Vantage Corporate Capital | PRO Business - Responsive Multi-Purpose Theme

Contact Person

Name

First Last

Email*

Enter Email Confirm Email

Please Enter Address Below

Street Address City State / Province / Region ZIP / Postal Code Country

Phone Number 1

Phone Number 2

Fax Number

Business Information

Business Name

Email address*

Enter Email Confirm Email

Please Enter Business Address Below

Street Address City State / Province / Region ZIP / Postal Code Country

Phone number 1

Fax Number

Web address if any

Is your business Incorporated

Yes
No

Give state of domicile

Indicate Entity Type. (Select one)

Please indicate

Do you presently have legal council?

Yes
No

Attorney Name

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Phone

Do you presently have an accountant?

Yes
No

Accountant Name

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Phone

Give a brief but somewhat detail description of your business and the products or services it provides. (500 characters)

Please upload a resume or 2-3 paragraph work history for each owner or officer who participates materially in the operation of the business.

Accepted file types: pdf, Max. file size: 512 MB.

Only pdf files accepted

Does any of the company principals with more than 10% corporate ownership have any outstanding regulatory complaints, enforcement orders, or license revocations from any state or federal securities regulators?

Yes
No

Please give a brief history that describes details and circumstances surrounding each case. Be sure to provide file numbers and governing regulatory bodies that have records of any incidents.

Is this business a start up?

Yes
No

how long has business been running?

is the business presently profitable?

Yes
No

have you attempted to raise money for your project before now?

Yes
No

Please describe what has been attempted thus far. Explain what have been the reasons for not obtaining funding. Give details on your experiences.

Please indicate Promotional code if any

Please indicate areas of interest.

Business Plan Preparation

Do you have any initial drafts, written plans, or outlines with respect to the future expected business operations?

Yes
No

Please upload a copy of the written plans or drafts

Accepted file types: pdf, Max. file size: 512 MB.

Only pdf files accepted

Type of Financing desired?

Loan/debt
Equity/Investment

Projected Amount of Funding Needed:

How Much of Your Own Money have you already Invested in the business?

How much of your own money do you intend to invest in the business?

What is the purpose of the Funding?

Purchase Land or Building $

Purchase Computer Equipment $

Purchase Office Equipment $

Purchase of Other Equipment $

Purchase of Vehicle(s) $

Retirement of Current Debt $

Purchase a Business $

Purchase Inventory $

Leasehold Improvements $

Working Capital requested $

Other Start-up Expenses $

Give brief explanation:

Please provide descriptions of all business notes payable that will remain after you receive the requested funding (don't include the requested loan or financing).

Purpose of Loan

Current Balance

Original Balance

Date of Origin

Monthly Payment

Term (Years)

Interest Rate

Corporate & Entity Formation

The intended name of the corporation shall be; Give three possibilities.

PRINCIPAL

OFFICE street address

Street Address City State / Province / Region ZIP / Postal Code Country

Mailing address, if different is

Street Address City State / Province / Region ZIP / Postal Code Country

Desired State of Incorporation

List initial officers and directors

How many officers and or directors does the company presently have?

Name

Title

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Name

Title

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Name

Title

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Name

Title

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Name

Title

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Registered Agent Information

Name

Email address*

Enter Email Confirm Email

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Phone number 1

Phone number 2

Fax Number

Incorporator’s Information

Name

Email address*

Enter Email Confirm Email

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Phone number 1

Phone number 2

Fax Number

Do you have any written plans with respect to the future corporate governance, by-laws, or business organizational structure?

Yes
No

Please upload a copy of the written plans of governance, by-laws, ect.?

Accepted file types: pdf, Max. file size: 512 MB.

Only pdf files accepted

Equity Valuation

Have you written a complete business plan with respect to the future expected business?

Yes
No

Please upload a copy of the business plan and answer the following questions.

Accepted file types: pdf, Max. file size: 512 MB.

Only pdf files accepted

Projected Amount of Funding Needed

How Much of Your Own Money have you already Invested in the business?

How much of your own money do you intend to invest in the business?

What is the purpose of the Funding?

Purchase Land or Building $

Purchase Computer Equipment $

Purchase Office Equipment $

Purchase of Other Equipment $

Purchase of Vehicle(s) $

Retirement of Current Debt $

Purchase a Business $

Purchase Inventory $

Leasehold Improvements $

Working Capital requested $

Other Expenses $

Give brief explanation

Please provide descriptions of all business notes payable that will remain after you receive the requested funding (don't include the requested loan or financing).

