Page 1 of 1

IP Qualification Form

Instructions:

Please complete this form to help us assess your IP royalty stream for funding prequalification.

* Fields marked with an asterisk (*) are required. * Optional fields are clearly labeled. * To ensure your responses are recorded, you must click "Submit" at the end of the form.

Estimated completion time: 3 min

Contact Information

*Business name

*Your name

*Your preferred contact email

Screening Questions

*Do you currently receive royalties?

*Do you currently receive royalties?
A
B

*Are your royalty rights assignable?

*Are your royalty rights assignable?
A
B
C

*Do you have more than 1 royalty agreement you want considered?

*Do you have more than 1 royalty agreement you want considered?
A
B

*Duration of the remaining royalty agreement (select "other" if you have multiple agreements you want considered)

*Duration of the remaining royalty agreement (select "other" if you have multiple agreements you want considered)
A
B
C
D

(optional) Estimated remaining royalty lifetime (years) for each royalty (eg. "royalty agreement 1" = 3 years, "royalty agreement 2" = 5 years, etc.)

(optional) Royalty payment cadence (select "other" if you have multiple agreements)

(optional) Is your agreement performance based? (select "other" if you have multiple agreements)

(optional) Who is paying the royalties?

(optional) Is the agreement exclusive (select "other" if you have multiple agreements)

IP Status & Ownership

*Do you own the IP?

*Do you own the IP?
A
B

*Is the IP in good standing?

*Is the IP in good standing?
A
B
C

*Are there any institutional or legal restraints on your IP that would prevent you from assigning the royalties?

*Are there any institutional or legal restraints on your IP that would prevent you from assigning the royalties?
A
B
C

Regulatory & Disclosure

*Are you open to supporting SEC (securities and exchange commission) compliance steps if needed?

*Are you open to supporting SEC (securities and exchange commission) compliance steps if needed?
A
B

Next Steps

We will review and follow-up shortly.

Interested in the process? You can view it here.
You can review our confidentiality policy here.
Additional Questions? Email us at [email protected] or schedule a call.