Embed

<!DOCTYPE html>
<html lang="en">
<head>
  <meta charset="UTF-8">
  <title>Investor Power of Attorney and Consent</title>
</head>
<body>

<form id="investorForm">

  <h2>Investor Information</h2>

  <input type="text" name="fullName" placeholder="Full name or company name" required>
  <input type="text" name="cvr" placeholder="CVR number (company only)">
  <input type="date" name="dob" placeholder="Date of birth (private individual)">
  <input type="text" name="address" placeholder="Address" required>
  <input type="text" name="postcodeCity" placeholder="Postcode and city" required>
  <input type="text" name="country" placeholder="Country" required>
  <input type="email" name="email" placeholder="Email" required>
  <input type="tel" name="telephone" placeholder="Telephone" required>

  <h2>Investor Profile</h2>

  <fieldset>
    <legend>Investor type</legend>
    <label><input type="radio" name="investorType" value="Private individual" required> Private individual</label><br>
    <label><input type="radio" name="investorType" value="Company"> Company</label><br>
    <label><input type="radio" name="investorType" value="Foundation/association"> Foundation/association</label><br>
    <label><input type="radio" name="investorType" value="Family office"> Family office</label><br>
    <label><input type="radio" name="investorType" value="Other"> Other</label>
    <input type="text" name="investorTypeOther" placeholder="If other">
  </fieldset>

  <fieldset>
    <legend>Preferred financing forms</legend>
    <label><input type="checkbox" name="financing" value="Equity"> Equity</label><br>
    <label><input type="checkbox" name="financing" value="Convertible loan"> Convertible loan</label><br>
    <label><input type="checkbox" name="financing" value="Loan/debt"> Loan/debt</label><br>
    <label><input type="checkbox" name="financing" value="Guarantees/security"> Guarantees/security</label><br>
    <label><input type="checkbox" name="financing" value="Other"> Other</label>
  </fieldset>

  <input type="text" name="industries" placeholder="Industries of interest">
  <input type="text" name="investmentStage" placeholder="Investment stage (pre-seed, seed, growth, mature)">
  <input type="text" name="ticketSize" placeholder="Typical ticket size">
  <input type="text" name="geography" placeholder="Geographical focus">
  <input type="text" name="involvement" placeholder="Degree of involvement (passive, advisor, board, operational)">

  <h2>Investor Power of Attorney and Consent</h2>

  <p>
    By submitting this form, the investor grants Shange &amp; Co ApS power of attorney to register,
    store and use the provided investor information for mediation purposes between investors and
    project owners. Shange &amp; Co ApS does not provide investment advice. All investment decisions
    are made solely by the investor at their own responsibility. This consent is governed by Danish law.
  </p>

  <label>
    <input type="checkbox" id="consentCheckbox" required>
    I have read and accept the Investor Power of Attorney and Consent
  </label>

  <br><br>
  <button type="submit">Submit</button>

</form>

<div id="confirmation" style="display:none;">
  <p>Thank you. Your information and consent have been successfully submitted.</p>
</div>

<script>
  document.getElementById('investorForm').addEventListener('submit', function (e) {
    e.preventDefault();

    const consentChecked = document.getElementById('consentCheckbox').checked;
    if (!consentChecked) {
      alert('You must accept the Investor Power of Attorney and Consent.');
      return;
    }

    const form = e.target;
    const formData = new FormData(form);

    const financing = [];
    form.querySelectorAll('input[name="financing"]:checked').forEach(cb => financing.push(cb.value));

    const data = {
      timestamp: new Date().toISOString(),
      consentAccepted: true,
      investorInformation: {
        fullName: formData.get('fullName'),
        cvr: formData.get('cvr'),
        dateOfBirth: formData.get('dob'),
        address: formData.get('address'),
        postcodeCity: formData.get('postcodeCity'),
        country: formData.get('country'),
        email: formData.get('email'),
        telephone: formData.get('telephone')
      },
      investorProfile: {
        investorType: formData.get('investorType'),
        investorTypeOther: formData.get('investorTypeOther'),
        financingForms: financing,
        industries: formData.get('industries'),
        investmentStage: formData.get('investmentStage'),
        ticketSize: formData.get('ticketSize'),
        geography: formData.get('geography'),
        involvement: formData.get('involvement')
      }
    };

    console.log(JSON.stringify(data));

    form.style.display = 'none';
    document.getElementById('confirmation').style.display = 'block';
  });
</script>

</body>
</html>
