RIG LTD INTAKE FORM

RONALD I GROSS LTD INTAKE FORM
Client Contact Information - Company Info
Date

MonthDayYear
Date
Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Country
Phone Number

Area CodePhone Number
Fax Number

Area CodePhone Number
Website
example@example.com
Company EIN
State of incorporation or Origination
Primary Contact
Name

First NameLast Name
Title/Role in Company
Direct Phone Number

Area CodePhone Number
Skype Name
Email
example@example.com
Secondary Contact
Name

First NameLast Name
Title/Role in Company
Direct Phone Number

Area CodePhone Number
Skype Name
Email
example@example.com
Patriot Act Information: (This information is requested and is a part of due diligence required by the Department of Homeland Security (DHS) as a Know-Your_Customer (KYC) requirment that we may need later in the funding process)
You are a citizen of which State:
Social Security #
Passport #
Place Passport Issued:
Date Passport Issued
Date Passport Expired
CFO Contact Information
Name

First NameLast Name
Direct Phone Number

Area CodePhone Number
Email
example@example.com
Skype Name
CPA Contact Information
Name

First NameLast Name
Direct Phone Number

Area CodePhone Number
Email
example@example.com
Skype Name
Legal Contact Information
Name

First NameLast Name
Direct Phone Number

Area CodePhone Number
Email
example@example.com
Skype Name
Company/Project/Deal Information
Describe your Company, Project or asset and the purpose of your capital request in the space provided below:
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Which Market or Industry best describes your Company, Project or Asset:
What stage is your Project In?

StartupExpansionAcquisitionRefinance
If other, please describe:
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Capital Amount sought ($USD):
Percentage (%) of Total Project/Capital Need:
Amount Invested to Date ($USD):
Amount Planned to be Contributed in the Future ($USD):
If Acquisition, what is the Price (USD):
What is the duration of the investment
Annual Revenue ($USD):
EBITDA ($USD):
Net Income ($USD):
Describe the starting date for the Company/Project. If the company is underway, please describe the stage it is in.
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Tell us the anticipated uses of the funds in detail, with expected timetables for each expense or investment involved in the Company/Project/Asset. (if attaching a separate "Sources and Uses" File, say File Attached - with File Name.)
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Describe when you require the capital, any time constraints on the deployment of capital, and if you anticipate one lump sum or drawdown schedules. (if attaching a separate "Drawdown Schedule" file, say File Attached - with file name.)
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Describe any liens, lien holders, debt or debt holders that have a claim on the Company or Project (or Indicate N/A).
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Describe the portion of the capital to be used for any refinancing of the Company or Project.
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Do you hold all necessary approvals to immediately proceed with the proposed Company, Project or Asset Acquisition? Explain any obstacles, hinderances acquisitions, negotiations, or refinancing that must take place prior to starting.
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Describe any Corporate, Bank or Personal Guarantees you have made, or can provide, related to the Company, Project, or Asset. Is there any other Collateral that may, or is intended to be, a part of this Company, Project, or Asset?
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Describe how Principal and interest will be repaid to lenders and expected return on investment (ROI) for equity investors.
Please Attach Proforma File in www.rigltd.net - Send Info
Describe the term/duration of the Capital Investment you are seeking as well as the exit strategy for the Capital Source.
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List all lenders, investors, or Capital Sources you have already engaged regarding this Company, Project or Asset.
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List all Intermediaries, Brokers, Agents or Consultants you have already engaged regarding this Company, Project or Asset. Include all Fee Agreements as a Percentage (%) of the Capital request as well as all flat fees.
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Calculator
Name the closest major city to the Company, Project or Asset:
Name the nearest Airport to the Company, Project or Asset:
Airport code:
Include a Link of the driving time from the local Airport to the location of the Company, Project, or Asset:
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GPS Directions
Management Information
Provide a short outline or summary of the Management Team's past experience in the related field of work.
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Describe the current ownership and ownership structure of the Company or Project being financed. Provide a list of Key Company Managment Persons, Contractors, Architects and/or Partners with a CV or Resume for each (if attaching a separate "Ownership History and Key Persons" or "Key Person CV" file, say File Attached - with file name.)
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List all personal contributions, investments, credit enhancements and all owners of more than 20% of the Company or Projects outstanding shares. (if attaching a separate "Capital Contributions" file, say File Attached - with file name.)
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Data Room - Due Diligence
Data List (Checklist) Please check each Document ready to be sent

Business Plan/Executive Summary of the OpportunityFinancial Forecasts (Income Statement, Balance Sheet, Cash Flow Statements)Last 3 years Financial StatementsLast 3 years Tax Returns (if Applicable)Any Appraisals or Valuations on the Company, Project or AssetSources and Uses of Funds (form available in "Send info" on Website)Development Costs and Stabilization ForecastsManagment CVs & ResumesPassports of all Principals with 20% or Greater InterestDriver's Licenses of all Principals with 20% or Greater InterestList all previous Projects by ManagementAll Contracts, Engagement Agreements, & LOIs related to the Company, Project or AssetList of all Contractors, Architects, Key Players involved in the Company, Project or AssetCompany Overview HistoryAny other Pertinent Documents
TO SEND FILES:
- Go to Browse Files below
- Click on your files to be sent
- Attach the Files
- Click on "Submit" at bottom of page upon completion of Form
Download Files and Docs:

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Click on Submit at bottom of Form to send files to Ronald I Gross LTD Dropbox Cancelof
Please Identify any Documents that you are not able to provide at this time:
List any Documents not available here
If you have any other questions regarding our due diligence process or uploading documents, please contact info@rigltd.net or 602.633.4144

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RONALD I GROSS LTD INTAKE FORM

Client Contact Information - Company Info

Primary Contact

Secondary Contact

CFO Contact Information

CPA Contact Information

Legal Contact Information

Company/Project/Deal Information

Management Information

Data Room - Due Diligence