Questionnaire

    This Questionnaire consists of 3 parts: (i) ‘About You’, (ii) ‘About the Company’, and (iii) a 6-Part Questionnaire. We anticipate it will take 5-7 minutes to complete. The Questionnaire tells us a bit about you, the technology sector you are in, and your current and future financing needs. It helps us appreciate the growth stage of your company, and determine whether we can help advance your company to the next level of growth. The information you volunteer will be kept confidential. Please fill out all the required fields in the form below. When complete, click the “SUBMIT” button to complete your submission.
    About You:
    Your name:

    Enter the One Time Passcode you received and continue (required).

    About the Company:
    Company Address
    PART 1 – BUSINESS SECTOR / PRODUCT OFFERING
    1. What best describes your company’s Deep Technology Sector [Select up to 4]
    Machine Learning 4Natural Language Processing (NLP) 4Computer Vision 5Reinforcement Learning 3 Quantum Algorithms 3Quantum Hardware 3Quantum Cryptography 3 Gene Editing (e.g., CRISPR-Cas9) 1Synthetic Biology 1Personalized Medicine 1Regenerative Medicine 1 Nanomaterials 5Nanoelectronics 4Nanomedicine 2 Blockchain Technology 0Cryptocurrencies (e.g., Bitcoin, Ethereum) 0Decentralized Finance (DeFi) 0 Graphene 5Metamaterials 5Superconductors 5 Autonomous Robots 5Soft Robotics 4Swarm Robotics 3 Solar Power 2Wind Energy 2Energy Storage (e.g., Batteries) 4Recycling 1 Space Exploration 2Satellite Technology 3Constellation 3Asteroid Mining 0 3D Printing/Additive Manufacturing 5Smart Factories 5Robotics in Manufacturing 5 Brain-Computer Interfaces (BCIs) 5Neuroprosthetics 1Neuromorphic Computing 4 Automated Trading Algorithms 1Robo-Advisors 1Peer-to-Peer Lending Platforms 1 Telemedicine 2Wearable Health Devices 3Digital Health Records 3 Precision Agriculture 1Vertical Farming 1Cellular Agriculture 1 Cyber Threat Intelligence 4Quantum-Safe Encryption 5Behavioral Analytics 5 Carbon Capture and Storage (CCS) 2Water Purification Technologies 2Air Quality Monitoring 2 Electric Vehicles (EVs) 2Autonomous Cars 3Hyperloop 2 AR/VR Gaming 4AR/VR Training Simulations 4Medical and Industrial AR/VR Applications 4 IoT Sensors 5IoT Platforms 5Industrial IoT (IioT) 5 Big Data Analytics 5Predictive Analytics 5Prescriptive Analytics 5Other 1
    Early development 1Proof of concept 3Minimal Viable Product / Demo stage 3Commercially Launched 4Post commercial launch (>Rev 2) 5Other 0 Hardware 4Software 3Systems 5Other 0 XaaS Model (Something as a Service) 5Product Sales 4Services Offering 4Subscription Model 4Pay-Per-Use 4Freemium Model 2Marketplace 2Franchise Model 2Consulting and Professional Services 2Nonprofit 0Licensing and Royalties 3Contract Manufacturing 0Contract Development 0Rental and Leasing 0Other 0 US 5Canada 5Africa 0Asia(India) 2Asia(China) 2Australia (Oceania) 1Europe 1South America 0Other 0 US 5Canada 5Africa 0Asia(India) 3Asia(China) 2Australia (Oceania) 1Europe 1South America 1Other 0 US 5Canada 5Africa 0Asia(India) 3Asia(China) 2Australia (Oceania) 2Europe 2South America 1Other 0
