue. Note contracted or subscription revenue.
Describe your current cash position and access to additional cash.
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)?
Have you ever engaged or paid anyone to help raise capital for the company (for example, an investment banker, placement agent, broker dealer, or finder)?
If yes: who, when, what happened, and is any agreement still in effect (including exclusivity or a fee owed on future investors)?
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)
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)
Does the business or asset pay, or expect to pay, regular income to investors (for example rent, interest, distributions, or royalties)?
If yes, briefly describe how and when investors are paid.
Beyond the immediate financing need, which of the following could be valuable to the company or its investors over time? Select all that apply.
Ownership and Investor Base

These questions help us understand how ownership and investor payments are structured.
What will investors own or finance?

Other
About how many investors or owners does the company or fund have today?
About how many investors do you expect to have after this raise?
Do any current or likely investors live outside the United States?
Do your company or fund documents (operating agreement, partnership agreement, bylaws, or fund documents) limit when or how owners can sell or transfer their ownership?
SEC Exemption and Prepared Materials
If issuing securities, under which SEC exemption are you raising capital?

Other
If other, please describe the SEC exemption
What is the biggest challenge you have encountered in securing capital to date?
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
How large is the total addressable market? Describe:
List any competitors in your industry:
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

Ownership and Investor Base

SEC Exemption and Prepared Materials

Capital Raise Readiness Screening

Preliminary Review Acknowledgement

Marketing & Competitive Landscape