Purpose of Loan

Current Balance

Original Balance

Date of Origin

Monthly Payment

Term (Years)

Interest Rate

Please consider making use of Business Plan Preparation Service. With out a business plan an Equity Valuation cannot be properly performed. Would you like for one of our staff to contact you about our Business Plan Preparation Service?

Yes
No

Debt Service Coverage Assessment

Have you written a complete business plan with respect to the future expected business operations?

Yes
No

Please upload a copy of the business plan and answer the following questions

Accepted file types: pdf, Max. file size: 512 MB.

Only pdf files accepted

What is the Projected Amount of Funding Needed

How Much of Your Own Money have you already Invested in the business?

How much of your own money do you intend to invest in the business?

What is the purpose of the Funding?

Purchase Land or Building $

Purchase Computer Equipment $

Purchase Office Equipment $

Purchase of Other Equipment $

Purchase of Vehicle(s) $

Retirement of Current Debt $

Purchase a Business $

Purchase Inventory $

Leasehold Improvements $

Working Capital requested $

Other Expenses $

Give brief explanation

Please provide descriptions of all business notes payable that will remain after you receive the requested funding (don't include the requested loan or financing).

Purpose of Loan

Current Balance

Original Balance

Date of Origin

Monthly Payment

Term (Years)

Interest Rate

Desired Loan Structure

Desired Amortization Term

Maximum acceptable interest rate

Please consider making use of our Business Plan Preparation Service. With out a Business Plan a Debt Service Coverage Assessment cannot be properly performed. Would you like for one of our staff to contact you about our Business Plan Preparation Service?

Yes
No

Document Preparation Services

What type of transaction are you looking to enter into? (select one)

Regulation D Private Placement
Hedge Fund Formation
Reverse Merger
Initial Public Offering/ Regulation A+
Rule 144

What rule are you looking to utilize?

Have you located a suitable Shell Company?

Yes
No

Have you come to terms with the current owners of the shell?

Yes
No

Is your company presently publicly traded?

Yes
No

What is your company’s Ticker Symbol?

Have you written a complete business plan with respect to the future expected business operations?

Yes
No

Please upload a copy of the business plan and answer the following questions

Accepted file types: pdf, Max. file size: 512 MB.

Only pdf files accepted

Please consider making use of our Business Plan Preparation Service. With out a Business Plan an offering document of any sort cannot be properly prepared. Would you like for one of our staff to contact you about our Business Plan Preparation Service?

Yes
No

Form D filing

Have you filed a form ID with the Securities and Exchange Commission (SEC)?

Yes
No

Please provide CIK number

Blue Sky Filings

Please indicate the states that you wish to make a Blue Sky filing?

Have you filed a Form D with the Securities and Exchange Commission (SEC)?

Yes
No

Please provide CIK number

Please consider making use of our Form D Filing Service. With out a Form D being filed many state regulators will not accept a Blue Sky Filing. Would you like for one of our staff to contact you about our Form D Filing Service? Y/N

Yes
No

Do you have a completely prepared a private placement memorandum?

Yes
No

Please consider taking advantage of our Document Preparation Services. Many state regulators require a copy of the completed memorandum document when making a Blue Sky Filing. Would you like for one of our staff to contact you about our Document Preparation Service?

Yes
No

Forms S-1 and 1-A Filing and Cosulting Services

Have you filed a Form ID with the Securities and Exchange Commission (SEC)?

Yes
No

Please provide CIK number.

Have you written a complete business plan with respect to the future expected business operations?

Yes
No

Please upload a copy of the business plan and answer the following questions.

Accepted file types: pdf, Max. file size: 512 MB.

Only pdf files accepted

Please consider making use of our Business Plan Preparation Service. With out a Business Plan an S-1 Registration cannot be properly prepared for filing. Nor can one prepare a Form 1-A for filing. Would you like for one of our staff to contact you about our Business Plan Preparation Service?

Yes
No

Marketing & Offering Placement

Is your offering going to be registered with the SEC?

Yes
No

What type of offering are you conducting? (Select one)

Initial Public Offering
Reverse Merger

Do you intend to employ securities underwriters to sell your offering?

Yes
No

Have you gotten a signed agreement stating they will sell your offering?

Yes
No

Have you filed a Form D or Form 1-A with the Securities and Exchange Commission (SEC)?

Yes
No

Please consider taking advantage of our Form D or From 1-A Filing Services. The SEC requires a Form D or form 1-A to be filed in order to offer securities under an exempt stauts. Otherwise the sucurities offering must be registered with SEC. Would you like for one of our staff to contact you about our Form D or Form 1-A Filing Services?

