Questionnaire

Screening Questionnaire for Investment Prospects

Please be advised that his form does NOT allow you to save and submit it at a later time. Please set aside ample time to finish the form in one sitting. We respect the value of your time. The purpose of this questionnaire is to save everyone time by accelerating the investment decision process. Please give candid responses but don’t go into greater depth than you have time for.

Screening Questionnaire for Investment Prospects
Contact Information
Please provide us the best means to contact you.
Name of contact*
Name of company*
Phone*
Email*
Name of founder/CEO*
Company website*

The Company
When was your company founded?*
MM
DD
YYYY
Which industry does your company belong to?*
Please select from the drop-down options. If you do not find a relevant option, enter Other and please indicate the name of your sector.
If Other, please indicate industry:*
What is your product/service in a few words?*
How do you define the problem you help solve - and how do you solve it?*
What are the words your customers/clients use to describe the problems you help solve?*
Why is it important to you personally?*
How do you define your company's value in terms such as additive, disruptive etc.*
Please describe key ways in which you are either - or both.

Key stakeholders
Who are the key stakeholders in this venture?*
Has any key personnel had prior successful exits?*
- Yes
- No
If yes, please describe who exited for how much and in which area. Feel free to provide multiple examples for serial exits..*
Who is the end user of your product/service?*
How do your customers value the specific product or service you provide?*
What shared purpose would others say your organization has?*
Have you had any recent changes in personnel, leadership or strategy?*
Please comment.
Who are your notable/lead investors?*
Can we speak to your lead investor(s)?*
- Yes
- No
If yes, please indicate contact information for lead investor: Name, Phone, Email*
What is the track record of your lead investor?*
Describe briefly.
Can we see a due diligence packet from one of your lead investors/VC forums (e.g. Keiretsu Forum):*
- Yes
- No
If yes, please provide a download link to the due diligence packet*
What are your primary revenue streams?*
How are you personally invested in this company? How can you quantify that (you may define this however you like; for instance, percentage of your net worth or annual income, invested time, hard cash you’ve invested, equity, etc.)?*
Have you forgone any enticing opportunities in order to focus on your core offerings?*

Exit scenarios
Have you talked to strategic partners about possible exits?*
- Yes
- No
If yes, who?*
If no, when and what type of strategic partnerships will you be pursuing?*
Have you interacted specifically with customers or strategic exit prospects on exactly how they value your product(s)/service(s) in advance of pricing it?*
- Yes
- No
If yes, what were their metrics behind the valuation of your product(s)/service(s)?*
Have you interacted specifically with customers or strategic exit prospects on exactly how they calculate your precise margins and exit valuation?
- Yes
- No
If yes, what were their metrics behind the valuation of your margins and exit valuation?*
Please describe your projected exit scenario(s) and timeline:*

Competitive landscape
Show us your competitive matrix*
Accepted file types: jpg, pptx, pdf, png.
Please upload an illustration of your matrix.
Describe something impressive/admirable about one of your competitors:*
Who are the main incumbents in your competitive space and how do you intend to compete with them?*
For online opportunities, incumbents could be e.g. Amazon, Google, Facebook, etc. For biotech opportunities, it could be e.g. big pharma companies, etc., etc.
What do you do exceptionally well that your competitors also do? What differentiates you?*
How is your intellectual property protected?*

Fundraising
What is your current capital structure?*
What is the total amount you are looking for in this round of fundraising?*
How do you plan to spend the funds you are raising?*
Do you have plans for future rounds of fundraising?*
- Yes
- No
If yes, when?*
MM
DD
YYYY
Will a future round be dilutive?*
- Yes
- No
Do you plan to go public at any point?*
- Yes
- No
- Not sure
If you have an IPO thesis how do you support it with market comparables?*
Please submit in dollars how much it would take to own a 1% stake in your company:*
How many total and outstanding units (e.g. warrant, options shares etc.) will you have at the end of this raise?*
What is your post-raise valuation?*
What is the minimum you are seeking from each investor?*
Do you have a closing date?*
- Yes
- No
If yes, when?*

Financials and projections
Do you have audited financials?*
- Yes
- No
What are your primary revenue streams?*
Please indicate maximum return for investors in best case scenario:*
Please indicate either as multiple or as time-weighted return.
What are the key factors for success?*
What key assumptions do your financial proformas rely on?*
What would a worst-case scenario look like?*

Questionnaire

Screening Questionnaire for Investment Prospects

Step 1 of 7 - Contact Information

Screening Questionnaire for Investment Prospects

Contact Information

The Company

Key stakeholders

Exit scenarios

Competitive landscape

Fundraising

Financials and projections