    8. Do you work in any of the following sectors?
    [Select up to 2]
    Nanotechnology 43D Printing/Additive Manufacturing 4Energy Storage 4Smart Materials 4Biomaterials 4Composite Materials 4Other 0 Advanced Chip Manufacturing 4Internet of Things 4High-Performance Computing 4Edge Computing 4Storage & System 4Network Infrastructure 4Other 0 Robotic Process Automation 4Collaborative Robotics 4Advanced Manufacturing 4Industrial Automation Software 4Machine Visions & Quality Inspection 4Other 0 MEMS Sensors 4Industrial Sensors 4Sensory Input Devices 4Precision A/D 4Other 0 M/L Models & Algorithms 4D/L Models & Algorithms 4Recommender Systems 4Generative AI 4Other 0
    PART 2 – INVESTMENT AND FUNDING
    Pre-Seed/Seed 0Series A 3Series B 5Series C 3Series D 2Beyond Series D 1Other 0
    Friends & Family 1Angels Investors 2Institutional Investors 5Corporate Investors 5Strategic Investors 5Other 1
    None 0< $5M 1$5M < $10M 2$10M < $20M 3$20M < $50M 4$50M < $75M 5$75M < $100M 5> $100M 2Other 0 < $5M 1$5M < $10M 1$10M < $20M 2$20M < $50M 4$50M < $75M 5$75M < $100M 5$100M < $150M 4> $150M 3Other 0 1 < 5 36 < 15 516 < 30 431 < 50 351 < 100 2>100 1Other 0 None 3$0M < $5M 5$5M < $10M 4$10M < $20M 3$20M < $50M 2> $50M 1Other 0 None 3$0M < $5M 5$5M < $10M 4$10M < $20M 3$20M < $50M 2> $50M 1Other 0
    PART 3 – ASSETS
    None 0Yes 3 None 01 < 5 16 < 15 216 < 30 330 < 50 4> 50 5 None 01 < 5 16 < 15 216 < 30 330 < 50 4> 50 5
    PART 4 – MARKET / SALES
    $0M (Pre-Revenue) 0< $5M 1$5M < $10M 1$10M < $20M 2$20M < $50M 3$50M < $100M 4> $100M 5 Consumers 3Business Customers 3Small Businesses 4Medium-size Businesses 5Large Corporations 5Multinationals 5 Domestic (USA/Canada) 5Africa 2Asia 4Australia (Oceania) 3Europe 5South America 3 None 01 < 3 23 < 6 36 < 10 410 < 20 5> 20 4
    PART 5 – HUMAN CAPITAL
    1 22 43 54 3>5 1Other 0 < 10 110 < 20 years 221 < 40 years 341 > 60 years 560 > 100 years 5> 100 years 3 None 11 12 23 54 45 36 27 2>7 1Other 0 None 1<10 310 < 30 430 < 50 550 < 80 3> 80 2 None 1<10 310 < 30 430 < 50 550 < 80 3> 80 2 0 < 2 years 13 < 5 years 46 < 10 years 511 < 15 years 4> 15 years 3
    PART 6 – YOUR NEEDS
    < $5M 2$5M < $7.5M 4$7.5M < $10M 5$10M < $20M 5$20M < $50M 4$50M < $100M 3>$100M 3 None 1< $5M 4$5M < $7.5M 5$7.5M < $10M 4$10M < $20M 3$20M < $50M 2$50M < $100M 1>$100M 0 None 1< $5M 4$5M < $7.5M 5$7.5M < $10M 4$10M < $20M 3$20M < $50M 2$50M < $100M 1>$100M 0
    Business Expansion 3Product Development 3Research and Development 2Debt Reduction 0Acquisitions 1Working Capital 1Marketing and Sales 2Technology and Infrastructure 2Human Resources 1Compliance and Regulation 0Risk Mitigation 1Dividend Payments 0Share Buybacks 1Environmental Sustainability 1Charitable Contributions 0Market Research 1International Expansion 3Innovation Initiatives 3Diversification 2
    By checking the box and submitting the completed Questionnaire, you agree to ReX Capital's Terms and Conditions.