Yes
No

Please provide CIK number.

Which exemption rule are you seeking to make use of? (Select one)

Are you looking to raise capital for a hedge fund?

Yes
No

What size budget do you have set aside to begin the marketing of your offering? (Select one)

How much money are you looking to raise in your offering? (Select one)

How much time per week will you be able to devote to supporting the marketing efforts? (Select one)

Corporate Treasury Management

Company Financial Profile

Current Liquid Account Balances (Give Approximate Balances $)

Checking

Savings

Money Markets

Current Investments (Give Approximate Balances $)

Stocks

Bonds

CDs

Mutual Funds

Pension Fund

401(K)’s

In-illiquid Assets

Accounts Receivable (Give Approximate Balances $)

More than 30 days old

More than 60 days old

More than 90 days old

More than 120 days old

Real Estate

Future Assets

How much increase in company assets do you expect over the next 12 months? (Give Balances $)

Checking

Savings

Money Markets

Stocks

Bonds

CDs

Mutual Funds

Financial Liaison Service

How many employees does your company presently have? (Select one)

How many locations does your business presently have?

Has your company taken in any outside investors?

Yes
No

How many investors does your company have at this time? (Select one)

What is the approximate amount of money that all investors have place with your company up until now?

What type of investors does the company have? (Select all that apply)

Lenders
Partners

How often does your company communicate with investors?

How many employees does your company expect to hire over the next 12 to 24 months? (Select one)

How much new capital do you expect to come into your company over the next 12 to 24 months? (Select one)

Type of New Financing desired? Check one

Loan/debt
Equity/Partners

Business plan preparation

If you have already filled out the Business Plan Preparation Services section please disregard the following questions and skip to the next section of interest.

Do you have any initial drafts, written plans, or outlines with respect to the future expected business operations?

Yes
No

Please down load a copy of the written plans or drafts.

Accepted file types: pdf, Max. file size: 512 MB.

Only pdf files accepted

Type of Financing desired?

Loan/debt
Equity/Investment

Projected Amount of Funding Needed:

How Much of Your Own Money have you already Invested in the business?

How much of your own money do you intend to invest in the business?

What is the purpose of the Funding?

Purchase Land or Building $

Purchase Computer Equipment $

Purchase Office Equipment $

Purchase of Other Equipment $

Purchase of Vehicle(s) $

Retirement of Current Debt $

Purchase a Business $

Purchase Inventory $

Leasehold Improvements $

Working Capital requested $

Other Start-up Expenses $

Give brief explanation:

Please provide descriptions of all business notes payable that will remain after you receive the requested funding (don't include the requested loan or financing).

Purpose of Loan

Current Balance

Original Balance

Date of Origin

Monthly Payment

Term (Years)

Interest Rate

Document Preparation Services

If you have already filled out the Document Preparation Services section please disregard the following questions and skip to the next section of interest.

What type of transaction are you looking to enter into? (select one)

Regulation D Private Placement
Hedge Fund Formation
Reverse Merger
Initial Public Offering
Rule 144

What rule are you looking to utilize?

Have you located a suitable Shell Company?

Yes
No

Have you come to terms with the current owners of the shell?

Yes
No

Is your company presently publicly traded?

Yes
No

What is your company’s Ticker Symbol?

Have you written a complete business plan with respect to the future expected business operations?

Yes
No

Please down load a copy of the business plan and answer the following questions.

Accepted file types: pdf, Max. file size: 512 MB.

Only pdf files accepted

Please consider making use of our Business Plan Preparation Service. With out a Business Plan an offering document of any sort cannot be properly prepared. Would you like for one of our staff to contact you about our Business Plan Preparation Service?

Yes
No

Form D filing

If you have already filled out the Form D Preparation Services section please disregard the following questions and skip to the next section of interest.

Have you filed a form ID with the Securities and Exchange Commission (SEC)?

Yes
No

Please provide CIK number

Client Intake Form

Contact Person

Business Information

Business Plan Preparation

What is the purpose of the Funding?

Corporate & Entity Formation

PRINCIPAL

List initial officers and directors

Registered Agent Information

Incorporator’s Information

Equity Valuation

Debt Service Coverage Assessment

Document Preparation Services

Form D filing

Blue Sky Filings

Forms S-1 and 1-A Filing and Cosulting Services

Marketing & Offering Placement

Corporate Treasury Management

Future Assets

Financial Liaison Service

Business plan preparation

Document Preparation Services

Form D filing